State Telehealth Policies
The health care workforce is stretched to its limits in most states and, despite federal, state and local efforts, the demand for health care providers outpaces the supply in many communities. Telehealth has emerged as a cost-effective alternative to traditional in-person consultations or examinations between provider and patient.
Telehealth is defined by the Department of Health and Human Services as “the use of technology to deliver health care, health information or health education at a distance.” The three primary types of telehealth applications are 1) real-time communication, 2) store-and-forward and 3) remote patient monitoring.
- Real-time communication allows patients to connect with providers via video conference, telephone or a home health monitoring device.
- Store-and-forward refers to transmission of data, images, sound or video from one care site to another for evaluation.
- Remote patient monitoring involves collecting a patient's vital signs or other health data while the patient is at home or another site, and transferring the data to a remote provider for monitoring and response as needed.
Mobile health (mhealth) is also an emerging telehealth application that includes health education, information or other services via a mobile device. The mhealth applications are less common in state policy.
Medicaid and Private Payer Coverage and Reimbursement Policies
States continue to refine their telehealth reimbursement policies with regard to Medicaid and private payer laws.
- Medicaid policies include those with some type of reimbursement for telehealth but the scope of these policies varies among states. All states and District of Columbia reimburse for live video services in their Medicaid program. At least 11 states stipulate Medicaid coverage and reimbursement for all three common modalities. The types of providers, services and locations eligible for reimbursement also vary within state Medicaid programs. The map below indicates states with reimbursement for at least one telehealth modality and service or specialty.
- Private payer policies include those related to telehealth coverage or reimbursement for private insurers. At least 43 states and the District of Columbia have some type of private payer policy. Typically, these policies require coverage and/or reimbursement that is comparable to what is covered and/or reimbursed for in-person visits—however, not all these policies mandate coverage or reimbursement. State laws governing private payers vary as to whether they require coverage or reimbursement, include all services, or set the same rates for reimbursement.