State Coverage for Telehealth Services
Last updated: January 2016
The health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to rural and underserved areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.
For states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. It is also increasingly being seen as a tool to overcome access barriers for other populations, such as aging adults, as well as a means to reduce costs and burdens for patients.
Telehealth is defined 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 real-time communication, store-and-forward and remote patient monitoring. Real-time communication allows patients to connect with providers via video conference, telephone or a home health monitoring device, while 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 transfering the data to a remote provider for monitoring and response as needed. Mobile health (mhealth) is also an emerging field that includes health education, information or other services via a mobile device. The mhealth applications are much less common in state policy.
The most common path being taken by states is to cover telehealth services in the Medicaid program. In fact, 48 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services. Another avenue is for states to create requirements for private insurance related to telehealth. Some of these laws include requirements to cover telehealth services. Currently, 32 states and the District of Columbia have some kind of private payer policy.
NCSL's report, Telehealth: Policy Trends and Considerations, goes into more detail about reimbursement policies as well as the areas of licensure and patient safety.
Medicaid and Private payer coverage and reimbursement policies for Telehealth
Medicaid policies include those with some type of reimbursement for telehealth. The scope of these policies varies among states, and the map 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. These policies vary as to whether they require coverage or reimbursement, include all services, or set the same rates for reimbursement.