ATA Releases Updates on Telemedicine Coverage and Reimbursement

See How Access to Telehealth Services Has Changed Over the Last Two Years

The American Telemedicine Association recently released its 2019 State of the States Report: Coverage and Reimbursement, a state-by-state assessment of how the telehealth industry continues to grow and evolve around the country. The report was last updated in 2017, and the new report suggests strong advances for virtual care providers and the overall telehealth community. 

According to the results, 40 states and the District of Columbia have “adopted substantive policies or received awards” to improve telehealth coverage since 2017. This indicates that more states are realizing the benefits of telehealth and are taking actions to make these services more accessible by improving their coverage and reimbursement policies. 

With each state enacting its own telehealth coverage and reimbursement policies, providers working across state lines can easily become confused when trying to get reimbursed for their services, but this new report is meant to shed light on the current telehealth landscape.

Designating a Patient Setting

Many states are changing their approved patient setting requirements for receiving telehealth services. If a patient is not in one of the approved settings, providers may not get reimbursed for their services. According to the report, ten states and Washington DC changed their rules on patient settings since 2017. 29 states don’t designate approved patient settings for receiving telehealth services, 12 states now recognize a patient’s home as an approved setting, and 12 states recognize schools as approved settings. 

Some states also designate how far away patients can be from care providers when receiving telehealth services, while others require trained healthcare providers to be immediately accessible to patients when accessing these services. 

Covering Different Types of Telehealth Technology

Different states will only cover certain types of telehealth technology. As of 2019, 16 states will only cover real-time telehealth services, such as provider-patient consulting using live audio and video. While 22 states cover remote patient monitoring and 29 states allow store-and-forward services, which means collecting patient information and then forwarding it to another site for evaluation. Other states are starting to cover audio-only telehealth services, which can benefit patients and providers in areas where broadband access can be hard to come by and video feeds can be unreliable. 

When it comes to remote patient monitoring, some states limit coverage to patients with specific conditions, such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes while enforcing strict hospitalization requirements. 

Changes in Insurance Coverage

States are also changing the way they manage Medicaid coverage for telehealth services. 21 states and Washington DC dictate that Medicaid covers telehealth services just as they would for in-person healthcare services. 28 states mandate reimbursement for Medicaid be the same as those for in-person healthcare services. 

The same trends are playing out with private health insurance. 36 states and Washington now regulate private insurance for telehealth services and 16 states mandate payment parity. 

The report also analyzes payment models for telehealth services, finding that 36 states offer telehealth services through an innovative payment model that uses waivers. 13 states use integrated care for Medicare-Medicaid dual-eligibles and four states use HCBS waivers. Yet nine states don’t have a capitated managed care organization model, and four have unique managed care models or will introduce them in the near future. 

Keeping up with the latest telehealth coverage and reimbursement trends can be challenging as each state continues to adjust its policies. The latest report from the ATA helps providers and patients make sense of these changing policies, so they can make use of telehealth services. One takeaway from the report remains clear: more states are embracing telehealth.