While the technology to deliver telehealth is poised for widespread implementation, as outlined in a previous blog, a number of barriers remain, most significantly barriers to provider incentives, cross-state licensure and reimbursement.
On the positive side, steady progress is being made to overcome cross-state licensure. The Interstate Medical Licensure Compact that facilitates physician licensing across state lines is making rapid progress. In January 2019, Michigan became the 25th state to sign onto the compact, pushing the number of provider licenses issued to 4,511 with another 2,400 applications in process according to the Federation of State Medical Boards.
In its biannual update survey of state telehealth laws and Medicaid reimbursement policies released in April 2019, however, the Center for Connected Health Policy’s (CCHP) found more uneven progress on state laws and policies governing reimbursement for telehealth services.
The organization found that while 39 states and the District of Columbia have enacted laws governing payer reimbursement for telehealth, no two states are alike in how telehealth is defined and regulated. In addition, even if a state has enacted telehealth policies and laws, such policies and laws may not be incorporated into its Medicaid program.
Live video reimbursement
That said, the organization found that all 50 states and the District of Columbia have some form of Medicaid reimbursement for telehealth in their public program. However, the extent of reimbursement is less clear state-by-state. While every state provides reimbursement for telehealth services over live video, what and how is reimbursed varies widely. As an example, the organization found that New Jersey only reimburses for telepsychiatry services, whereas California reimburses for live video across a wide spectrum of medical specialties.
Store and forward policies
Reimbursement for store-and-forward telehealth services has been even more uneven at best, with some states restricting reimbursement to “real-time” services thus excluding store-and-forward telehealth services. While 11 other states have recognized the technology for reimbursement, some of those have limited it to a handful of specialties, such as teleradiology, teledentistry, and teledermatology.
Remote patient monitoring
Similarly, while 21 states reimburse for remote patient monitoring, many of those states have restrictions limiting its use, most commonly restricting monitoring to home health agencies, while others restrict reimbursement to specific conditions such as COPD, asthma or diabetes.
The differences across states for online prescriptions are even more varied. Most states consider an online questionnaire as inadequate to establishing a patient-provider relationship for writing a prescription. Some states also require a physical examination prior to writing a prescription, but not all states require in-person examinations, while others specifically allow a telehealth examination. As for prescriptions for controlled substances, a few states will allow it within federal limits. Others allow medically assisted therapy through telehealth only within the practitioner’s scope of practice.
Private payer reimbursement policies
The survey found that 39 states and D.C. have laws that govern private payer telehealth reimbursement, however, only a few of these state laws/policies require reimbursement for telehealth service to be equal to reimbursement for in-person services. At the time of the survey, many states had private payer reimbursement bills under consideration, most of which aimed to expand applicability to additional specialties.
The 420-page report includes a state-by-state breakdown of laws and policies covering telehealth. The full report is available online.
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Source: Center for Connected Health Policy: “Spring 2019 State Telehealth Laws & Reimbursement Policies”