Almost all state Medicaid programs offer some form of coverage for telehealth programs, primarily for live-video conferencing. Laws and policies for telehealth coverage can be quite different from state to state; some states reimburse for telehealth with few restrictions, while others have more limited coverage.
If you’re having trouble navigating your state Medicaid telehealth reimbursement guidelines, here’s a quick summary of the most common policies and requirements that many Medicaid programs follow:
Definition of Telehealth/Telemedicine
48 states and the District of Columbia all have definitions of telehealth or telemedicine written into law or their Medicaid program—Rhode Island and New Jersey still lack legal definitions. In many states, the definitions contain restrictions such as excluding email, phone, and/or fax from the definitions. Differences in these definitions can create some confusion when looking into reimbursement, so be sure to do some research into the official definition in your state.
Type of Telemedicine
There are a number of variations of telemedicine services. The services that are primarily covered under Medicaid programs are store-and-forward, remote patient monitoring (RPM), and the most common type, live-video conferencing.
The originating site, otherwise known as the patient setting, refers to where the patient is located during the time they are receiving telehealth services. In some Medicaid cases, patient settings that are eligible for telemedicine are limited to list of specific health facilities, which are located in what is called a Health Professional Shortage Area (HPSA).
The good news is, many programs have moved away from this restriction and currently 25 states recognize the home as an eligible originating site.
Thankfully, almost all states offer state-wide telemedicine coverage with no geographic limits, but there are still a few Medicaid programs that only cover telemedicine cases where the patients are in rural areas or remote locations far from healthcare providers.
Type of Healthcare Provider
There are currently only 15 states that have no restrictions on which healthcare providers are eligible for telemedicine coverage. Every covered state allows physicians to provide telemedicine services, but some state Medicaid programs have restrictions on coverage for any other healthcare providers.
As a leading provider of an end-to-end home care software platform, AlayaCare offers a mix of real-time telehealth and face-to-face visit solutions, including robust clinical documentation, ADL tracking, exceptional software for Medicaid billing, and next-generation technology such as integrated Client Family Portals, Virtual Care and Remote Patient Monitoring, Machine Learning, electronic visit verfication through our home care app. Through our research wing, AlayaLabs, we constantly strive to not only build the best solution for home care but to contribute to the overall evolution of post-acute care.