Analysis
******Please use the attachment and use the state of Maryland******
Using the site “The Center for Connected Health Policy” (
http://cchpca.org/state-laws-and-reimbursement-policies
), locate your current states. Next, review the attached American Telemedicine Association (ATA) 2016 “State Telemedicine Gap Analysis: Coverage and Reimbursement Report. Locate the findings of your current state within the Gap Analysis. Analyze, assess, compare and ultimately, discuss your interpretation of the findings (that may include implemented laws and/or regulations). Note: If there are no immediate actions in your home state, simply select a state of choice to complete the assignment. Share your response in a 500-word count briefing. Your submission must include an APA-formatted cover sheet. Submit one (1) single Microsoft Word document at the conclusion of Week Three no later than Sunday, by 11:59 PM EST.
50
State
Telemedicine
Gaps
Analysis
Coverage
&
Reimbursement
Latoya
Thomas
and
Gary
Capistrant
January
2016
None
of
the
information
contained
in
the
Gaps
Analysis
Series
or
in
this
document
constitutes
legal
advice.
The
information
presented
is
informational
and
intended
to
serve
as
a
reference
for
interested
parties,
and
not
to
be
relied
upon
as
authoritative.
Your
own
legal
counsel
should
be
consulted
as
appropriate.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
TABLE
OF
CONTENTS
Executive
Summary …………………………………………………………………………………………………. 1
Purpose…………………………………………………………………………………………………………………. 5
Overview……………………………………………………………………………………………………………….. 5
Assessment
Methods……………………………………………………………………………………………….. 6
Scoring ……………………………………………………………………………………………………………………….6
Limitations ………………………………………………………………………………………………………………….7
Indicators ………………………………………………………………………………………………………………. 8
Parity………………………………………………………………………………………………………………………….8
Private
Insurance ……………………………………………………………………………………………………..8
Medicaid …………………………………………………………………………………………………………………9
State
Employee
Health
Plans ……………………………………………………………………………………10
Medicaid
Service
Coverage
&
Conditions
of
Payment……………………………………………………..11
Patient
Setting………………………………………………………………………………………………………..11
Eligible
Technologies……………………………………………………………………………………………….14
Distance
or
Geography
Restrictions…………………………………………………………………………..15
Eligible
Providers…………………………………………………………………………………………………….17
Physician-‐provided
Telemedicine
Services …………………………………………………………………19
Mental
and
Behavioral
Health
Services ……………………………………………………………………..20
Rehabilitation
Services…………………………………………………………………………………………….22
Home
Health
Services ……………………………………………………………………………………………..23
Informed
Consent …………………………………………………………………………………………………..24
Telepresenter…………………………………………………………………………………………………………25
Innovative
Payment
or
Service
Delivery
Models …………………………………………………………….26
State
Report
Cards…………………………………………………………………………………………………. 28
Alabama……………………………………………………………………………………………………………………29
Alaska……………………………………………………………………………………………………………………….30
Arizona……………………………………………………………………………………………………………………..31
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
Arkansas……………………………………………………………………………………………………………………32
California…………………………………………………………………………………………………………………..33
Colorado …………………………………………………………………………………………………………………..34
Connecticut……………………………………………………………………………………………………………….35
Delaware…………………………………………………………………………………………………………………..36
District
of
Columbia ……………………………………………………………………………………………………37
Florida………………………………………………………………………………………………………………………38
Georgia …………………………………………………………………………………………………………………….39
Hawaii ………………………………………………………………………………………………………………………40
Idaho………………………………………………………………………………………………………………………..41
Illinois……………………………………………………………………………………………………………………….42
Indiana……………………………………………………………………………………………………………………..43
Iowa …………………………………………………………………………………………………………………………44
Kansas………………………………………………………………………………………………………………………45
Kentucky …………………………………………………………………………………………………………………..46
Louisiana…………………………………………………………………………………………………………………..47
Maine……………………………………………………………………………………………………………………….48
Maryland…………………………………………………………………………………………………………………..49
Massachusetts …………………………………………………………………………………………………………..50
Michigan …………………………………………………………………………………………………………………..51
Minnesota…………………………………………………………………………………………………………………52
Mississippi…………………………………………………………………………………………………………………53
Missouri ……………………………………………………………………………………………………………………54
Montana …………………………………………………………………………………………………………………..55
Nebraska…………………………………………………………………………………………………………………..56
Nevada……………………………………………………………………………………………………………………..57
New
Hampshire …………………………………………………………………………………………………………58
New
Jersey………………………………………………………………………………………………………………..59
New
Mexico………………………………………………………………………………………………………………60
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
New
York…………………………………………………………………………………………………………………..61
North
Carolina …………………………………………………………………………………………………………..62
North
Dakota …………………………………………………………………………………………………………….63
Ohio …………………………………………………………………………………………………………………………64
Oklahoma………………………………………………………………………………………………………………….65
Oregon……………………………………………………………………………………………………………………..66
Pennsylvania……………………………………………………………………………………………………………..67
Rhode
Island ……………………………………………………………………………………………………………..68
South
Carolina …………………………………………………………………………………………………………..69
South
Dakota …………………………………………………………………………………………………………….70
Tennessee…………………………………………………………………………………………………………………71
Texas………………………………………………………………………………………………………………………..72
Utah …………………………………………………………………………………………………………………………73
Vermont……………………………………………………………………………………………………………………74
Virginia……………………………………………………………………………………………………………………..75
Washington……………………………………………………………………………………………………………….76
West
Virginia……………………………………………………………………………………………………………..77
Wisconsin………………………………………………………………………………………………………………….78
Wyoming…………………………………………………………………………………………………………………..79
Appendix……………………………………………………………………………………………………………… 80
State
Ratings
–
Map:
Parity
Laws
for
Private
Insurance
Coverage
of
Telemedicine…………….81
State
Ratings
–
Map:
Medicaid
Policies
for
Telemedicine
CoverageState
Ratings ………………82
State
Ratings
–
Map:
State
Employee
Health
Plan
Laws
for
Telemedicine
Coverage…………..83
State
Ratings
–
Map:
Medicaid
Patient
Setting ……………………………………………………………..84
State
Ratings
–
Map:
Medicaid
Eligible
Technologies……………………………………………………..85
State
Ratings
–
Map:
Medicaid
Distance
or
Geography
Restrictions…………………………………86
State
Ratings
–
Map:
Medicaid
Eligible
Providers…………………………………………………………..87
State
Ratings
–
Map:
Medicaid
Physician-‐provided
Telemedicine
Services ……………………….88
State
Ratings
–
Map:
Medicaid
Mental
and
Behavioral
Health
Services ……………………………89
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
State
Ratings
–
Map:
Medicaid
Rehabilitation
Services…………………………………………………..90
State
Ratings
–
Map:
Medicaid
Home
Health
Services……………………………………………………91
State
Ratings
–
Map:
Medicaid
Informed
Consent …………………………………………………………92
State
Ratings
–
Map:
Medicaid
Telepresenter……………………………………………………………….93
References …………………………………………………………………………………………………………… 94
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
1
EXECUTIVE
SUMMARY
Payment
and
coverage
for
services
delivered
via
telemedicine
are
some
of
the
biggest
challenges
for
telemedicine
adoption.
Patients
and
health
care
providers
may
encounter
a
patchwork
of
arbitrary
insurance
requirements
and
disparate
payment
streams
that
do
not
allow
them
to
fully
take
advantage
of
telemedicine.
The
American
Telemedicine
Association
(ATA)
has
captured
the
complex
policy
landscape
of
50
states
with
50
different
telemedicine
policies,
and
translated
this
information
into
an
easy
to
use
format.
This
report
complements
our
50
State
Gaps
Analysis:
Physician
Practice
Standards
&
Licensure,
and
extracts
and
compares
telemedicine
coverage
and
reimbursement
standards
for
every
state
in
the
U.S.
ultimately
leaving
each
state
with
two
questions:
• “How
does
my
state
compare
regarding
policies
that
promote
telemedicine
adoption?”
• “What
should
my
state
do
to
improve
policies
that
promote
telemedicine
adoption?”
Using
data
categorized
into
13
indicators
related
to
coverage
and
reimbursement,
our
analysis
continues
to
reveal
a
mix
of
strides
and
stagnation
in
state-‐based
policy
despite
decades
of
evidence-‐based
research
highlighting
positive
clinical
outcomes
and
increasing
telemedicine
utilization.
Since
our
initial
report
in
September
2014
11
states
and
D.C.
have
adopted
policies
that
improved
coverage
and
reimbursement
of
telemedicine-‐provided
services,
while
two
states
have
adopted
policies
further
restricting
coverage
(Figure
1).1
FIGURE
1
–
Sept.
2014
-‐
December
2015
Comparison
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
2
States
have
made
efforts
to
improve
their
grades
through
the
removal
of
arbitrary
restrictions
and
adoption
of
laws
ensuring
coverage
parity
under
private
insurance,
state
employee
health
plans,
and/or
Medicaid
plans,
as
indicated
in
Figure
2.
Overall,
there
are
more
states
now
with
above
average
grades,
“A”
or
“B”,
including
Iowa
which
improved
from
an
‘F’
to
‘B’,
than
reported
in
September
2014.
FIGURE
2
–
Sept.
2014
-‐
December
2015
Comparison
In
recent
months,
five
states
(Delaware,
Iowa,
Mississippi,
Nevada,
and
Oklahoma)
have
higher
scores
suggesting
a
supportive
policy
landscape
that
accommodates
telemedicine
adoption
while
one
state
saw
a
drop
in
their
composite
grade.
New
Hampshire
dropped
from
an
‘A’
to
‘B’
as
a
result
of
adopted
legislation
that
includes
Medicaid
telehealth
coverage
language
similar
to
Medicare.
Despite
the
adoption
of
a
private
insurance
parity
law
earlier
this
year,
Connecticut,
like
Rhode
Island,
continues
to
average
the
lowest
composite
score
suggesting
many
barriers
and
little
opportunity
for
telemedicine
advancement
(Table
1).
0
5
10
15
20
25
30
35
F
C
B
A
NUMBER
OF
STATES
C
O
M
P
O
SI
TE
G
R
A
D
ES
Sept.
2014
Dec.
2015
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
3
Table
1
–
Composite
Scores
by
State
State
Composite
Grade
State
Composite
Grade
State
Composite
Grade
State
Composite
Grade
AK
B
ID
C
MT
B
RI
F
AL
B
IL
C
NC
C
SC
B
AR
C
IN
C
ND
B
SD
B
AZ
B
KS
B
NE
B
TN
A
CA
B
KY
B
NH
B
TX
B
CO
B
LA
B
NJ
C
UT
B
CT
F
MA
B
NM
A
VA
A
DC
A
MD
B
NV
A
VT
B
DE
A
ME
A
NY
B
WA
B
FL
C
MI
B
OH
B
WI
C
GA
B
MN
B
OK
A
WV
C
HI
C
MO
B
OR
B
WY
B
IA
B
MS
A
PA
B
When
broken
down
by
the
13
indicators,
the
state-‐by-‐state
comparisons
reveal
even
greater
disparities.
• Eight
states
have
enacted
telemedicine
parity
laws
since
the
initial
report
in
2014.
Of
the
29
states
that
have
telemedicine
parity
laws
for
private
insurance,
22
of
them
and
D.C.
scored
the
highest
grades
indicating
policies
that
authorize
state-‐wide
coverage,
without
any
provider
or
technology
restrictions
(Figure
3).
Less
than
half
of
the
country,
22
states,
ranked
the
lowest
with
failing
scores
for
having
either
no
parity
law
in
place
or
numerous
artificial
barriers
to
parity.
This
is
a
significant
improvement
as
more
states
adopt
parity
laws.
Arkansas
maintains
a
failing
grade
because
it
places
arbitrary
limits
in
its
parity
law.
• Forty-‐eight
state
Medicaid
programs
have
some
type
of
coverage
for
telemedicine.
Only
eight
states
and
D.C.
scored
the
highest
grades
by
offering
more
comprehensive
coverage,
with
few
barriers
for
telemedicine-‐provided
services
(Figure
4).
Delaware,
Iowa,
Nevada,
and
Oklahoma
passed
reforms
that
ensure
parity
coverage
with
little
or
no
restrictions.
Connecticut,
Hawaii,
Idaho,
New
Hampshire,
Rhode
Island,
and
West
Virginia
ranked
the
lowest
with
failing
scores
in
this
area.
New
Hampshire
dropped
from
an
‘A’
to
‘B’
as
a
result
of
adopted
legislation
that
includes
Medicaid
telehealth
coverage
language
similar
to
Medicare.
• Another
area
of
improvement
includes
coverage
and
reimbursement
for
telemedicine
under
state
employee
health
plans.
Twenty-‐six
states
have
some
type
of
coverage
for
telehealth
under
one
or
more
state
employee
health
plan.
Most
states
self-‐insure
their
plans
thus
traditional
private
insurer
parity
language
does
not
automatically
affect
them.
Oregon
is
an
exception
which
amended
its
parity
law
this
year
to
include
self-‐
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
4
insured
state
employee
health
plans.
50
percent
of
the
country
is
ranked
the
lowest
with
failing
scores
due
to
partial
or
no
coverage
of
telehealth
(Figure
5).
Regarding
Medicaid,
states
continue
to
move
away
from
the
traditional
hub-‐and-‐spoke
model
and
allow
a
variety
of
technology
applications.
Twenty-‐six
states
and
D.C.
do
not
specify
a
patient
setting
as
a
condition
for
payment
of
telemedicine
(Figure
6).
Aside
from
this,
36
states
recognize
the
home
as
an
originating
site,
while
18
states
recognize
schools
and/or
school-‐
based
health
centers
as
an
originating
site
(Figures
7-‐8).
Vermont
improved
a
letter
grade
because
it
now
covers
home
remote
patient
monitoring.
Half
of
the
country
ranks
the
lowest
with
failing
scores
either
because
they
only
cover
synchronous
only
or
provide
no
coverage
for
telemedicine
at
all.
Idaho,
Missouri,
North
Carolina
and
South
Carolina
prohibit
the
use
of
“cell
phone
video”
to
facilitate
a
telemedicine
encounter
(Figure
9).
There
is
still
a
national
trend
to
allow
state-‐wide
Medicaid
coverage
of
telemedicine
instead
of
focusing
solely
on
rural
areas
or
designated
mileage
requirements
(Figure
10).
States
are
also
increasingly
using
telemedicine
to
fill
provider
shortage
gaps
and
ensure
access
to
specialty
care.
Seventeen
states
and
D.C.
do
not
specify
the
type
of
healthcare
provider
allowed
to
provide
telemedicine
as
a
condition
of
payment
(Figure
11).
While
20
states
ranked
the
lowest
with
failing
scores
for
authorizing
less
than
nine
health
provider
types.
Florida,
Idaho,
and
Montana
ranked
the
lowest
with
coverage
for
physicians
only.
Overall,
coverage
of
specialty
services
for
telemedicine
under
Medicaid
is
a
checkered
board
and
no
two
states
are
alike.
• Ten
states
and
D.C.
rank
the
highest
for
coverage
of
telemedicine-‐provided
physician
services
and
most
states
cover
an
office
visit
or
consultations,
with
ultrasounds
and
echocardiograms
being
the
least
covered
telemedicine-‐provided
services
(Figure
12).
• For
mental
and
behavioral
health
services,
generally
mental
health
assessments,
individual
therapy,
psychiatric
diagnostic
interview
exam,
and
medication
management
are
the
most
covered
via
telemedicine.
Twelve
states
and
D.C.
rank
the
highest
for
coverage
of
mental
and
behavioral
health
services
(Figure
13).
The
lowest
ranking
states
for
all
Medicaid
services,
scoring
an
‘F’,
are
Connecticut
and
Rhode
Island
which
have
no
coverage
for
telemedicine
under
their
Medicaid
plans.
• Although
state
policies
vary
in
scope
and
application,
five
more
states
have
expanded
coverage
to
include
telerehabilitation.
Seventeen
states
are
known
to
reimburse
for
telerehabilitative
services
in
their
Medicaid
plans.
Of
those,
11
states
rank
the
highest
with
telemedicine
coverage
for
therapy
services
(Figure
14).
• Alaska
is
the
only
state
with
the
highest
ranking
for
telemedicine
provided
services
under
the
home
health
benefit
(Figure
15).
Seventy
percent
of
the
country
ranked
the
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
5
lowest
with
failing
scores
due
to
a
lack
of
telemedicine
services
covered
under
the
home
health
benefit.
Finally,
twenty-‐seven
states
have
unique
patient
informed
consent
requirements
for
telemedicine
encounters
(Figure
16).
Twenty-‐two
states
do
not
require
a
telepresenter
during
the
encounter
or
on
the
premises
(Figure
17).
PURPOSE
Patients
and
health
care
enthusiasts
across
the
country
want
to
know
how
their
state
compares
to
other
states
regarding
telemedicine.
While
there
are
numerous
resources
that
detail
state
telemedicine
policies,
they
lack
a
state-‐by-‐state
comparison.
ATA
has
created
a
tool
that
identifies
state
policy
gaps
with
the
hope
that
states
will
respond
with
more
streamlined
policies
that
improve
health
care
quality
and
reduce
costs
through
accelerated
telemedicine
adoption.
This
report
fills
that
gap
by
answering
the
following
questions:
• “How
does
my
state’s
telemedicine
policies
compare
to
others?”
• “Which
states
offer
the
best
coverage
for
telemedicine
provided
services?”
• “Which
states
impose
barriers
to
telemedicine
access
for
patients
and
providers?”
It
is
important
to
note
that
this
report
is
not
a
“how-‐to
guide”
for
telemedicine
reimbursement.
This
is
a
tool
aimed
to
serve
as
a
reference
for
interested
parties
and
to
inform
future
policy
decision
making.
The
results
presented
in
this
document
are
based
on
information
collected
from
state
statutes,
regulations,
Medicaid
program
manuals/bulletins/fee
schedules,
state
employee
handbooks,
and
other
federal
and
state
policy
resources.
It
is
ATA’s
best
effort
to
interpret
and
understand
each
state’s
policies.
Your
own
legal
counsel
should
be
consulted
as
appropriate.
OVERVIEW
State
lawmakers
around
the
country
are
giving
increased
attention
to
how
telehealth
can
serve
their
constituents.
Policymakers
seek
to
reduce
health
care
delivery
problems,
contain
costs,
improve
care
coordination,
and
alleviate
provider
shortages.
Many
are
using
telemedicine
to
achieve
these
goals.
Over
the
past
four
years
the
number
of
states
with
telemedicine
parity
laws
–
that
require
private
insurers
to
cover
telemedicine-‐provided
services
comparable
to
that
of
in-‐person
–
has
doubled.2
Moreover,
Medicaid
agencies
are
developing
innovative
ways
to
use
telemedicine
in
their
payment
and
delivery
reforms
resulting
in
48
state
Medicaid
agencies
with
some
type
of
coverage
for
telemedicine
provided-‐services.
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Driving
the
momentum
for
telemedicine
adoption
is
the
creation
of
new
laws
that
enhance
access
to
care
via
telemedicine,
and
the
amendment
of
existing
policies
with
greater
implications.
Patients
and
health
care
providers
are
benefitting
from
policy
improvements
to
existing
parity
laws,
expanded
service
coverage,
and
removed
statutory
and
regulatory
barriers.
While
there
are
some
states
with
exemplary
telemedicine
policies,
lack
of
enforcement
and
general
awareness
have
led
to
a
lag
in
provider
participation.
Ultimately
these
pioneering
telemedicine
reforms
have
trouble
reaching
their
true
potential.
Other
areas
of
concern
include
states
that
have
adopted
policies
which
are
limiting
in
scope
or
prevent
providers
and
patients
from
realizing
the
full
benefits
of
telemedicine.
Specifically,
artificial
barriers
such
as
geographic
discrimination
and
restrictions
on
provider
and
patient
settings
and
technology
type
are
harmful
and
counterproductive.
ASSESSMENT
METHODS
Scoring
This
report
considers
telemedicine
coverage
and
reimbursement
policies
in
each
state
based
on
two
categories:
• Health
plan
parity
• Medicaid
conditions
of
payment.
These
categories
were
measured
using
13
indicators.
The
indicators
were
chosen
based
on
the
most
recent
and
generally
accessible
information
assembled
and
published
by
state
public
entities.
Using
this
information,
we
took
qualitative
characteristics
based
on
scope
of
service,
provider
and
patient
eligibility,
technology
type,
and
arbitrary
conditions
of
payment
and
assigned
them
quantitative
values.
States
were
given
a
certain
number
of
points
for
each
indicator
depending
on
its
effectiveness.
The
points
were
then
used
to
rank
and
compare
each
state
by
indicator.
We
used
a
four-‐graded
system
to
rank
and
compare
each
state.
This
is
based
off
of
the
scores
given
to
each
state
by
indicator.
Each
of
the
two
categories
was
broken
down
into
indicators
–
three
indicators
for
health
plan
parity
and
10
indicators
for
Medicaid
conditions
of
payment.
Each
indicator
was
given
a
maximum
number
of
points
ranging
from
1
to
35.
The
aggregate
score
for
each
indicator
was
ranked
on
a
scale
of
A
through
F
based
on
the
maximum
number
of
points.
The
report
also
includes
a
category
to
capture
innovative
payment
and
service
delivery
models
implemented
in
each
state.
In
addition
to
state
supported
networks
in
specialty
care
and
correctional
health,
the
report
identifies
a
few
federally
subsidized
programs
and
waivers
that
states
can
leverage
to
enhance
access
to
health
care
services
using
telemedicine.
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Limitations
Telemedicine
policies
in
state
health
plans
vary
according
to
a
number
of
factors
–
service
coverage,
payment
methodology,
distance
requirements,
eligible
patient
populations
and
health
care
providers,
authorized
technologies,
and
patient
consent.
These
policy
decisions
can
be
driven
by
many
considerations,
such
as
budget,
public
health
and
safety
needs,
available
infrastructure
or
provider
readiness.
As
such,
the
material
in
this
report
is
a
snapshot
of
information
gathered
through
December
2015.
The
report
relies
on
dynamic
policies
from
payment
streams
that
are
often
dissimilar
and
unaligned.
Illinois
and
Massachusetts
have
enacted
“If,
then”
telemedicine
coverage
laws
which
prevent
the
enforcement
of
discriminatory
practices
such
as
an
in-‐person
encounter.34
“If”
the
state
regulated
plan
chooses
to
cover
telemedicine-‐provided
services,
“then”
the
plan
is
prohibited
from
requiring
an
in-‐person
visit.
ATA
does
not
interpret
these
statutes
as
parity
laws.
We
analyzed
both
Medicaid
fee-‐for-‐service
(FFS)
and
managed
care
plans.
Benefit
coverage
under
these
plans
vary
by
size
and
scope.
We
used
physician,
mental
and
behavioral
health,
home
health,
and
rehabilitation
services
as
a
benchmark
for
our
analysis.
Massachusetts
and
New
Hampshire
do
not
cover
telemedicine-‐provided
services
under
their
FFS
plans
but
do
have
some
coverage
under
at
least
one
of
their
managed
care
plans.
As
such,
the
analysis
and
scores
are
reflective
of
the
telemedicine
offerings
in
each
program,
and
not
the
Medicaid
program
itself,
regardless
of
size
and
scope.
We
did
not
analyze
state
Children’s
Health
Insurance
Plans
(CHIP)
plans.
We
are
aware
that
states
provide
some
coverage
of
telemedicine-‐provided
services
for
CHIP
beneficiaries.
Additionally,
some
states
recognize
schools
and/or
school-‐based
health
centers
as
originating
sites,
however
we
did
not
separately
score
or
rank
school-‐based
programs.
Although
two
states
include
coverage
of
telemedicine-‐provided
services
under
worker’s
compensation
plans,
we
did
not
analyze
this
coverage
benefit.
ATA
may
include
these
plans
in
future
versions
of
this
report
as
states
extend
coverage
to
include
telemedicine
under
worker’s
compensation
and
disability
insurance.
Other
notable
observations
in
our
analysis
include
state
Medicaid
plans
that
do
not
cover
therapy
services
(i.e.
physical
therapy,
occupational
therapy,
and
speech
language
pathology).5
States
with
no
coverage
for
these
benefits
were
not
applicable
for
scoring
or
ranking.
Additionally,
some
states
policies
can
be
conflicting.
States
like
Arkansas
and
New
York
have
enacted
laws
requiring
telemedicine
parity
in
their
Medicaid
plans.
However,
regulations
and
Medicaid
provider
manuals
do
not
reflect
all
of
these
policy
changes.
In
those
cases,
the
analysis
and
scores
are
reflective
of
the
authorized
regulations
and
statutes
enacted
by
law
unless
otherwise
noted.
Future
reports
will
reflect
changes
in
the
law
if
applicable.
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Also,
this
report
is
about
what
each
state
has
“on
paper”,
not
necessarily
in
service.
Important
factors,
such
as
the
actual
provision
and
utilization
of
telemedicine
services
and
provider
collaboration
to
create
service
networks
are
beyond
the
scope
of
this
report.
Indicators
Parity
A. Private
Insurance
Full
parity
is
classified
as
comparable
coverage
for
telemedicine-‐provided
services
to
that
of
in-‐
person
services.
Twenty-‐eight
states
and
the
District
of
Columbia
have
enacted
full
parity
laws.
Only
Arizona
has
enacted
a
partial
parity
law
that
requires
coverage
and
reimbursement,
but
limits
coverage
to
a
certain
geographic
area
(e.g.,
rural)
or
a
predefined
list
of
health
care
services.
Since
our
initial
report,
some
parity
laws
have
included
restrictions
on
patient
settings.
For
this
report’s
purpose,
we
added
this
component
to
our
methodology,
and
continue
to
measure
other
components
of
state
policies
that
enable
or
impede
parity
for
telemedicine-‐provided
services
under
private
insurance
health
plans.
Scale
–
Private
Insurance
Parity
A
7
points
B
6
points
C
5
points
F
≤
4
points
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FIGURE
3
–
Private
Insurance
Parity
States
with
the
highest
grades
for
private
insurance
telemedicine
parity
provide
state-‐wide
coverage,
and
have
no
provider,
technology,
or
patient
setting
restrictions
(Figure
3).
Among
states
with
parity
laws,
Arizona,
New
York,
and
Vermont
scored
about
average
(C).
New
York
and
Vermont
lawmakers
have
placed
patient
setting
restrictions
on
those
services
eligible
for
coverage
parity.
While
Arizona
continues
to
limit
coverage
to
interactive
audio-‐video
only
modalities
and
the
types
of
services
and
conditions
that
are
covered
via
telemedicine.
Despite
enacting
a
parity
law
in
March
2015,
Arkansas
maintains
a
failing
grade
because
it
places
arbitrary
limits
on
patient
location,
eligible
provider
type,
and
requires
an
in-‐person
visit
to
establish
a
provider-‐patient
relationship.
Forty-‐four
percent
of
the
country
ranks
the
lowest
with
failing
(F)
scores,
a
drop
from
the
initial
report.
B. Medicaid
Each
state’s
Medicaid
plan
was
assessed
based
on
service
limits
and
patient
setting
restrictions.
Other
components
assessed
for
all
three
plans
include
provider
eligibility
and
the
type
of
technology
allowed
were
also
examined
to
determine
the
state’s
capacity
to
fully
utilize
telemedicine
to
overcome
barriers
to
care.
For
this
report’s
purpose,
we
measured
components
of
state
policies
that
enable
or
impede
parity
for
telemedicine-‐provided
services
under
Medicaid
plans.
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Scale
–
Medicaid
Coverage
A
14+
points
B
10-‐13
points
C
6-‐9
points
F
≤
5
points
Forty-‐eight
state
Medicaid
programs
have
some
type
of
coverage
for
telemedicine.
FIGURE
4
–
Medicaid
Coverage
Eight
states
and
D.C.
have
the
highest
grades
for
Medicaid
coverage
of
telemedicine-‐provided
services
(Figure
4).
Connecticut,
Hawaii,
Idaho,
New
Hampshire,
Rhode
Island,
and
West
Virginia
ranked
the
lowest
with
failing
(F)
scores.
Iowa,
Nevada,
Oklahoma,
and
Washington
have
all
made
improvements
to
expand
coverage
of
telemedicine
for
their
Medicaid
populations.
Connecticut
and
Rhode
Island
are
the
only
states
without
coverage
for
telemedicine
under
their
Medicaid
plans.
Of
the
48
states
with
coverage,
Idaho
offers
the
least
amount
of
coverage
for
telemedicine-‐provided
services.
While
Hawaii,
Idaho,
New
Hampshire,
and
West
Virginia
still
apply
geography
limits
in
addition
to
restrictions
on
service
coverage,
provider
eligibility,
and
patient
setting.
C. State
Employee
Health
Plans
We
measured
components
of
state
policies
that
enable
or
impede
parity
for
telemedicine-‐
provided
services
under
state-‐employee
health
plans.
Most
states
self-‐insure
their
plans
therefore
traditional
private
insurer
parity
language
does
not
automatically
affect
them.
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Oregon
is
an
exception
which
amended
its
parity
law
this
year
to
include
self-‐insured
state
employee
health
plans.
Scale
–
State-‐employee
Health
Plan
Parity
A
7
points
B
6
points
C
5
points
F
≤
4
points
Twenty-‐six
states
provide
some
coverage
for
telemedicine
under
their
state
employee
health
plans
with
26
states
extending
coverage
under
their
parity
laws
(Figure
5).
Most
states
self-‐
insure
their
plans
and
50
percent
of
the
country
is
ranked
the
lowest
with
failing
scores
due
to
partial
or
no
coverage
of
telehealth.
FIGURE
5
–
State
Employee
Health
Plan
Coverage
Medicaid
Service
Coverage
&
Conditions
of
Payment
D. Patient
Setting
In
telemedicine
policy,
the
place
where
the
patient
is
located
at
the
time
of
service
is
often
referred
to
as
the
originating
site
(in
contrast,
to
the
site
where
the
provider
is
located
and
often
referred
to
as
the
distant
site).
The
location
of
the
patient
is
a
contentious
component
of
telemedicine
coverage.
A
traditional
approach
to
telemedicine
coverage
is
to
require
that
the
patient
be
served
from
a
specific
type
of
health
facility,
such
as
a
hospital
or
physician’s
office.
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Left
out
by
these
approaches
are
the
sites
where
people
predominantly
spend
their
time,
such
as
homes,
office/place
of
work,
schools,
or
traveling
around.
With
advances
in
decentralized
computing
power,
such
as
cloud
processing,
and
mobile
telecommunications,
such
as
4G
wireless,
the
current
approach
is
to
cover
health
services
to
patients
wherever
they
are.
For
this
report,
we
measured
components
of
state
Medicaid
policies
that,
for
conditions
of
coverage
and
payment,
broaden
or
restrict
the
location
of
the
patient
when
telemedicine
is
used.
The
following
sites
are
observed
as
qualified
patient
locations:
• Hospitals
• doctor’s
office
• other
provider’s
office
• dentist
office
• home
• federally
qualified
health
center
(FQHC)
• critical
access
hospital
(CAH)
• rural
health
center
(RHC)
• community
mental
health
center
(CMHC)
• sole
community
hospital
• school/school-‐based
health
center
(SBHC)
• assistive
living
facility
(ALF)
• skilled
nursing
facility
(SNF)
• stroke
center
• rehabilitation/therapeutic
health
setting
• ambulatory
surgical
center
• residential
treatment
center
• health
departments
• renal
dialysis
centers
• habilitation
centers.
States
received
one
(1)
point
for
each
patient
setting
authorized
as
an
eligible
originating
site.
Those
states
that
did
not
specify
an
originating
site
were
given
the
maximum
score
possible
(20).
Scale
–
Medicaid:
Patient
Settings
A
16+
points
B
11-‐15
points
C
6-‐10
points
F
≤
5
points
Twenty-‐six
states
and
D.C.
do
not
specify
a
patient
setting
or
patient
location
as
a
condition
of
payment
for
telemedicine
(Figure
6).
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FIGURE
6
–
Medicaid:
Patient
Setting
Aside
from
this,
36
states
allow
the
home
as
an
originating/patient
site,
while
18
states
recognize
schools
and/or
SBHCs
as
an
originating
site
(Figures
7-‐8).
FIGURE
7
–
Medicaid:
Home
Setting
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FIGURE
8
-‐
Medicaid:
School
Setting
Six
states
ranked
the
lowest
with
failing
(F)
scores
for
designating
less
than
six
patient
settings
as
originating
sites
with
Florida
and
New
Jersey
ranking
the
lowest
with
only
two
eligible
originating
sites.
E. Eligible
Technologies
Telemedicine
includes
the
use
of
numerous
technologies
to
exchange
medical
information
from
one
site
to
another
via
electronic
communications.
The
technologies
closely
associated
with
services
enabled
by
telemedicine
include
videoconferencing,
the
transmission
of
still
images
(also
known
as
store-‐and-‐forward),
remote
patient
monitoring
(RPM)
of
vital
signs,
and
telephone
calls.
For
this
report,
we
measured
components
of
state
Medicaid
policies
that
allow
or
prohibit
the
coverage
and/or
reimbursement
of
telemedicine
when
using
these
technologies.
Scale
–
Medicaid:
Eligible
Technologies
A
5
points
B
4
points
C
3
points
F
≤
2
points
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FIGURE
9
–
Medicaid:
Eligible
Technologies
Seven
states
score
above
average
on
our
scale
with
Alaska
taking
the
highest
ranking
(Figure
9).
The
state
covers
telemedicine
when
providers
use
interactive
audio-‐video,
store-‐and-‐forward,
remote
patient
monitoring,
and
audio
conferencing
for
some
telemedicine
encounters.
Alaska,
Minnesota,
Mississippi,
Nebraska,
and
Texas
all
cover
telemedicine
when
using
synchronous
technology
as
well
as
store-‐and-‐forward
and
remote
patient
monitoring
in
some
capacity.
Fifty
percent
of
the
states
rank
the
lowest
with
failing
(F)
scores
either
because
they
only
cover
synchronous
only
or
provide
no
coverage
for
telemedicine
at
all.
Further,
Idaho,
Missouri,
North
Carolina
and
South
Carolina
prohibit
the
use
of
“cell
phone
video”
or
“video
phone”
to
facilitate
a
telemedicine
encounter.
F. Distance
or
Geography
Restrictions
Distance
restrictions
are
measured
in
miles
and
designate
the
amount
of
distance
necessary
between
a
distance
site
provider
and
patient
as
a
condition
of
payment
for
telemedicine.
Geography
is
classified
as
rural,
urban,
metropolitan
statistical
area
(MSA),
defined
population
size,
or
health
professional
shortage
area
(HPSA).
We
measured
components
of
state
Medicaid
policies
that
apply
distance
or
geography
restrictions
for
conditions
of
coverage
and
payment
when
telemedicine
is
performed.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
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Page.
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Scale
–
Medicaid:
Distance
&
Geography
Restrictions
A
3
points
B
2
points
C
1
point
F
0
points
Over
the
past
year,
states
have
made
considerable
efforts
to
rescind
mileage
requirements
for
covered
telemedicine
services.
Nevada
and
Oklahoma
now
offer
telemedicine
state-‐wide,
while
Iowa
successfully
removed
its
distance
requirements.
New
Hampshire
adopted
legislation
that
includes
geographically
restricted
language
similar
to
Medicare.
Indiana
has
statutory
authority
to
remove
their
mileage
requirements
for
all
distance
site
providers
but
chooses
to
enforce
the
mileage
requirement
for
some
eligible
providers.
Earlier
this
year,
Ohio
Medicaid
approved
a
regulation
that
would
expand
coverage
of
telemedicine
services,
and
includes
a
five
mile
distance
restriction
as
a
condition
of
payment.
FIGURE
10
-‐
Medicaid:
Distance/Geography
Restrictions
Eighty-‐six
percent
of
the
states
cover
telemedicine
services
state-‐wide
without
distance
restrictions
or
geographic
designations
(Figure
10).
This
evidence
dispels
the
misconception
that
telemedicine
is
only
appropriate
for
rural
settings
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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Telemedicine
Association
2016
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Page.
17
G. Eligible
Providers
Most
states
allow
physicians
to
perform
telemedicine
encounters
within
their
scope
of
practice.
We
measured
components
of
state
Medicaid
policies
that,
for
conditions
of
coverage
and
payment,
broaden
or
restrict
the
types
of
distant
site
providers
allowed
to
perform
the
telemedicine
encounter.
The
following
providers
are
observed
as
qualified
health
care
professionals
for
covered
telemedicine-‐provided
services:
• physician
(MD
and
DO)
• podiatrist
• chiropractor
• optometrist
• genetic
counselor
• dentist
• physician
assistant
(PA)
• nurse
practitioner
(NP)
• registered
nurse
• licensed
practical
nurse
• certified
nurse
midwife
• clinical
nurse
specialist
• psychologist
• marriage
and
family
therapist
• clinical
social
worker
(CSW)
• clinical
counselor
• behavioral
analyst
• substance
abuse/addictions
specialist
• clinical
therapist
• pharmacist
• physical
therapist
• occupational
therapist
• speech-‐language
pathologist
and
audiologist
• registered
dietitian/nutritional
professional
• diabetes/asthma/nutrition
educator
• home
health
aide
• home
health
agency
(HHA)
• FQHC
• CAH
• RHC
• CMHC
• SNF.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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Telemedicine
Association
2016
|
Page.
18
Each
state
received
two
(2)
points
for
designating
a
physician,
and
one
(1)
point
for
each
additional
eligible
provider
authorized
to
provide
covered
telemedicine
services.
Those
states
that
did
not
specify
an
eligible
provider
were
given
the
maximum
score
possible
(35).
Scale
–
Medicaid:
Eligible
Providers
A
25+
points
B
17-‐24
points
C
9-‐16
points
F
≤
8
points
Sixteen
states
and
D.C.
do
not
specify
the
type
of
health
care
provider
allowed
to
provide
telemedicine
as
a
condition
of
payment
(Figure
11).
FIGURE
11
-‐
Medicaid:
Eligible
Providers
Other
interesting
trends
include
Alaska,
California,
and
Illinois
which
cover
services
when
provided
by
a
podiatrist.
Alaska,
California,
and
Kentucky
cover
services
when
provided
by
a
chiropractor.
California,
Kentucky,
and
Washington
are
the
only
states
to
specify
coverage
for
services
when
provided
by
an
optometrist,
while
Arizona,
California,
and
New
York
will
cover
services
provided
by
a
dentist.
Although
CMS
has
issued
guidance
clarifying
their
position
on
coverage
for
services
related
to
autism
spectrum
disorder,
only
New
Mexico,
Oklahoma,
and
Washington
specify
coverage
for
telemedicine
when
provided
by
behavioral
analysts.
This
trend
is
unique
because
these
specialists
are
critical
for
the
treatment
of
autism
spectrum
disorders.
New
Mexico,
Oklahoma,
Virginia,
West
Virginia,
and
Wyoming
specify
coverage
for
telemedicine
when
provided
by
a
substance
abuse
or
addiction
specialist.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
19
Eighteen
states
ranked
the
lowest
with
failing
(F)
scores
for
authorizing
less
than
nine
health
provider
types.
Florida,
Idaho,
and
Montana
ranked
the
lowest
with
coverage
for
physicians
only.
H. Physician-‐provided
Telemedicine
Services
Physician-‐provided
telemedicine
services
are
commonly
covered
and
reimbursed
by
Medicaid
health
plans.
However,
some
plans
base
coverage
on
a
prescribed
set
of
health
conditions
or
services,
place
restrictions
on
patient
or
provider
settings,
the
frequency
of
covered
telemedicine
encounters,
or
exclude
services
performed
by
other
medical
professionals.
For
this
report,
we
measured
components
of
state
Medicaid
policies
that
broaden
or
restrict
a
physician’s
ability
to
use
telemedicine
for
conditions
of
coverage
and
payment.
Scale
–
Medicaid:
Physician-‐provided
Services
A
13
points
B
10-‐12
points
C
7-‐9
points
F
≤
6
points
Eleven
states
and
D.C.
rank
the
highest
for
coverage
of
telemedicine-‐provided
physician
services
(Figure
12).
These
states
have
no
restrictions
on
service
coverage
or
additional
conditions
of
payment
for
services
provided
via
telemedicine.
Additionally,
these
states
also
allow
a
physician
assistant
and/or
advanced
practice
nurse
as
eligible
distant
site
providers.
Moreover,
most
states
cover
an
office
visit
or
consultations,
with
ultrasounds
and
echocardiograms
being
the
least
covered
telemedicine-‐provided
services.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
20
FIGURE
12
–
Medicaid:
Physician
Services
The
lowest
ranking
states,
which
scored
an
F,
are
Connecticut
and
Rhode
Island
which
have
no
coverage
for
telemedicine
under
their
Medicaid
plans
and
Iowa
and
Ohio
with
limited
service
coverage
and
other
arbitrary
restrictions.
I. Mental
and
Behavioral
Health
Services
According
to
ATA’s
telemental
health
practice
guidelines,
telemental
health
consists
of
the
practice
of
mental
health
specialties
at
a
distance
using
video-‐conferencing.
The
scope
of
services
that
can
be
delivered
using
telemental
health
includes:
mental
health
assessments,
substance
abuse
treatment,
counseling,
medication
management,
education,
monitoring,
and
collaboration.
Forty-‐eight
states
have
some
form
of
coverage
and
reimbursement
for
mental
health
provided
via
telemedicine
video-‐conferencing.
While
the
number
of
states
with
coverage
in
this
area
suggests
enhanced
access
to
mental
health
services,
it
is
important
to
note
that
state
policies
for
telemental
health
vary
in
specificity
and
scope.
We
measured
components
of
state
Medicaid
policies
that
broaden
or
restrict
the
types
of
providers
allowed
to
perform
the
telemedicine
encounter,
telemedicine
coverage
for
mental
and
behavioral
health
services.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
21
Scale
–
Medicaid:
Mental
and
Behavioral
Health
Services
A
14
points
B
10-‐13
points
C
6-‐9
points
F
≤
5
points
Generally
the
telemedicine-‐provided
services
that
are
most
often
covered
under
state
Medicaid
plans
include
mental
health
assessments,
individual
therapy,
psychiatric
diagnostic
interview
exam,
and
medication
management.
Twelve
states
and
D.C.
rank
the
highest
for
coverage
of
mental
and
behavioral
health
services
(Figure
13).
These
states
have
no
restrictions
on
service
coverage
or
additional
conditions
of
payment
for
services
provided
via
telemedicine.
Additionally,
these
states
also
classify
at
least
one
other
medical
professional
(i.e.
physician
assistant
and
advanced
practice
nurse)
as
an
eligible
distant
site
provider.
FIGURE
13
–
Medidcaid:
Mental/Behavioral
Health
Services
It
is
also
more
common
for
states
with
telemental
health
coverage
to
allow
physicians
that
are
psychiatrists,
advanced
practice
nurses
with
clinical
specialties,
and
psychologists
to
perform
the
telemedicine
encounter.
However,
many
states
allow
non-‐medical
providers
to
perform
and
reimburse
for
the
telemedicine
encounter.
States
including
Alaska,
Arizona,
Arkansas,
California,
Hawaii,
Indiana,
Kentucky,
Michigan,
Minnesota,
Nevada,
New
Hampshire,
New
Mexico,
New
York,
North
Carolina,
Ohio,
Oklahoma,
Texas,
Virginia,
Washington,
West
Virginia
and
Wyoming
cover
telemedicine
when
performed
by
a
licensed
social
worker.
Alaska,
Arizona,
Arkansas,
California,
Indiana,
Kentucky,
Minnesota,
Nevada,
New
Mexico,
Ohio,
Oklahoma,
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
22
Texas,
Virginia,
Washington,
West
Virginia,
and
Wyoming
cover
telemedicine
when
provided
by
a
licensed
professional
counselor.
Further,
New
Mexico,
Oklahoma,
and
Washington
are
the
only
states
to
specify
coverage
for
telemedicine
when
provided
by
behavioral
analysts.
This
trend
is
unique
because
these
specialists
are
critical
for
the
treatment
of
autism
spectrum
disorders.
The
lowest
ranking
states,
which
scored
an
F,
are
Connecticut
and
Rhode
Island
which
have
no
coverage
for
telemedicine
under
their
Medicaid
plans.
Iowa
improved
their
grade
from
an
‘F’
to
‘B’
due
to
expanded
service
coverage
offered
through
a
contracted
plan.
J. Rehabilitation
Services
The
ATA
telerehabilitation
guidelines
define
telerehabilitation
as
the
“delivery
of
rehabilitation
services
via
information
and
communication
technologies.
Clinically,
this
term
encompasses
a
range
of
rehabilitation
and
habilitation
services
that
include
assessment,
monitoring,
prevention,
intervention,
supervision,
education,
consultation,
and
counseling”.
Rehabilitation
professionals
utilizing
telerehabilitation
include:
neuropsychologists,
speech-‐language
pathologists,
audiologists,
occupational
therapists,
and
physical
therapists.
We
measured
components
of
state
Medicaid
policies
that
broaden
or
restrict
the
types
of
providers
allowed
to
perform
the
telemedicine
encounter,
restrictions
on
patient
or
provider
settings,
and
coverage
for
telerehabilitation
services.
Scale
–
Medicaid:
Rehabilitation
Services
A
6+
points
B
4-‐5
points
C
2-‐3
points
F
≤
1
points
Only
37
states
were
analyzed,
scored
and
ranked
for
this
indicator.
Thirteen
states
and
D.C.
do
not
cover
rehabilitation
services
for
their
Medicaid
recipients.
Although
state
policies
vary
in
scope
and
application,
17
states
are
known
to
reimburse
for
telerehabilitative
services
in
their
Medicaid
plans.
Of
those,
11
states
rank
the
highest
with
telemedicine
coverage
for
therapy
services
(Figure
14).
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
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Page.
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FIGURE
14
–
Medicaid:
Rehabilitation
Services
Further,
of
the
25
states
that
cover
home
telemedicine,
only
Alaska,
Colorado,
Delaware,
Iowa,
Kentucky,
Maine,
Nebraska,
Nevada,
New
Mexico,
and
Tennessee
reimburse
for
telerehabilitative
services
within
the
home
health
benefit.
K. Home
Health
Services
One
well-‐proven
form
of
telemedicine
is
remote
patient
monitoring.
Remote
patient
monitoring
may
include
two-‐way
video
consultations
with
a
health
provider,
ongoing
remote
measurement
of
vital
signs
or
automated
or
phone-‐based
check-‐ups
of
physical
and
mental
well-‐being.
The
approach
used
for
each
patient
should
be
tailored
to
the
patient’s
needs
and
coordinated
with
the
patient’s
care
plan.
For
this
report,
we
measured
components
of
state
Medicaid
policies
that
broaden
or
restrict
the
types
of
providers
allowed
to
perform
the
telemedicine
encounter
and
services
covered
for
home
health
services.
Scale
–
Medicaid:
Home
Health
A
6+
points
B
4-‐5
points
C
2-‐3
points
F
≤
1
point
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
24
Alaska
is
the
only
state
with
the
highest
ranking
for
telemedicine
provided
services
under
the
home
health
benefit
(Figure
15).
FIGURE
15
–
Medicaid:
Home
Health
Services
Of
the
25
states
that
cover
home
telemedicine,
only
Alaska,
Colorado,
Delaware,
Iowa,
Kentucky,
Maine,
Nebraska,
Nevada,
New
Mexico,
and
Tennessee
reimburse
for
telerehabilitative
services
within
the
home
health
benefit.
Additionally,
Pennsylvania
is
the
only
state
that
will
cover
telemedicine
in
the
home
when
provided
by
a
caregiver.
Arizona
no
longer
covers
telemedicine
under
their
home
health
benefit.
Seventy
percent
of
the
country
ranked
the
lowest
with
failing
(F)
scores
due
to
a
lack
of
telemedicine
services
covered
under
the
home
health
benefit.
L. Informed
Consent
We
measured
components
of
state
Medicaid
and
medical
licensing
board
policies
that
apply
more
stringent
requirements
for
telemedicine
as
opposed
to
in-‐person
services.
States
were
evaluated
based
on
requirements
for
written
or
verbal
informed
consent,
or
unspecified
methods
of
informed
consent
before
a
telemedicine
encounter
can
be
performed.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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Association
2016
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Scale
–
Medicaid:
Informed
Consent
A
4
points
B
3
points
C
2
points
F
≤
1
point
FIGURE
16
–
Medicaid:
Informed
Consent
Of
the
27
states
with
informed
consent
requirements,
19
states
have
such
requirements
imposed
by
their
state
Medical
Board
(Figure
16).
Although
their
Medicaid
programs
do
not
cover
telehealth,
Rhode
Island
and
Connecticut’s
Medical
Boards
require
informed
consent.
M. Telepresenter
We
measured
components
of
state
Medicaid
and
medical
licensing
board
policies
that
apply
more
stringent
requirements
for
telemedicine
as
opposed
to
in-‐person
services.
States
were
evaluated
based
on
requirements
for
a
telepresenter
or
health
care
provider
on
the
premises
during
a
telemedicine
encounter.
Scale
–
Medicaid:
Telepresenter
A
3
points
B
2
points
C
1
point
F
0
points
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
26
FIGURE
17
–
Medicaid:
Telepresenter
Alabama,
Georgia,
Iowa,
Maryland,
Minnesota,
Missouri,
New
Jersey,
North
Carolina,
and
West
Virginia
only
require
a
health
care
provider
to
be
on
the
premises
and
not
physically
with
the
patient
during
a
telemedicine
encounter
(Figure
17).
Although
Connecticut
and
Rhode
Island
have
no
telemedicine
coverage
under
Medicaid,
their
Medical
Boards
do
not
require
a
telepresenter
for
telemedicine
related
services.
Innovative
Payment
or
Service
Delivery
Models
This
report
also
includes
a
category
to
capture
innovative
payment
and
service
delivery
models
implemented
in
each
state.
In
addition
to
state
supported
networks
in
specialty
care
and
correctional
health,
the
report
identifies
a
few
federally
subsidized
programs
and
waivers
that
states
have
leveraged
to
enhance
access
to
health
care
services
using
telemedicine.
Over
the
years,
states
have
increasingly
used
managed
care
organizations
(MCOs)
to
create
payment
and
delivery
models
involving
capitated
payments
to
provide
better
access
to
care
and
follow-‐up
for
patients,
and
also
to
control
costs.
The
variety
of
payment
methods
and
other
operational
details
among
Medicaid
managed
care
arrangements
is
a
useful
laboratory
for
devising,
adapting
and
advancing
long-‐term
optimal
health
delivery.
MCOs
experimenting
with
innovative
delivery
models
including
medical
homes
and
dual-‐eligible
coordination
have
incorporated
telemedicine
as
a
feature
of
these
models
especially
because
it
helps
to
reduce
costs
related
to
emergency
room
use
and
hospital
admissions.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
27
Twenty-‐four
states
authorize
telemedicine-‐provided
services
under
their
Medicaid
managed
care
plans.
Most
notably,
Massachusetts
and
New
Hampshire
offer
coverage
under
select
managed
care
plans
but
not
under
FFS.
The
federal
Affordable
Care
Act
(ACA)
offers
states
new
financing
and
flexibility
to
expand
their
Medicaid
programs,
as
well
as
to
integrate
Medicare
and
Medicaid
coverage
for
dually
eligible
beneficiaries
(“duals”).
Michigan,
New
York
and
Virginia
are
the
only
states
that
extend
coverage
of
telemedicine-‐provided
services
to
their
dual
eligible
population
through
the
Centers
for
Medicare
and
Medicaid
Services
(CMS)
Capitated
Financial
Alignment
Model
for
Medicare-‐Medicaid
Enrollees.6
The
ACA
also
includes
a
health
home
option
to
better
coordinate
primary,
acute,
behavioral,
and
long-‐term
and
social
service
needs
for
high-‐need,
high-‐cost
beneficiaries.
The
chronic
conditions
include
mental
health,
substance
use
disorder,
asthma,
diabetes,
heart
disease,
overweight
(body
mass
index
over
25),
and
other
conditions
that
CMS
may
specify.
Nineteen
states
have
approved
health
home
state
plan
amendments
(SPAs)
from
CMS.7
Alabama,
Iowa,
Maine,
New
York,
Ohio,
and
West
Virginia
are
the
only
states
that
have
incorporated
some
form
of
telemedicine
into
their
approved
health
home
proposals.
Medicaid
plans
have
several
options
to
cover
remote
patient
monitoring,
usually
under
a
federal
waiver
such
as
the
Home
and
Community-‐based
Services
(HCBS)
under
Social
Security
Act
section
1915(c).8
States
may
apply
for
this
waiver
to
provide
long-‐term
care
services
in
home
and
community
settings
rather
than
institutional
settings.
Kansas,
Pennsylvania,
and
South
Carolina
are
the
only
states
that
have
used
their
waivers
to
provide
telemedicine
to
beneficiaries
in
the
home,
specifically
for
the
use
of
home
remote
patient
monitoring.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
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State
Report
Cards
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
29
Telemedicine
in
Alabama
PARITY:
GAPS:
Private
Insurance
F
Medicaid9
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services10
B
Rehabilitation
N/A
Home
Health11
F
Informed
Consent
F
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home12
✔
HCBS
Waiver
Corrections
✔
Other13
✔
• AL
has
no
parity
law
and
is
bordered
by
GA,
MS,
and
TN
which
enacted
private
insurance
parity
laws.
Medicaid
• Limited
patient
settings
include
hospital,
physician’s
office,
FQHC,
CAH,
RHC,
CMHC.
The
home
is
recognized
as
an
originating
site
under
the
Health
Home
model
for
RPM
use
only.
• Eligible
providers
are
restricted
to
MDs/DOs,
PAs,
and
NPs
for
physician
and
mental
health
services.
• Requires
written
informed
consent
and
a
telepresenter
on
the
premises.
Innovation
• CMS
approved
Health
Home
program
based
off
of
the
successful
Patient
1st
medical
home
model
uses
home
health
nurses
employed
by
the
Department
of
Health
to
remotely
monitor
vital
signs
for
patients
with
diabetes,
hypertension,
and
congestive
heart
disease.
Although
the
use
of
RPM
was
approved
for
this
program,
there
is
no
mention
of
using
other
telemedicine
modalities.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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2016
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Telemedicine
in
Alaska
PARITY:
GAPS:
Private
Insurance
F
Medicaid15-‐21
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
A
Distance
or
Geography
Restrictions
A
Eligible
Providers
B
Physician-‐provided
Services
A
Mental/behavioral
Health
Services22-‐23
A
Rehabilitation24
A
Home
Health25
A
Informed
Consent
A
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
N/A
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
• AK
has
no
parity
law.
Medicaid
• Telemedicine
coverage
under
the
Medicaid
plan
is
broad
and
the
least
restrictive
compared
to
other
states.
However
not
all
benefits
are
covered
when
using
telemedicine,
thus
leaving
out
services
including
dental
and
ocular
care.
• Will
cover
services
when
delivered
using
dedicated
audio
conferencing
system.
• Alaska
Medicaid
covers
school-‐based
services
when
provided
via
telemedicine:
audiology,
behavioral
health,
nursing,
occupational
therapy,
physical
therapy,
and
speech-‐language
therapy.14
• Although
Medicaid
does
not
require
a
telepresenter
as
a
condition
of
payment,
the
state’s
Medical
Board
has
such
practice
standard
requirements.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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Association
2016
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Telemedicine
in
Arizona
PARITY:
GAPS:
Private
Insurance
C
Medicaid27-‐28
B
State
Employee
Health
Plan
C
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies29
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services30
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
B
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network31
✔
Medicaid
Managed
Care32
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
• Arizona’s
partial
parity
law
was
enacted
in
2013.
Coverage
under
private
and
state
employee
health
plans
applies
to
rural
areas
and
only
seven
health
services.26
Medicaid
• AZ
has
varying
service
coverage
under
its
Medicaid
FFS,
managed
care
plans,
and
Indian
Health
Service.
This
includes
echocardiography,
retinal
screening,
medical
nutrition
therapy
and
patient
education
for
diabetes
and
chronic
kidney
disease
care.
• The
agency
now
covers
teledentistry.
• The
eligible
distant
site
provider
and
patient
site
varies
according
to
the
participating
AHCCCS
program.
• Does
not
cover
for
the
use
of
RPM.
Innovation
• AZ
Telemedicine
Program
offers
clinical,
educational,
and
administrative
services
via
telemedicine
across
the
state.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
32
Telemedicine
in
Arkansas
PARITY:
GAPS:
Private
Insurance
F
Medicaid
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services33
C
Mental/behavioral
Health
Services34
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
A
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other35-‐36
✔
Progress
• Arkansas’s
parity
law
was
enacted
in
2015
and
includes
telemedicine
coverage
for
physician-‐
provided
services
under
private
insurance,
Medicaid,
and
state
employee
health
plans.
Effective
January
2016,
the
new
parity
law
will
affect
payment
for
physician
services.
This
is
the
only
telemedicine
parity
law
that
requires
an
in-‐person
encounter
as
a
condition
of
coverage
and
payment.
Medicaid
• Effective
January
2016,
the
new
parity
law
will
affect
payment
for
physician
services.
• Telemedicine
coverage
under
Medicaid
includes
limits
on
service
coverage,
frequency,
patient
settings
and
eligible
distant
site
providers.
• One
of
few
states
with
coverage
for
fetal
echography
and
echocardiography.
• Medicaid
also
places
frequency
limits
on
covered
telemedicine
services.
• Requires
a
telepresenter
at
the
originating
site.
• Coverage
for
interactive
audio-‐video
only.
Innovation
• Specialty
maternal-‐fetal
telemedicine
network
operated
by
University
of
Arkansas.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
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Telemedicine
in
California
PARITY:
GAPS:
Private
Insurance
A
Medicaid41-‐43
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies44-‐45
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services46
B
Rehabilitation
F
Home
Health
F
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network47
✔
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• One
of
few
Medicaid
programs
that
covers
teledentistry.
Private
Insurance
• California’s
private
insurance
parity
law
was
enacted
in
1996.37
Medicaid
• Coverage
for
interactive
audio-‐video
and
store-‐
and-‐forward
for
the
purposes
of
dermatology,
ophthalmology,
and
dentistry.
• Also
recognizes
OT,
PT,
speech
language
therapists,
and
audiologists
as
eligible
providers
of
telemedicine
but
offers
no
billing
details
for
rehabilitation
services
via
telehealth.
• 2014
law
allows
verbal
or
written
method
of
collection
to
satisfy
patient
informed
consent
requirements.38-‐40
Innovation
• California
Telehealth
Network
supports
broadband
connections
of
many
institutions
state-‐wide.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
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Telemedicine
in
Colorado
PARITY:
GAPS:
Private
Insurance
A
Medicaid52-‐53
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
B
Home
Health
C
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network54
✔
Medicaid
Managed
Care55
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Colorado
enacted
a
law
to
improve
the
existing
parity
law
and
remove
the
rural
restrictions.
Effective
2017,
the
state
will
have
state-‐wide
telehealth
parity
coverage
for
all
private
and
state
employee
health
plans
in
the
state.48
• Removed
rural
and
distance
restrictions
that
were
applied
under
Medicaid
managed
care.
Medicaid
• CO
Medicaid
imposes
restrictions
on
covered
services
and
designates
certain
provider
types
to
render
the
service.
• The
program
will
pay
certain
facilities
an
originating
site
but
that
does
not
limit
reimbursement
to
a
distant
site
provider
if
a
patient
is
located
elsewhere.
• Coverage
for
interactive
audio-‐video
only
for
physician,
mental/behavioral
health
services,
and
speech
therapy
services.
• Coverage
only
for
RPM
for
chronic
disease
management
under
the
home
health
benefit.49
-‐
51
• Requires
written
informed
consent.
Opportunities
• Colorado
Telehealth
Network
supports
broadband
connections
of
many
institutions
state-‐wide.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
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Telemedicine
in
Connecticut
PARITY:
GAPS:
Private
Insurance
A
Medicaid
F
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
F
Distance
or
Geography
Restrictions
F
Eligible
Providers
F
Physician-‐provided
Services
F
Mental/behavioral
Health
Services
F
Rehabilitation
N.A
Home
Health
F
Informed
Consent
N/A
Telepresenter
N/A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• CT
enacted
a
telemedicine
parity
law
for
private
insurance
coverage
in
2015.56
• Home
Health
workgroup
having
conversations
about
RPM
reimbursement
under
Medicaid57
Medicaid
• No
coverage
under
Medicaid
although
the
statute
authorizes
a
telemedicine
demonstration
for
beneficiaries
located
at
FQHCs.58
• The
agency
will
not
cover
information
or
services
provided
to
a
client
by
a
provider
electronically
or
over
the
telephone.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
36
Telemedicine
in
Delaware
PARITY:
GAPS:
Private
Insurance
A
Medicaid
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
B
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• DE
enacted
telemedicine
parity
law
introduced
in
2015.59
Medicaid
• Coverage
for
any
services
included
in
the
SPA
that
would
be
provided
in
a
face-‐to-‐face
setting
including
the
home.60
• Also
includes
coverage
under
school-‐based
program.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
37
Telemedicine
in
D.C.
PARITY:
GAPS:
Private
Insurance61
A
Medicaid62
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
N/A
Home
Health
C
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• DC
Medicaid
will
draft
and
publish
rulemaking
to
further
define
appropriate
billing
conditions
for
telemedicine
in
2016.
• D.C.
parity
law
was
enacted
in
2013
and
requires
coverage
for
telemedicine-‐provided
services
under
private
plans
and
Medicaid.
Medicaid
• The
law
requires
Medicaid
to
cover
and
reimburse
for
services
via
telemedicine
if
they
are
covered
in-‐person.
However,
provider
manuals
have
not
been
updated
to
reflect
the
current
law.
• No
explicit
coverage
of
store-‐and-‐forward
or
remote
patient
monitoring.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
38
Telemedicine
in
Florida
PARITY:
GAPS:
Private
Insurance
F
Medicaid64
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
F
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Proposed
regulations
to
expand
coverage
under
Medicaid63
Private
Insurance
• Bordered
by
GA
which
has
a
private
insurance
parity
law.
No
parity
legislation
introduced
in
2015.
Medicaid
• Covers
a
limited
number
of
services
provided
by
physicians,
NPs,
and
PAs.
• Originating
patient
sites
are
limited
to
hospitals
and
physician’s
office.
• Coverage
for
interactive
audio-‐video
only.
• Requires
written
informed
consent
and
telepresenter.
FL
Medicaid
has
transitioned
a
majority
of
their
beneficiaries
to
managed
care.
Therefore,
providers
have
more
flexibility
to
negotiate
coverage
for
telehealth-‐provided
services.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
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Telemedicine
in
Georgia
PARITY:
GAPS:
Private
Insurance
A
Medicaid67
C
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
C
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
F
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network68
✔
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• Georgia’s
parity
law
was
enacted
in
2006
which
includes
coverage
under
state-‐employee
health
plans.65
Medicaid
• Medicaid
imposes
restrictions
on
the
patient
settings,
covered
services
and
designates
eligible
distant
site
providers
and
provider
settings
as
a
condition
of
payment.
• Includes
school-‐based
clinic
as
an
originating
site.66
• Medicaid
also
places
frequency
limits
on
some
covered
telemedicine
services.
• Coverage
for
interactive
audio-‐video
only.
• Requires
written
informed
consent
and
provider
on
the
premises.
Innovation
• Georgia
Partnership
for
Telehealth
creates
and
provides
multi-‐point
web
access
to
new
and
existing
telemedicine
providers
all
over
the
state.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
40
Telemedicine
in
Hawaii
PARITY:
GAPS:
Private
Insurance69
A
Medicaid72
F
State
Employee
Health
Plan
B
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
C
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Hawaii’s
private
insurance
parity
law
was
enacted
in
1999.
In
2014,
the
Governor
approved
legislation
improving
the
existing
parity
law
with
requirements
for
payment
parity
and
inclusion
of
other
health
care
providers.70
• HI
self-‐funds
some
of
their
state
employee
health
plan
offerings
but
has
fully
insured
HMO.
The
parity
law
applies
to
those
plans
offered
under
the
HMO.71
Medicaid
• Coverage
for
telemedicine
under
Medicaid
is
about
average.
The
agency
imposes
restrictions
on
covered
services
and
is
limited
to
originating
sites
located
in
rural
areas.
• Medicaid
also
places
frequency
limits
on
some
covered
telemedicine
services.
• Coverage
for
interactive
audio-‐video
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
41
Telemedicine
in
Idaho
PARITY:
GAPS:
Private
Insurance
F
Medicaid74-‐76
F
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
C
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Medicaid
has
proposed
draft
regulations
that
would
enhance
coverage
for
physician-‐provided
services
as
well
as
OT,
PT,
and
speech.73
Private
Insurance
• Bordered
by
MT
and
OR
which
have
private
insurance
parity
laws.
No
telemedicine
parity
law
and
no
history
of
proposed
legislation
within
the
past
2
years.
Medicaid
• Covers
limited
physician-‐provided
mental
and
behavioral
health
services,
as
well
as
some
services
for
children
with
developmental
disabilities.
• Although
no
specific
patient
setting
is
specified,
coverage
is
limited
to
patients
located
in
rural
areas
or
outside
of
a
metropolitan
statistical
area.
• Coverage
for
interactive
audio-‐video
only.
• Requires
written
informed
consent.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
42
Telemedicine
in
Illinois
PARITY:
GAPS:
Private
Insurance
F
Medicaid81-‐83
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services84
B
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
✔
Progress
• In
2014,
IL
submitted
a
CMS
§1115
waiver
proposal
which
includes
the
development
of
a
statewide
specialty
telemedicine
network.
The
application
is
still
pending.77
• A
2014
law
prohibits
individual
and
group
accident
and
health
insurance
plans,
who
choose
to
cover
telemedicine,
from
requiring
in-‐person
contact.78
Private
Insurance
• Bordered
by
KY
and
MO
which
have
private
insurance
parity
laws.
No
telemedicine
parity
law.
In
2015,
SB
452
was
introduced
to
achieve
full
parity,
and
HB
76
to
include
telehealth
in
the
mental
health
parity
law.79
Medicaid
• Medicaid
imposes
restrictions
on
covered
services,
patient
settings,
and
distant
site
providers
but
includes
coverage
for
services
provided
by
local
education
agencies
(schools)
and
a
podiatrist.
• IL
Department
of
Aging
is
authorized
to
fund
older
adult
services
such
as
home
telemedicine
monitoring
devices.80
• Store-‐and-‐forward
allowed
for
dermatologic
purposes.
• Telepresenter
required.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
43
Telemedicine
in
Indiana
PARITY:
GAPS:
Private
Insurance
A
Medicaid88
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• IN
enacted
telemedicine
parity
law
in
2015
which
covers
private
insurance,
but
does
not
include
dental
or
vision
plans.85
• 2013
law
expanded
coverage
to
include
FQHCs,
RHCs,
CMHCs,
CAHs,
and
home
health
agencies86
Medicaid
• Rulemaking
maintains
20
mile
distance
limit
for
other
qualifying
health
facilities.
• Requires
at
least
one
in-‐person
follow-‐up
by
a
physician.
• Agency
issued
final
regulations
on
“telehealth”
coverage
under
the
home
health
benefit
including
remote
patient
monitoring
but
will
not
extend
telemedicine
coverage
under
the
benefit.87
• Coverage
for
interactive
audio-‐video
and
RPM,
yet
no
telehealth
coverage
for
skilled
nursing
or
other
home
health
benefits
such
as
rehab.
• Requires
written
informed
consent.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
44
Telemedicine
in
Iowa
PARITY:
GAPS:
Private
Insurance
F
Medicaid
A
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
B
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
✔
HCBS
Waiver
Corrections
Other
Progress
• IA
legislature
enacted
a
new
law
in
2015
that
ensures
telehealth
parity
under
Medicaid.
Agency
finalized
new
rules
that
enforce
parity
for
existing
covered
services.89-‐90
Private
Insurance
• Bordered
by
MO
which
has
a
private
insurance
parity
law.
No
law
for
telehealth
parity
under
private
insurance
or
state
employee
health
plans
despite
2015
legislation.91
Innovation
• IA’s
health
home
plan
will
provide
services
to
individuals
with
2
chronic
conditions
including
24/7
access
to
the
care
team
that
includes
but
is
not
limited
to
a
phone
triage
system
with
appropriate
scheduling
during/after
regular
business
hours
to
avoid
unnecessary
ER
visits
and
hospitalizations.
Use
of
email,
text
messaging,
patient
portals
and
other
technology
as
available
to
the
practice
to
communicate
with
patients
is
encouraged.92
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
45
Telemedicine
in
Kansas
PARITY:
GAPS:
Private
Insurance
F
Medicaid
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
B
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
✔
Corrections
✔
Other
Private
Insurance
• Bordered
by
CO,
MO,
and
OK
which
have
private
insurance
parity
laws.
No
telemedicine
parity
law.
Medicaid
• No
coverage
for
therapies
via
telemedicine
under
home
health
benefit.
Innovation
• Coverage
for
RPM
and
medication
management
available
through
approved
HCBS
waiver.93-‐94
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
46
Telemedicine
in
Kentucky
PARITY:
GAPS:
Private
Insurance
A
Medicaid96-‐97
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
B
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation98
A
Home
Health
C
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care99
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• Kentucky’s
private
insurance
parity
law
was
enacted
in
2000
and
also
includes
coverage
for
state
employee
health
plans.95
Medicaid
• Independent
rehabilitation
specialists
are
not
eligible
for
telemedicine
reimbursement
under
Medicaid
rules.
• Coverage
for
interactive
audio-‐video
only.
• Requires
written
informed
consent.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
47
Telemedicine
in
Louisiana
PARITY:
GAPS:
Private
Insurance
B
Medicaid105
B
State
Employee
Health
Plan
B
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
N/A
Home
Health
F
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• 2014
law
removed
licensing
boards’
ability
to
impose
telepresenter
requirements.100
• 2013
letter
from
the
Department
of
Health
and
Human
Services
indicated
a
need
to
change
and
clarify
policies
related
to
telemedicine
including
coverage
for
store-‐and-‐forward
and
RPM.101
• LA
Taskforce
created
by
legislature
to
study
telemedicine
opportunities
and
gaps
in
the
state.102
Private
Insurance
• Louisiana’s
private
insurance
parity
law
was
enacted
in
1995.
It
is
the
only
state
with
a
parity
law
that
specifies
coverage
of
telemedicine
when
provided
by
physicians
only.103
Medicaid
• Coverage
for
interactive
audio-‐video
only.
• LA
Medical
Board
requires
patient
informed
consent
but
does
not
specify
method
of
collection.104
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
48
Telemedicine
in
Maine
PARITY:
GAPS:
Private
Insurance
A
Medicaid110-‐111
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
B
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network112
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
✔
HCBS
Waiver
Corrections
✔
Other
Progress
• CMS
Approved
SPA
which
includes
originating
site
fees,
and
coverage
for
home
RPM
and
interprofessional
services
provided
by
a
consultative
physician.106
Private
Insurance
• Maine’s
parity
law
for
Medicaid
and
private
insurance
was
enacted
in
2009
and
also
includes
coverage
for
state
employee
health
plans.107
Medicaid
• No
limits
on
patient
setting,
covered
services,
or
eligible
providers.
• Coverage
for
interactive
audio-‐video
as
well
as
audio-‐only
under
certain
circumstances.
• Medicaid
released
a
draft
proposal
for
comment
to
expand
coverage
of
telemedicine
in
November
2015.108
Innovation
• Maine
Telemedicine
Services
is
an
open
and
interoperable
network
that
offers
clinical,
educational,
and
administrative
services
via
telemedicine
across
the
state.
Health
home
proposal
was
approved
by
CMS.
Model
includes
support
for
care
management/coordination
activities.
The
health
home
practice
and
community
care
team
will
have
the
option
of
utilizing
technology
conferencing
tools
including
audio,
video
and/or
web
deployed
solutions
to
support
care
management/coordination
activities.109
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
49
Telemedicine
in
Maryland
PARITY:
GAPS:
Private
Insurance
A
Medicaid116
C
State
Employee
Health
Plan
B
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
A
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• The
state
no
longer
has
2
distinct
telemedicine
programs
for
rural
patients
and
stroke/cardiovascular
services
for
Medicaid
coverage.113
Private
Insurance
• Maryland’s
private
insurance
parity
law
was
enacted
in
2012.114
• The
parity
law
also
applies
to
the
fully
insured
health
plan
offerings
for
Maryland’s
state
employees.
Medicaid
• MD
Medicaid
issued
new
rules
effective
October
2015.115
• Despite
having
statutory
authority
to
cover
and
reimburse
for
all
services
appropriately
provided
via
telemedicine
the
new
rules
place
limits
on
allowable
patient
settings
and
types
of
providers
who
may
render
and
get
reimbursed
for
telemedicine.
• The
state
no
longer
has
2
distinct
telemedicine
programs
for
rural
patients
and
stroke/cardiovascular
services.
Telemedicine
must
enable
the
patient
“to
see
and
interact”
with
the
health
care
provider.
The
agency
does
not
cover
RPM
or
store-‐and-‐forward.
Distant
site
and
originating
site
providers
must
have
formal
agreements
detailing
their
telemedicine
service
delivery
plan.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
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Telemedicine
Association
2016
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Telemedicine
in
Massachusetts
PARITY:
GAPS:
Private
Insurance
F
Medicaid
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health123
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
✔
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• MA
is
bordered
by
NH
and
VT
which
have
private
insurance
parity
laws.
No
telemedicine
parity
law
despite
a
number
of
bills
introduced
in
2015
to
achieve
parity
under
private
insurance,
Medicaid
and
state
employee
plans.117
Medicaid
• Offers
coverage
under
select
managed
care
plans
but
not
under
FFS.118-‐120
• Authorized
to
cover
remote
monitoring
for
home
health
agencies.
Rules
are
in
development
Innovation
• Received
grant
to
establish
a
National
Sexual
Assault
TeleNursing
Center
that
will
use
telemedicine
technology
to
provide
24/7,
365
day
remote
expert
consultation
by
24-‐25
MA
Sexual
Assault
Nurse
Examiners
(SANEs)
to
clinicians
caring
for
adult
and
adolescent
sexual
assault
patients
in
remote
and/or
underserved
regions
of
the
United
States.121
Partners
Telestroke
Network
–
members
receive
24-‐hour
acute
neurology/stroke
expertise-‐on-‐
demand.122
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
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51
Telemedicine
in
Michigan
PARITY:
GAPS:
Private
Insurance
B
Medicaid127-‐128
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
B
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
C
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
✔
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• Michigan’s
private
insurance
parity
law
was
enacted
in
2012.
MI
is
1
of
3
states
that
cover
interactive
audio-‐video
only
as
a
condition
of
their
parity
law.124
Medicaid
• Coverage
for
interactive
audio-‐video
only.
• Eliminated
distance
requirements
in
2013.
• Limits
on
covered
services
and
patient
settings,
but
the
agency
does
not
specify
the
types
of
practitioners
who
are
eligible
distant
site
providers.
• The
agency
covers
telepractice
for
speech-‐
language
and
audiology
services
provided
within
the
School
Based
Services
(SBS)
program
which
is
now
in
effect.125
Innovation
• CMS
approved
duals
proposal
includes
coverage
for
telemedicine.126
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
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Page.
52
Telemedicine
in
Minnesota
PARITY:
GAPS:
Private
Insurance
A
Medicaid132-‐133
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
B
Eligible
Technologies
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
B
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation134
A
Home
Health135
C
Informed
Consent
A
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Minnesota
enacted
a
telemedicine
parity
law
in
2015
for
private
insurers
and
state
employee
health
plans,
including
dental
and
joint
self
insured
plans.129
Medicaid
• New
policies
included
in
the
parity
law
impose
attestation
requirements
before
payment
is
made
for
telemedicine.
• Coverage
for
interactive
audio-‐video
and
store-‐
and-‐forward.
• Distant
site
provider
is
limited
to
a
menu
set
of
providers
including
OT,
PT,
and
speech
therapists,
and
audiologists.
Providers
are
not
required
to
be
located
in
a
medical
facility.
• Medicaid
also
places
frequency
limits
on
all
covered
telemedicine
services.
• MN
Medicaid
now
covers
dental
and
alcohol
and
substance
abuse
services
via
telemedicine
under
the
physician
services
benefit.
• Covers
skilled
nursing
and
cost
of
RPM
equipment
rental
under
home
health
benefit.
• Telepresenter
required
on
premises.
Innovation
Chemical
Dependency
Continuum
of
Care
Pilot
Project
implemented
in
2013
to
improve
access
to
treatment
and
recovery
support
for
alcohol
and
drug
abuse
services.130-‐131
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
53
Telemedicine
in
Mississippi
PARITY:
GAPS:
Private
Insurance
A
Medicaid
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
N/A
Home
Health
A
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• Mississippi’s
parity
law
was
enacted
in
2013.
The
law
requires
parity
for
telemedicine
under
private
insurance,
state
employee
health
plans,
and
public
assistance.136
In
2014,
lawmakers
passed
a
law
requiring
insurance
plans
to
cover
and
reimburse
for
services
via
store-‐and-‐forward
as
well
as
remote
patient
monitoring
for
chronic
disease
management.137
• Medicaid
places
no
restrictions
on
the
patient
setting
for
telemedicine
coverage,
but
will
only
pay
the
originating
site
fee
to
a
menu
set
of
facilities.138
Medicaid
• The
law
requires
Medicaid
to
cover
and
reimburse
for
services
via
telemedicine
including
store-‐and-‐forward
and
remote
patient
monitoring.
• CMS
approved
the
agency’s
SPA
to
limit
the
originating
site
fee
payment
to
a
provider’s
office,
outpatient
hospitals,
CAHs,
RHCs,
FQHCs,
CMHCs,
therapeutic
group
homes,
IHS
clinics,
and
school-‐based
clinics.139
• MS
Medical
Board
requires
unspecified
method
of
obtaining
patient’s
informed
consent.140
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
54
Telemedicine
in
Missouri
PARITY:
GAPS:
Private
Insurance
A
Medicaid144
C
State
Employee
Health
Plan145
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Providers
F
Physician-‐provided
Services
A
Mental/behavioral
Health
Services146-‐148
F
Rehabilitation
B
Home
Health
B
Informed
Consent
F
Telepresenter
F
Eligible
Providers
F
Physician-‐provided
Services
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network149
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• MO’s
private
insurance
parity
law
was
enacted
in
2013
and
included
coverage
for
state
employee
health
plans.141
Medicaid
• Coverage
for
telemedicine
under
Medicaid
is
about
average.
The
agency
imposes
restrictions
on
covered
services
and
designates
certain
patient
settings
(excluding
the
home
and
school)
and
eligible
distant
site
providers
(physicians,
advanced
registered
nurse
practitioners,
and
psychologists
as
a
condition
of
payment.
• Coverage
for
interactive
audio-‐video
only.
• Requires
written
informed
consent
and
telepresenter
on
premises.142
• A
number
of
bills
were
introduced
but
failed
passage
in
2015.
The
bills
would
have
expanded
telehealth
coverage
in
schools,
home,
as
well
as
home
RPM
and
store-‐and-‐forward.143
Innovation
• Missouri
Telehealth
Network
offers
clinical,
educational,
emergency
and
disaster
preparedness,
and
technical
assistance
via
telemedicine
across
the
state.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
55
Telemedicine
in
Montana
PARITY:
GAPS:
Private
Insurance
A
Medicaid151
C
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• MT’s
private
insurance
parity
law
was
enacted
in
2013
and
includes
coverage
for
state
employee
health
plans.150
Medicaid
• Coverage
for
telemedicine
under
Medicaid
is
about
average.
The
agency
imposes
restrictions
on
covered
services
when
provided
by
physicians
only.
• Coverage
for
interactive
audio-‐video
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
56
Telemedicine
in
Nebraska
PARITY:
GAPS:
Private
Insurance
F
Medicaid156-‐158
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services159
B
Mental/behavioral
Health
Services160
B
Rehabilitation
A
Home
Health
B
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
✔
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• 2015
legislation
introduced
to
highlight
telemedicine
providers
in
health
plan
provider
directories
but
no
parity
legislation.152
• CMS
approved
SPA
expands
Medicaid
telehealth
coverage
to
include
store-‐and-‐forward,
RPM,
home
health
services,
OT,
PT,
speech
and
audiology,
podiatry
and
optometric
services.153
Private
Insurance
• Bordered
by
CO
which
has
a
parity
law
for
private
insurance.
NE
does
not
have
a
parity
law.
• Private
insurance
and
state-‐employee
plans
require
coverage
of
autism
treatment
via
telemedicine.154
Innovation
Nebraska
Statewide
Telehealth
Network
is
a
state-‐wide
communications
network
that
supports
clinical,
educational,
and
administrative
services
via
telemedicine.155
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
57
Telemedicine
in
Nevada
PARITY:
GAPS:
Private
Insurance
A
Medicaid163
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
B
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• Nevada
enacted
a
telemedicine
parity
law
in
2015
which
affects
coverage
under
private
insurance,
Medicaid,
and
state
employee
health
plans.161
• Regulations
were
approved
in
2014
to
require
coverage
of
telemedicine
for
injured
employees
as
a
condition
of
workers
compensation.162
Medicaid
• Medicaid
removed
the
rural
only
restriction
and
now
covers
telemedicine
state-‐wide.
• Medicaid
also
places
frequency
limits
on
some
covered
telemedicine
services.
• Some
telemedicine
services
require
at
least
1
in-‐
person
visit.
• Coverage
for
interactive
audio-‐video
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
58
Telemedicine
in
New
Hampshire
PARITY:
GAPS:
Private
Insurance
A
Medicaid
F
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
C
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• NH’s
parity
law
was
enacted
in
2009
and
includes
coverage
under
state
employee
health
plans.164
Medicaid
• NH
enacted
legislation
that
includes
Medicaid
telehealth
coverage
language
similar
to
Medicare.165
• Offers
coverage
under
select
managed
care
plans
but
not
under
FFS.166-‐167
• Coverage
for
interactive
audio-‐video
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
59
Telemedicine
in
New
Jersey
PARITY:
GAPS:
Private
Insurance
F
Medicaid171
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
B
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• NJ
Individual
Health
Coverage
and
Small
Employer
Health
Benefits
Programs
approved
new
language
in
2015
to
cover
“telemedicine”,
“e-‐visits”,
and
“virtual
visits”
under
individual
health
and
small
employer
plans.168-‐169
Private
Insurance
• No
telemedicine
parity
law.
2015
legislation
introduced
to
provide
parity
under
private
insurance,
managed
care
plans
and
state
employee
plans.170
Medicaid
• Authorized
coverage
of
telemedicine-‐provided
services
for
the
first
time
in
December
2013.
Coverage
offered
under
managed
care
plans
but
not
FFS.
• Coverage
for
telepsychiatry
only
by
psychiatrist
or
psychiatric
advance
nurse
practitioner.
• Patient
setting
must
be
a
mental
health
clinic
or
outpatient
hospital.
• Coverage
for
interactive
audio-‐video
only.
Medicaid
requires
telepresenter
on
premises
and
unspecified
method
of
obtaining
patient
informed
consent.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
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Telemedicine
in
New
Mexico
PARITY:
GAPS:
Private
Insurance
A
Medicaid174
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services175
A
Rehabilitation176
A
Home
Health
B
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network177
✔
Medicaid
Managed
Care178-‐179
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• NM’s
parity
law
was
enacted
in
2013.172
Medicaid
• True
parity
under
NM
Medicaid
for
FFS
and
managed
care
plans.
All
services
are
covered
via
telemedicine
including
school-‐based,
dental,
home
health,
hospice,
and
rehabilitation.173
• 1
of
3
states
with
coverage
for
services
provided
by
a
behavioral
analyst.
These
specialists
are
critical
for
the
treatment
of
autism
spectrum
disorders.
• No
limits
on
patient
setting.
• No
coverage
for
phone
calls
or
remote
patient
monitoring.
• No
coverage
for
skilled
nursing,
therapies,
or
RPM
under
home
health
benefit.
Innovation
New
Mexico
Telehealth
Alliance
offers
technical
and
program
support
to
ensure
coordinated
services
via
telemedicine
across
the
state.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
61
Telemedicine
in
New
York
PARITY:
GAPS:
Private
Insurance
C
Medicaid185
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services186
C
Mental/behavioral
Health
Services
C
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care187
✔
Medicare-‐Medicaid
Dual
Eligibles
✔
Health
Home
✔
HCBS
Waiver
Corrections
Other
Progress
• New
York
parity
law
enacted
in
2014
and
amended
in
2015.
The
law
requires
telehealth
parity
under
private
insurance,
Medicaid,
and
state
employee
health
plans.
The
law
does
restrict
the
patient
setting
as
a
condition
of
payment.180-‐181
Medicaid
• The
new
law
authorizes
Medicaid
to
cover
telehealth
via
interactive
audio-‐video,
store-‐and-‐
forward,
and
home
remote
patient
monitoring.182
• Restrictions
are
placed
on
the
patient
settings
and
types
of
providers
eligible
to
render
the
service
and
reimburse.
• Speech
language
pathologist
and
audiologist
are
covered
under
the
new
law.
Innovation
• CMS
approved
duals
proposal
includes
coverage
for
telemedicine.183
CMS
approved
health
home
proposal
gives
provider
the
option
to
use
technology
conferencing
tools
including
audio,
video
and/or
web
deployed
solutions
to
support
care
management/coordination
activities.184
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
62
Telemedicine
in
North
Carolina
PARITY:
GAPS:
Private
Insurance
F
Medicaid190
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
A
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• Bordered
by
GA
and
VA
which
have
private
insurance
parity
laws.
No
telemedicine
parity
law.
Legislation
introduced
and
failed
passage
in
2015
which
would
have
establish
telehealth
parity
for
all
health
insurers
in
the
state.188
Medicaid
• Medicaid
imposes
restrictions
on
the
patient
settings,
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
• Coverage
for
interactive
audio-‐video
only,
but
does
not
permit
the
use
of
“video
cell
phones”.
• Requires
a
provider
to
be
on
the
premises
with
the
patient.
Innovation
• State-‐wide
telepsychiatry
network.189
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
63
Telemedicine
in
North
Dakota
PARITY:
GAPS:
Private
Insurance
F
Medicaid193
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
B
Home
Health
F
Informed
Consent
A
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• HB
1038
was
enacted
in
2015
to
establish
telemedicine
parity
for
state
employee
health
plans.191
Private
Insurance
• Bordered
by
MT
which
has
a
private
insurance
parity
law.
No
telemedicine
parity
law
for
private
insurance.
Medicaid
• Medicaid
imposes
restrictions
on
the
patient
settings
and
covered
services
as
a
condition
of
payment.
• Includes
coverage
for
speech
therapy.
• Coverage
for
interactive
audio-‐video
and
RPM
under
the
home
health
benefit.192
Non-‐home
health
services
require
a
telepresenter.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
64
Telemedicine
in
Ohio
PARITY:
GAPS:
Private
Insurance
F
Medicaid
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
B
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
B
Home
Health
F
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
✔
HCBS
Waiver
Corrections
✔
Other
Private
Insurance
• No
telemedicine
parity
law.
SB
32
introduced
in
2015
to
establish
telehealth
parity
under
private
insurance
and
Medicaid.194
Medicaid
• New
Medicaid
regulations
expand
telemedicine
coverage
to
include
consultations
by
physicians
and
a
limited
selection
of
practitioners.
The
new
rules
also
requires
that
the
distant
and
originating
site
be
at
least
5
miles
away.195-‐196
• Coverage
also
includes
school-‐based
speech
therapy,
behavioral
health
counseling
and
therapy,
mental
health
assessment,
pharmacological
management,
and
community
psychiatric
supportive
treatment
service
via
interactive
audio-‐video
only.197
• Medicaid
allows
beneficiaries
to
choose
the
patient
location
when
telemedicine
is
used
for
some
mental/behavioral
health
services.
• Requires
written
informed
consent
for
mental
and
behavioral
health
services.
Innovation
• CMS
approved
health
home
proposal
allows
service
delivery
via
in-‐person,
by
telephone,
or
by
video
conferencing.198
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
65
Telemedicine
in
Oklahoma
PARITY:
GAPS:
Private
Insurance
A
Medicaid
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
N/A
Home
Health
F
Informed
Consent
F
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• Medicaid
regulations
updated
in
2015
which
removed
the
originating
site
and
geography
restrictions
as
well
as
expanded
coverage
to
include
other
services.199
Private
Insurance
• OK’s
private
insurance
parity
law
was
enacted
in
1997.200
Medicaid
• Coverage
for
interactive
audio-‐video
only.
• Medicaid
requires
written
informed
consent
from
patient
before
a
telemedicine
encounter
and
a
telepresenter.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
66
Telemedicine
in
Oregon
PARITY:
GAPS:
Private
Insurance
B
Medicaid203
B
State
Employee
Health
Plan
B
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• 2015
legislation
enacted
to
include
telemedicine
parity
for
self-‐insured
state
employee
health
plans
and
remove
originating
site
restrictions
from
existing
parity
law.201
Private
Insurance
• Oregon’s
private
insurance
parity
law
was
enacted
in
2009.
OR
is
1
of
3
states
that
cover
interactive
audio-‐video
only
as
a
condition
of
their
parity
law.202
Medicaid
• Medicaid
imposes
restrictions
on
the
covered
services.
Allows
coverage
for
interactive
audio-‐video,
telephone,
and
online/e-‐mail
consultations.
Medicaid
will
also
cover
store-‐and-‐forward
when
used
in
lieu
of
video
conferencing.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
67
Telemedicine
in
Pennsylvania
PARITY:
GAPS:
Private
Insurance
F
Medicaid206
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services207
B
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
C
Informed
Consent
B
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
✔
Corrections
Other
Private
Insurance
• Bordered
by
MD
and
NY
which
have
private
insurance
parity
laws.
2015
legislation
introduced
to
establish
telemedicine
parity
for
private
insurance.204
Medicaid
• Medicaid
imposes
restrictions
on
the
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
• PA
offers
a
number
of
telemedicine
modalities
in
the
home
of
qualified
beneficiaries
including
sensors,
medication
management,
and
RPM
under
a
CMS
HCBS
waiver.
This
waiver
expires
in
2018.205
• Coverage
for
interactive
audio-‐video
only
for
physician
and
mental
health
services.
• Requires
written
informed
consent
and
a
telepresenter.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
68
Telemedicine
in
Rhode
Island
PARITY:
GAPS:
Private
Insurance
F
Medicaid
F
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
F
Eligible
Technologies
F
Distance
or
Geography
Restrictions
F
Eligible
Providers
F
Physician-‐provided
Services
F
Mental/behavioral
Health
Services
F
Rehabilitation
N/A
Home
Health
F
Informed
Consent
N/A
Telepresenter
N/A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• No
telemedicine
parity
law
despite
a
multi-‐year
effort
to
introduce
legislation
regarding
coverage
under
private
insurance
and
Medicaid.208
Medicaid
No
coverage
for
telemedicine
under
Medicaid
plans.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
69
Telemedicine
in
South
Carolina
PARITY:
GAPS:
Private
Insurance
F
Medicaid212
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
N/A
Home
Health
F
Informed
Consent
A
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
✔
Corrections
Other
✔
Private
Insurance
• Bordered
by
GA
which
has
a
parity
law.
No
telemedicine
parity
legislation
introduced
in
2015.
Medicaid
• Medicaid
imposes
restrictions
on
the
covered
services,
patient
settings
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
• Coverage
for
interactive
audio-‐video
only
and
RPM
for
chronic
disease
management
in
the
home
under
their
HCBS
waiver.
This
waiver
expires
in
2016.209
• Medicaid
requires
a
telepresenter
for
all
audio-‐
video
related
telemedicine
encounters.
Innovation
• State-‐wide
telepsychiatry
network.210
OB/GYN
Telemedicine
demonstration
project
went
into
effect
in
July
2014.
The
project
will
leverage
telemedicine
to
enhance
access
to
obstetric
and
gynecological
services
for
women
in
four
rural
counties.211
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
70
Telemedicine
in
South
Dakota
PARITY:
GAPS:
Private
Insurance
F
Medicaid214
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health215
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
✔
Private
Insurance
• Bordered
by
MT
which
has
a
parity
law.
No
history
of
proposed
legislation
within
the
past
2
years.
Medicaid
• Coverage
for
telemedicine
under
Medicaid
is
above
average.
The
agency
imposes
restrictions
on
the
patient
settings,
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
• SD
Medicaid
no
longer
includes
phone
calls
and
store-‐and-‐forward
under
its
telemedicine
definition.
Coverage
for
interactive
audio-‐video
and
RPM
only.
Innovation
• Received
grant
from
US
Bureau
of
Justice
Assistance
to
implement
a
telehealth
drug
treatment
program
for
nonviolent
offenders.213
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
71
Telemedicine
in
Tennessee
PARITY:
GAPS:
Private
Insurance
A
Medicaid
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
A
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
B
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• TN
parity
law
enacted
in
2014
which
includes
telemedicine
coverage
for
Medicaid,
including
managed
care
plans,
and
state
employee
health
plans.216
Medicaid
• Parity
law
goes
into
effect
2015.
It
does
limit
coverage
to
specific
patient
settings
and
includes
telemedicine
when
provided
to
schools
and
the
home
under
the
home
health
benefit.
Most
of
the
state’s
Medicaid
program
operates
under
managed
care.
• Home
health
does
not
include
coverage
for
RPM
under
new
parity
law.
• Coverage
for
interactive
audio-‐video
and
store-‐
and-‐forward.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
72
Telemedicine
in
Texas
PARITY:
GAPS:
Private
Insurance
A
Medicaid219
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
B
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health220
F
Informed
Consent
B
Telepresenter
C
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• Legislation
enacted
that
recognizes
schools
as
an
originating
site
for
telemedicine
covered
services
under
Medicaid.217
Private
Insurance
• TX
private
insurance
parity
law
enacted
in
1997
and
also
includes
coverage
for
state
employee
health
plans.218
Medicaid
• Two
distinct
definitions
of
telemedicine
vs.
telehealth.
• Originating
site
includes
established
medical
health
site
and
state
mental
health
facility,
which
excludes
the
home.
• Patients
must
receive
an
in-‐person
evaluation
for
the
same
diagnosis
or
condition
being
rendered
via
telemedicine.
Patients
with
mental
health
diagnoses
or
conditions
are
exempt
from
this
requirement
if
the
purpose
of
telemedicine
is
to
screen
and
refer
for
additional
services.
In
order
to
continue
receiving
telemedicine
services,
the
patient
must
have
an
in-‐person
evaluation
at
least
once
within
the
12
months
before
receiving
telemedicine.
• Coverage
for
interactive
audio-‐video
only
as
well
as
RPM
for
home
health
agencies
and
hospitals.
Requires
written
informed
consent
and
a
telepresenter
during
the
telemedicine
encounter.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
73
Telemedicine
in
Utah
PARITY:
GAPS:
Private
Insurance
F
Medicaid225
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
A
Mental/behavioral
Health
Services226
B
Rehabilitation
F
Home
Health
C
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Medicaid
issued
a
notice
in
2015
clarifying
CMS
guidance
on
telemedicine
coverage.
UT
will
cover
physician
and
NP
services
delivered
via
telemedicine.
However
non-‐medical
mental
and
behavioral
health
providers
are
not
included
in
this
coverage.221
Private
Insurance
• Bordered
by
AZ
and
CO
which
have
parity
laws
for
private
insurance.
UT
has
no
history
of
proposed
parity
legislation
within
the
past
2
years.
Medicaid
• No
restrictions
imposed
on
patient
or
provider
settings
• Coverage
for
skilled
nursing
services
and
medication
management
under
the
skilled
nursing
home
telemedicine
pilot.222-‐223
• Coverage
for
interactive
audio-‐video
only.
Innovation
• Utah
Telehealth
Network
offers
clinical,
educational,
and
administrative
services
via
telemedicine
across
the
state.224
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
74
Telemedicine
in
Vermont
PARITY:
GAPS:
Private
Insurance
C
Medicaid229
B
State
Employee
Health
Plan
C
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
A
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
A
Rehabilitation
A
Home
Health
F
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
✔
Other
Progress
• 2015
Legislation
enacted
which
removes
facility
restrictions
from
Medicaid
coverage
of
telemedicine-‐provided
services.
New
law
also
allows
coverage
of
telemedicine
primary
care
services
in
the
home.227
Private
Insurance
• VT’s
parity
law
was
enacted
in
2012.
It
includes
telemedicine
coverage
for
state
employee
health
plans.228
• VT
is
1
of
3
states
that
cover
interactive
audio-‐
video
only
as
a
condition
of
their
parity
law.
• Although
the
law
does
not
require
coverage
of
services
via
store-‐and-‐forward,
it
does
require
informed
consent
from
any
patient
receiving
teledermatology
and
teleophthalmology
via
store-‐and-‐forward.
• The
parity
law
also
limits
telemedicine
coverage
to
services
provided
in
health
care
facilities
only.
Medicaid
• Coverage
for
interactive
audio-‐video
and
home
RPM.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
75
Telemedicine
in
Virginia
PARITY:
GAPS:
Private
Insurance
A
Medicaid235
B
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services236-‐
237
B
Mental/behavioral
Health
Services
B
Rehabilitation
B
Home
Health
F
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network238
✔
Medicaid
Managed
Care239
✔
Medicare-‐Medicaid
Dual
Eligibles240
✔
Health
Home
HCBS
Waiver
Corrections241
✔
Other
Private
Insurance
• VA’s
parity
law
was
enacted
in
2010
and
includes
coverage
for
telemedicine
under
private
insurance
and
self-‐funded
state
employee
health
plans.230
Medicaid
• Coverage
for
telemedicine
under
Medicaid
extends
to
managed
care
plans
as
well.
The
agency
imposes
restrictions
on
the
patient
setting.
• Medicaid
restrictions
on
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
However
Virginia
is
1
of
3
states
that
includes
specific
coverage
of
obstetric
and
gynecological
services
including
ultrasounds.231
• Covers
speech-‐language
therapy
under
its
school-‐based
program.232-‐234
• Coverage
for
interactive
audio-‐video
and
store-‐
an-‐forward
for
diabetic
retinopathy
and
dermatological
services.
Innovation
• CMS
approved
VA
plan
to
waive
Medicare
telemedicine
statutory
restrictions
(1834m)
for
dual
eligible
population
(Commonwealth
Coordinated
Care).
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
76
Telemedicine
in
Washington
PARITY:
GAPS:
Private
Insurance
A
Medicaid246
A
State
Employee
Health
Plan
A
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
B
Eligible
Technologies
C
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health247
C
Informed
Consent
F
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Progress
• Washington’s
parity
law
was
enacted
in
2015
and
provides
coverage
for
all
essential
health
benefits
offered
by
private
insurance,
state
employee
health
plans,
and
Medicaid
managed
care.242
Medicaid
• The
new
parity
law
which
goes
into
effect
2017
will
impact
Medicaid
managed
care
and
not
FFS
plan
offerings.
• New
SPA
approved
by
CMS
adds
the
home
and
school
to
list
of
eligible
originating
sites.
It
also
expands
the
list
of
providers
who
may
render
services
including
dentists
and
a
number
of
mental
and
behavioral
health
providers.
The
Medicaid
program
manual
has
not
been
updated
to
reflect
this
emergency
rulemaking.243
• Medicaid
restrictions
on
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
However
Washington
is
1
of
3
states
that
covers
services
provided
by
behavioral
analysts
which
are
critical
to
the
treatment
of
autism
spectrum
disorders.
The
regulations
were
amended
earlier
this
year
to
allow
this
expansion.244
• Coverage
for
interactive
audio-‐video
as
and
RPM
under
the
home
health
benefit.245
Written
informed
consent
required.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
77
Telemedicine
in
West
Virginia
PARITY:
GAPS:
Private
Insurance
F
Medicaid248
F
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
C
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services249-‐250
A
Rehabilitation
F
Home
Health
F
Informed
Consent
B
Telepresenter
B
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care251
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home252
HCBS
Waiver
Corrections
Other
Private
Insurance
• WV
is
bordered
by
two
states
with
private
insurance
parity
laws:
Kentucky
and
Virginia.
No
parity
legislation
introduced
in
2015.
Medicaid
• Coverage
is
limited
to
originating
sites
located
in
non-‐metropolitan
professional
shortage
areas
for
services
listed
under
the
physician
benefit.
This
restriction
does
not
apply
to
telemedicine
services
provided
under
the
mental
and
behavioral
health
benefit.
In
fact
WV
Medicaid
encourages
providers
to
use
telemedicine
to
enhance
access
to
mental
and
behavioral
health
services.
• Coverage
for
interactive
audio-‐video
only.
• Managed
care
plan
covers
weight
management
services
including
preventative
medicine
counseling
and
individual
and
group
exercise
classes
with
nutritional
counseling.
Only
state
to
allow
exercise
physiologists
and
certified
trainers
as
eligible
distant
site
providers.
Requires
telepresenter
on
patient
site
premises
and
unspecified
form
of
consent
only
for
behavioral
health
services.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
78
Telemedicine
in
Wisconsin
PARITY:
GAPS:
Private
Insurance
F
Medicaid253
B
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
A
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
F
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
F
Home
Health
F
Informed
Consent
B
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network
Medicaid
Managed
Care
✔
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• No
telemedicine
parity
law
and
no
history
of
proposed
legislation
within
the
past
2
years.
Medicaid
• Coverage
for
telemedicine
under
Medicaid
includes
fee-‐for-‐service
and
managed
care
plans.
The
agency
imposes
no
restrictions
on
the
patient
setting
or
originating
site
and
defers
to
the
universal
place
of
service
(POS)
used
by
most
payors.
This
list
includes
the
home
and
schools.
• Medicaid
imposes
restrictions
on
covered
services
and
designates
eligible
distant
site
providers
as
a
condition
of
payment.
• Medicaid
requires
informed
consent
from
the
patient
but
does
not
specify
how
the
consent
should
be
obtained.
• Coverage
for
interactive
audio-‐video
only.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
79
Telemedicine
in
Wyoming
PARITY:
GAPS:
Private
Insurance
F
Medicaid254
C
State
Employee
Health
Plan
F
MEDICAID
SERVICE
COVERAGE
&
CONDITIONS
OF
PAYMENT:
Patient
Setting
C
Eligible
Technologies
F
Distance
or
Geography
Restrictions
A
Eligible
Providers
C
Physician-‐provided
Services
B
Mental/behavioral
Health
Services
B
Rehabilitation
B
Home
Health
F
Informed
Consent
A
Telepresenter
A
INNOVATIVE
PAYMENT
OR
SERVICE
DELIVERY
MODELS:
State-‐wide
Network255
✔
Medicaid
Managed
Care
Medicare-‐Medicaid
Dual
Eligibles
Health
Home
HCBS
Waiver
Corrections
Other
Private
Insurance
• No
telemedicine
parity
law
and
no
history
of
proposed
legislation
within
the
past
2
years.
Medicaid
• Coverage
for
telemedicine
under
Medicaid
is
about
average.
The
agency
imposes
restrictions
on
covered
services
and
designates
certain
patient
settings
(excluding
the
home
and
school)
and
eligible
distant
site
providers
as
a
condition
of
payment.
• One
of
few
states
with
coverage
for
services
provided
by
substance
abuse/addiction
specialist.
• Covers
nutrition
patient
education
and
speech
therapy.
• Coverage
for
interactive
audio-‐video
only.
• No
coverage
for
telemedicine
under
the
home
health
benefit.
Innovation
Wyoming
Telehealth
Consortium
offers
provider
registry
and
informational
resources
to
assist
providers
in
adopting
telemedicine.
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
80
Appendix
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
81
State
Ratings
–
Parity
Laws
for
Private
Insurance
Coverage
of
Telemedicine
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
82
State
Ratings
–
Medicaid
Policies
for
Telemedicine
Coverage
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
83
State
Ratings
–
State
Employee
Health
Plan
Laws
for
Telemedicine
Coverage
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
84
State
Ratings
–
Medicaid
Patient
Setting
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
85
State
Ratings
–
Medicaid
Eligible
Technologies
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
86
State
Ratings
–
Medicaid
Distance
or
Geography
Restrictions
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
87
State
Ratings
–
Medicaid
Eligible
Providers
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
88
State
Ratings
–
Medicaid
Physician-‐provided
Telemedicine
Services
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
89
State
Ratings
–
Medicaid
Mental
and
Behavioral
Health
Services
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
90
State
Ratings
–
Medicaid
Rehabilitation
Services
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
91
State
Ratings
–
Medicaid
Home
Health
Services
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
92
State
Ratings
–
Medicaid
Informed
Consent
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
93
State
Ratings
–
Medicaid
Telepresenter
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
94
References
1
Thomas,
L.
&
Capistrant,
G.
American
Telemedicine
Association.
“State
Telemedicine
Gaps
Analysis”
September
2014.
2
ATA
State
Policy
Toolkit,
2015.
3
215
ILCS
5/356z.22;
http://www.ilga.gov/legislation/ilcs/documents/021500050K356z.22.htm
4
MCL
Ch.
175
section
47BB;
https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47BB
5
Medicaid
Benefits
-‐
Physical
Therapy
and
Other
Services.
Kaiser
Family
Foundation.
2012.
6
CMS
tests
models
with
States
to
better
align
the
financing
of
Medicare
and
Medicaid
programs
and
integrate
primary,
acute,
behavioral
health
and
long-‐term
services
and
supports
for
their
Medicare-‐Medicaid
enrollees.
For
the
Capitated
Model,
a
state,
CMS,
and
a
health
plan
enter
into
a
three-‐way
contract,
and
the
plan
receives
a
prospective
blended
payment
to
provide
comprehensive,
coordinated
care;
http://www.cms.gov/Medicare-‐
Medicaid-‐Coordination/Medicare-‐and-‐Medicaid-‐Coordination/Medicare-‐Medicaid-‐Coordination-‐
Office/FinancialAlignmentInitiative/CapitatedModel.html
7
Medicaid.gov,
2015;
https://www.medicaid.gov/state-‐resource-‐center/medicaid-‐state-‐technical-‐
assistance/health-‐homes-‐technical-‐assistance/downloads/hh-‐map_v51
8
Medicaid.gov,
2015;
http://www.medicaid.gov/Medicaid-‐CHIP-‐Program-‐Information/By-‐Topics/Waivers/Home-‐
and-‐Community-‐Based-‐1915-‐c-‐Waivers.html
9
AL
Medicaid
Management
Information
System
Provider
Manual,
Chapter–28
Physicians,
p.
17;
http://medicaid.alabama.gov/CONTENT/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2015/6.7.1.2_April_
2015.aspx
10
AL
Medicaid
Management
Information
System
Provider
Manual,
Chapter–105
Rehabilitative
Services:
DHR,
DYS,
DPH,
DMH,
p.
11;
http://medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2015/6.7.1.2_Apri
l_2015/Apr15_105
11
AL
Medicaid
Management
Information
System
Provider
Manual,
Chapter–39
Patient
1st
Billing
Manual,
p.
32;
http://medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2015/6.7.1.2_Apri
l_2015/Apr15_39
12
AL
Medicaid
Agency,
Amendment
to
Alabama
State
Plan
for
Medical
Assistance
(PN-‐11-‐10),
May
2011;
http://www.alabamaadministrativecode.state.al.us/UpdatedMonthly/AAM-‐MAY-‐11/MISC.PDF
13
AL
Medicaid
Patient
1st
In-‐Home
Monitoring
Program;
January
2011;
http://medicaid.alabama.gov/documents/4.0_Programs/4.4_Medical_Services/4.4.10_Patient_1st/4.4.10_In_Hom
e_Monitoring_Revised_1-‐24-‐11
14
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–School-‐Based
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/sbs/sbs.htm
15
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
I:
Physician,
Advanced
Nurse
Practitioner
&
Physician
Assistant
Services;
http://manuals.medicaidalaska.com/physician/physician.htm
16
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Podiatry
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/podiatry/podiatry.htm
17
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Early
and
Periodic
Screening,
Diagnosis
and
Treatment
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/epsdt/epsdt.htm
18
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Tribal
Facility
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/tribal/tribal.htm
19
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Hospice
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/docs/dnld/BillingManual_Hospice
20
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Nutrition
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/docs/dnld/BillingManual_Nutrition
21
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Chiropractor
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/docs/dnld/BillingManual_Chiropractic
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
95
22
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Community
Behavioral
Health
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/cbhs/cbhs.htm
23
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telemental
and
Behavioral
Health.
August
2013;
http://www.americantelemed.org/docs/default-‐source/policy/ata-‐best-‐practice-‐-‐-‐telemental-‐and-‐
behavioral-‐health ?sfvrsn=10
24
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Therapy
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/therapies/therapies.htm
25
Alaska
Medical
Assistance
Provider
Billing
Manual,
Section
II–Home
Health
Services,
Policies
and
Procedures;
http://manuals.medicaidalaska.com/docs/dnld/BillingManual_HomeHealth
26
ARS
20-‐841.09;
http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/20/00841-‐
09.htm&Title=20&DocType=ARS
27
AZ
Health
Care
Cost
Containment
System,
AHCCCS
Fee-‐For-‐Service
Provider
Manual,
Chapter–10
Professional
and
Technical
Services,
p.
41;
http://www.azahcccs.gov/commercial/Downloads/FFSProviderManual/FFS_Chap10
28
AHCCCS
Telehealth
Training
Manual;
http://www.azahcccs.gov/commercial/Downloads/IHS-‐
TribalManual/IHSTelehealthTrainingManual
29
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Store
and
Forward
Telemedicine.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐store-‐and-‐forward-‐
telemedicine ?sfvrsn=10
30
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telestroke.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐
telestroke ?sfvrsn=8
31
Arizona
Telemedicine
Program;
http://telemedicine.arizona.edu/
32
AHCCCS
Medical
Policy
Manual,
Chapter
300-‐Medical
Policy
for
Covered
Services,
p.21;
http://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/Chap300
33
Arkansas
Medicaid,
Physician/Independent
lab/CRNA/Radiation
Therapy
Center-‐Section
II,
p.
34;
https://www.medicaid.state.ar.us/Download/provider/provdocs/Manuals/PHYSICN/PHYSICN_II
34
Arkansas
Medicaid,
Rehabilitative
Services
for
Persons
with
Mental
Illness-‐Section
II,
p.
14;
https://www.medicaid.state.ar.us/InternetSolution/Provider/docs/rspmi.aspx
35
University
of
Arkansas
for
Medical
Sciences
–
ANGELS
Program;
http://angels.uams.edu/
36
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telehealth
for
High-‐risk
Pregnancy.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐telehealth-‐for-‐
high-‐risk-‐pregnancy ?sfvrsn=6
37
CA
Insurance
Code
Sec.
10110
-‐
10127.19;
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS§ionNum=10123.85
38
AB
1310;
http://www.leginfo.ca.gov/cgi-‐bin/postquery?bill_number=ab_1310&sess=1314&house=A
39
AB
1771;
http://www.leginfo.ca.gov/cgi-‐bin/postquery?bill_number=ab_1771&sess=1314&house=A
40
AB
1174;
http://www.leginfo.ca.gov/cgi-‐bin/postquery?bill_number=ab_1174&sess=1314&house=A
41
CA
Department
of
Health
Care
Services,
Medi-‐Cal
Part
2
General
Medicine
Manual,
Telehealth,
http://files.medi-‐
cal.ca.govpublications/masters-‐mtp/part2/mednetele_m01o03
42
Department
of
Health
Care
Services
(DHCS),
Telehealth
Billing
Recorded
Webinar,
September
2013.
43
CA
Welfare
and
Institutions
Code
Sec.
14132.72;
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14132.72.
44
CA
Welfare
and
Institutions
Code
Sec.
14132.725;
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14132.725.
45
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Store
and
Forward
Telemedicine.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐store-‐and-‐forward-‐
telemedicine ?sfvrsn=10
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
96
46
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telemental
and
Behavioral
Health.
August
2013;
http://www.americantelemed.org/docs/default-‐source/policy/ata-‐best-‐practice-‐-‐-‐telemental-‐and-‐
behavioral-‐health ?sfvrsn=10
47
California
Telehealth
Network;
http://www.caltelehealth.org/
48
CO
Revised
Statutes
10-‐16-‐123
49
10
CCR
2505-‐10.15
50
CO
Revised
Statutes
25.5-‐5-‐321
51
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Remote
Patient
Monitoring
and
Home
Video
Visits.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐
remote-‐patient-‐monitoring-‐and-‐home-‐video-‐visits ?sfvrsn=6
52
CA
Department
of
Health
Care
Services,
Medi-‐Cal
Part
2
General
Medicine
Manual,
Telehealth,
http://files.medi-‐
cal.ca.govpublications/masters-‐mtp/part2/mednetele_m01o03
53
Department
of
Health
Care
Services
(DHCS),
Telehealth
Billing
Recorded
Webinar,
September
2013.
54
California
Telehealth
Network;
http://www.caltelehealth.org/
55
California
Telehealth
Network;
http://www.caltelehealth.org/
56
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
57
Medicaid
Rates
for
Home
Health
Care
Working
Group;
https://www.cga.ct.gov/hs/taskforce.asp?TF=20151008_Medicaid%20Rates%20for%20Home%20Health%20Care%
20Working%20Group
58
Conn.
Gen.
Stat.
Sec.
17b-‐245c;
http://search.cga.state.ct.us/dtsearch_pub_statutes.asp?cmd=getdoc&DocId=13656&Index=I%3a\zindex\surs&Hit
Count=2&hits=190+191+&hc=2&req=%28number+contains+17b-‐245c%29&Item=0
59
2015
Delaware
State
Legislative
Session;
HB
69
-‐
http://www.legis.delaware.gov/LIS/LIS148.NSF/db0bad0e2af0bf31852568a5005f0f58/bae11c3e3516baa085257e3
5006685bb?OpenDocument
60
19
DE
Reg.191;
http://regs.cqstatetrack.com/info/get_text?action_id=763841&text_id=766299&type=action_text
61
DC
Code
Sec.
31-‐3861
62
DC
Code
Sec.
31-‐3863
63
AGENCY
FOR
HEALTH
CARE
ADMINISTRATION
Notice
of
Development
of
Rulemaking
59G-‐1.057;
https://www.flrules.org/gateway/readFile.asp?sid=1&tid=16726988&type=1&file=59G-‐1.057
64
Florida
Medicaid,
PRACTITIONER
SERVICES
COVERAGE
AND
LIMITATIONS
HANDBOOK,
Chapter-‐2,
p.120;
http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/HANDBOOKS/Practitioner%20Services%20Hand
book_Adoption
65
OCGA
§
33-‐24-‐56.4
66
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
School-‐based
Telehealth.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐school-‐based-‐
telehealth ?sfvrsn=8
67
Georgia
Medicaid
Telemedicine
Handbook;
https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/HANDBOOKS/Telemedicine%20Handbo
ok%20OCT%202015%2001-‐10-‐2015%20180926
68
California
Telehealth
Network;
http://www.caltelehealth.org/
69
HI
Revised
Statutes
§
431:10A-‐116.3
70
SB
2469
–
27th
Legislature;
http://www.capitol.hawaii.gov/measure_indiv.aspx?billtype=SB&billnumber=2469&year=2014
71
National
Conference
of
State
Legislatures.
State
Employee
Health
Benefits;
http://www.ncsl.org/research/health/state-‐employee-‐health-‐benefits-‐ncsl.aspx#Self-‐fund
72
HI
Administrative
Rules
§17-‐1737-‐51.1;
http://humanservices.hawaii.gov/wp-‐content/uploads/2013/10/HAR-‐17-‐
1737-‐Scope-‐Contents-‐of-‐the-‐fee-‐for-‐service-‐medical-‐assistant-‐program
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
97
73
IDAHO
DEPARTMENT
OF
HEALTH
AND
WELFARE
NOTICE
OF
RULEMAKING
-‐
PROPOSED
RULE
16-‐0309-‐1502;
http://adminrules.idaho.gov/bulletin/2015/10
74
CA
Department
of
Health
Care
Services,
Medi-‐Cal
Part
2
General
Medicine
Manual,
Telehealth,
http://files.medi-‐
cal.ca.govpublications/masters-‐mtp/part2/mednetele_m01o03
75
Department
of
Health
Care
Services
(DHCS),
Telehealth
Billing
Recorded
Webinar,
September
2013.
76
CA
Welfare
and
Institutions
Code
Sec.
14132.72;
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14132.72.
77
The
Path
to
Transformation:
Illinois
§
1115
Waiver
Proposal;
http://www2.illinois.gov/hfs/PublicInvolvement/1115/Pages/1115.aspx
78
SB
647
–
98th
General
Assembly;
http://www.ilga.gov/legislation/BillStatus.asp?DocNum=647&GAID=12&DocTypeID=SB&SessionID=85&GA=98
79
ATA
State
Telemedicine
Matrix
2016;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix_2016147931CF25A6 ?sfvrsn=2
80
320
ILCS
42/20;
http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2630&ChapterID=31
81
CA
Department
of
Health
Care
Services,
Medi-‐Cal
Part
2
General
Medicine
Manual,
Telehealth,
http://files.medi-‐
cal.ca.govpublications/masters-‐mtp/part2/mednetele_m01o03
82
Department
of
Health
Care
Services
(DHCS),
Telehealth
Billing
Recorded
Webinar,
September
2013.
83
CA
Welfare
and
Institutions
Code
Sec.
14132.72;
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14132.72.
84
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telemental
and
Behavioral
Health.
August
2013;
http://www.americantelemed.org/docs/default-‐source/policy/ata-‐best-‐practice-‐-‐-‐telemental-‐and-‐
behavioral-‐health ?sfvrsn=10
85
IN
State
Legislative
Session
2015
HB
1269;
https://iga.in.gov/static-‐
documents/e/f/4/c/ef4c65a0/HB1269.05.ENRH
86
IC
12-‐15-‐5-‐11;
https://iga.in.gov/legislative/laws/2015/ic/titles/012/articles/015/chapters/005/
87
20140326-‐IR;
http://www.in.gov/legislative/iac/20140326-‐IR-‐405140102ONA.xml
88
Indiana
Health
Coverage
Programs
Provider
Manual,
Chapter-‐8
Section
3,
p.139;
http://provider.indianamedicaid.com/ihcp/manuals/chapter08
89
IA
State
Legislative
Session
2015
Act
Chapter
137;
http://www.legis.iowa.gov/docs/publications/iactc/86.1/CH0137
90
IAC
441—78.55(249A);
https://www.legis.iowa.gov/docs/aco/arc/2166C
91
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
92
Iowa
Health
Home
State
Plan
Amendment
for
Adults
and
Children
with
Severe
and
Persistent
Mental
Illness;
http://www.medicaid.gov/State-‐Resource-‐Center/Medicaid-‐State-‐Technical-‐Assistance/Health-‐Homes-‐Technical-‐
Assistance/Downloads/IOWA-‐Approved-‐2nd-‐HH-‐SPA-‐
93
Dept.
of
Health
and
Environment,
Kansas
Medical
Assistance
Program,
Provider
Manual,
Home
Health
Agency,
p.
33
(Jan.
2013)
94
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Remote
Patient
Monitoring
and
Home
Video
Visits.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐
remote-‐patient-‐monitoring-‐and-‐home-‐video-‐visits ?sfvrsn=6
95
KY
Revised
Statutes
§
304.17A-‐138
96
KY
Revised
Statutes
§
205.559
97
907
KAR
3:170
98
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telerehabilitation.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐
telerehabilitation ?sfvrsn=6
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
98
99
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Managed
Care
and
Telehealth.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐managed-‐care-‐and-‐
telehealth ?sfvrsn=6
100
HCR
No.
88;
https://www.legis.la.gov%2Flegis%2FViewDocument.aspx%3Fd%3D898417&usg=AFQjCNEvK6diYXFnhdLdLiuqWnK
Tw9-‐tvA&sig2=sjaC-‐9r0NOzFI-‐8M2OCuJA&cad=rja
101
LA
Department
of
Health
and
Hospitals
Report
to
House
and
Senate
Committees
on
Health
and
Welfare,
January
20,
2013;
http://www.dhh.louisiana.gov/assets/docs/LegisReports/HCR96-‐2013
102
HCR
No.
88;
https://www.legis.la.gov%2Flegis%2FViewDocument.aspx%3Fd%3D898417&usg=AFQjCNEvK6diYXFnhdLdLiuqWnK
Tw9-‐tvA&sig2=sjaC-‐9r0NOzFI-‐8M2OCuJA&cad=rja
103
LA
Revised
Statutes
22:1821
104
La.
Admin.
Code
tit.
46,
§
7507
and
7511
105
LA
Dept.
of
Health
and
Hospitals,
Professional
Services
Provider
Manual,
Chapter-‐5
Section
5.1
106
Maine
State
Plan
Amendment,
September
2015;
http://www.medicaid.gov/State-‐resource-‐center/Medicaid-‐
State-‐Plan-‐Amendments/Downloads/ME/ME-‐15-‐007
107
ME
Revised
Statutes
Annotated.
Title
24
Sec.
4316
108
Maine
Department
of
Health
and
Human
Services
Proposed
Rule
2015-‐P211;
http://www.maine.gov/sos/cec/rules/notices/2015/111815.html
109
Maine
Health
Home
State
Plan
Amendment;
http://www.medicaid.gov/State-‐Resource-‐Center/Medicaid-‐State-‐
Plan-‐Amendments/Downloads/ME/ME-‐12-‐004-‐Att
110
Code
of
ME
Rules.
10-‐144-‐101
111
MaineCare
Benefits
Manual,
General
Administrative
Policies
and
Procedures,
10-‐144
Chapter-‐101,
p.
20;
http://www.maine.gov/sos/cec/rules/10/ch101.htm
112
Michael
A.
Edwards
and
Arvind
C.
Patel.
Telemedicine
Journal
and
e-‐Health.
March
2003,
9(1):
25-‐39.
113
Maryland
Register,
Volume
42,
Issue
21
Notice
of
Final
Action
[15-‐188-‐F];
http://www.dsd.state.md.us/MDR/4221/Assembled.htm
114
MD
Insurance
Code
Annotated
Sec.
15-‐139
115
Maryland
Register,
Volume
42,
Issue
21
Notice
of
Final
Action
[15-‐188-‐F];
http://www.dsd.state.md.us/MDR/4221/Assembled.htm
116
Maryland
Medical
Assistance
Program
–
Telemedicine
2014;
https://mmcp.dhmh.maryland.gov/SitePages/Telemedicine%20Provider%20Information.aspx
117
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
118
Boston
Medical
Center
HealthNet
Plan;
http://www.bmchp.org/providers/claims/reimbursement-‐
policies
119
http://hnetalk.com/member/2015/08/01/health-‐new-‐england-‐introduces-‐
teladoc/?_ga=1.45474596.106012203.1447256463
120
http://www.fchp.org/providers/medical-‐
management/~/media/Files/ProviderPDFs/PaymentPolicies/TelemedicinePayPolicy.ashx
121
National
Telenursing
Center;
http://www.mass.gov/eohhs/gov/departments/dph/programs/community-‐
health/dvip/violence/sane/telenursing/the-‐national-‐telenursing-‐center.html
122
Partners
Telestroke
Network;
http://telestroke.massgeneral.org/phstelestroke.aspx
123
101
CMR
350;
http://www.mass.gov/eohhs/docs/eohhs/eohhs-‐regs/101-‐cmr-‐350-‐hha-‐redlined
124
MI
Compiled
Law
Services
Sec.
500.3476
125
Michigan
Department
of
Health
and
Human
Services
Medical
Services
Administration
1518-‐SBS;
www.michigan.gov/documents/mdch/1518-‐SBS-‐P_487449_7
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
99
126
Medicare-‐Medicaid
Capitated
Financial
Alignment
Demonstration
for
Michigan;
https://www.cms.gov/Medicare-‐Medicaid-‐Coordination/Medicare-‐and-‐Medicaid-‐Coordination/Medicare-‐
Medicaid-‐Coordination-‐Office/FinancialAlignmentInitiative/Downloads/MIMOU
127
Medicaid
Policy
Bulletin
MSA
13-‐34;
http://www.michigan.gov/documents/mdch/MSA_13-‐34_432621_7
128
MDCH
Telemedicine
Database
January
2014;
http://www.michigan.gov/documents/mdch/Telemedicine-‐
012014_445921_7
129
Minnesota
State
Legislature
2015
Session
Chapter
71;
https://www.revisor.mn.gov/laws/?year=2015&type=0&doctype=Chapter&id=71&format=pdf
130
MN
Statute
254B.14;
https://www.revisor.mn.gov/statutes/?id=254B.14
131
MN
Dept.
of
Human
Services,
Provider
Manual,
Continuum
of
Care
Pilot;
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=Lat
estReleased&dDocName=dhs16_194151
132
MN
Statute
Sec.
256B.0625;
https://www.revisor.mn.gov/statutes/?id=256B.0625
133
MN
Dept.
of
Human
Services,
Provider
Manual,
Physician
and
Professional
Services;
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=Lat
estReleased&dDocName=id_008926#Telemedicine
134
MN
Dept.
of
Human
Services,
Provider
Manual,
Rehabilitative
Services;
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=Lat
estReleased&dDocName=id_008951
135
MN
Statute
Sec.
256B.0653;
https://www.revisor.mn.gov/statutes/?id=256B.0653
136
MS
Code
Sec.
83-‐9-‐351
137
SB
2646;
http://billstatus.ls.state.ms.us/2014/pdf/history/SB/SB2646.xml
138
Miss.
Admin.
Code
Part
225,
Chapter
1;
http://www.sos.ms.gov/ACProposed/00021320b
139
Mississippi
Division
of
Medicaid,
SPA
15-‐003
Telehealth
Services;
http://www.medicaid.ms.gov/wp-‐
content/uploads/2015/04/SPA-‐15-‐003
140
Code
Miss.
R.
30-‐5-‐2635;
http://www.msbml.ms.gov/msbml/web.nsf/webpages/Regulations_Regulations/$FILE/11-‐
2013AdministrativeCode ?OpenElement
141
MO
Revised
Statutes
§
376.1900.1
142
MO
Code
of
State
Regulation,
Title
13,
70-‐3.190
143
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
144
MO
HealthNet
Provider
Manuals
–
Physicians
Section
13;
http://207.15.48.5/collections/collection_phy/Physician_Section13
145
MO
Consolidated
State
Reg.
22:10-‐3.057
146
MO
HealthNet
Provider
Manuals
–
Behavioral
Health
Section
13;
http://207.15.48.5/collections/collection_psy/Behavioral_Health_Services_Section13
147
MO
HealthNet
Provider
Manuals
–
Comprehensive
Substance
Abuse
Treatment
and
Rehabilitation
Section
13;
http://207.15.48.5/collections/collection_cst/CSTAR_Section13
148
MO
HealthNet
Provider
Manuals
–
Comprehensive
Substance
Abuse
Treatment
and
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Missouri
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150
MT
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151
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2014;
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LB
254;
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State
Telemedicine
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Coverage
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Reimbursement
American
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School-‐based
Telehealth.
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2013;
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158
Revised
Statutes
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NMAP
Services,
471
NAC
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Proposed
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NMAP
Services,
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regs/regtrack/proposals/0000000000001346
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Nevada
State
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Industry
Division
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Industrial
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Medical
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Services.,
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Services
Manual,
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NH
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Statutes
Annotated,
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165
New
Hampshire
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Law
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sQTg4YCQCg&ved=0CAYQFjAA&client=internal-‐uds-‐cse&usg=AFQjCNGBBItpApuMULB1o7VV9mAYi3KKdg
167
New
Hampshire
Healthy
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New
Jersey
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Health
Coverage
Program;
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169
New
Jersey
Small
Employer
Health
Benefits
Programs;
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170
ATA
State
Telemedicine
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legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
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NJ
Department
of
Human
Services
Division
of
Medical
Assistance
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Health
Services,
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2013
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NM
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State
Medicaid
Best
Practice:
School-‐based
Telehealth.
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2013;
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telehealth ?sfvrsn=8
174
NMAC
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175
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telemental
and
Behavioral
Health.
August
2013;
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behavioral-‐health ?sfvrsn=10
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American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Telerehabilitation.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐
telerehabilitation ?sfvrsn=6
177
New
Mexico
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178
NMAC
8.308.9.18;
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179
American
Telemedicine
Association,
State
Medicaid
Best
Practice:
Managed
Care
and
Telehealth.
January
2014;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐managed-‐care-‐
and-‐telehealth ?sfvrsn=6
50
State
Telemedicine
Gaps
Analysis:
Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
Page.
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180
S07852
–
General
Assembly;
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181
A02552
–
General
Assembly;
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182
American
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Association,
State
Medicaid
Best
Practice:
Remote
Patient
Monitoring
and
Home
Video
Visits.
July
2013;
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remote-‐patient-‐monitoring-‐and-‐home-‐video-‐visits ?sfvrsn=6
183
Medicare-‐Medicaid
Capitated
Financial
Alignment
Demonstration
for
New
York;
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Coordination-‐Office/FinancialAlignmentInitiative/Downloads/VAMOU
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New
York
Health
Home
State
Plan
Amendment
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Individuals
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Chronic
Behavioral
and
Mental
Health
Conditions;
http://www.medicaid.gov/State-‐Resource-‐Center/Medicaid-‐State-‐Technical-‐Assistance/Health-‐Homes-‐
Technical-‐Assistance/Downloads/New-‐York-‐SPA-‐12-‐11.PDF
185
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York
State
Medicaid
Program
Update,
Volume
31
Number
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March
2015;
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American
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State
Medicaid
Best
Practice:
Telestroke.
January
2014;
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telestroke ?sfvrsn=8
187
American
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Association,
State
Medicaid
Best
Practice:
Managed
Care
and
Telehealth.
January
2014;
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188
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
189
NC
General
Statutes
Article
3,
Ch.
143B,
Sect.
12A.2B.(b)
190
NC
Div.
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Medical
Assistance,
Medicaid
and
Health
Choice
Manual,
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Coverage
Policy
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Telemedicine
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191
North
Dakota
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Session
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1038;
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2015/documents/15-‐0079-‐05000
192
North
Dakota
State
Plan
Amendment,
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2012;
http://www.medicaid.gov/State-‐resource-‐
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193
ND
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Human
Services,
General
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Medicaid
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194
ATA
State
Telemedicine
Matrix
2015;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐
legislation-‐matrix-‐as-‐of-‐4-‐28-‐2015A6D18E449A99 ?sfvrsn=4
195
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123;
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196
OAC
5160-‐1-‐18
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American
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State
Medicaid
Best
Practice:
School-‐based
Telehealth.
July
2013;
http://www.americantelemed.org/docs/default-‐source/policy/state-‐medicaid-‐best-‐practice-‐-‐-‐school-‐based-‐
telehealth ?sfvrsn=8
198
Ohio
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State
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OK
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201
Oregon
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OARS
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203
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State
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State
Telemedicine
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Coverage
&
Reimbursement
American
Telemedicine
Association
2016
|
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State
Telemedicine
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211
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Texas
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Reimbursement
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Association
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American
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Best
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January
2014;
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American
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Association,
State
Medicaid
Best
Practice:
Managed
Care
and
Telehealth.
January
2014;
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telehealth ?sfvrsn=6
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241
http://www.telemedicine.vcuhealth.org/
242
HB
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–
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Telemedicine
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WAC
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Applied
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Medicaid
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Virginia
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State
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WI
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WY
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