Last week’s announcement of the Center for Medicare and Medicaid Services’ new fee schedule could mean a big increase in the amount of care given via telemedicine that’s reimbursed by Medicare. But for its state-funded cousin Medicaid, the availability of telemedicine services varies greatly based on where you are.
A new survey out last week from Manatt Health looks at Medicaid fee-for-service reimbursement policies as well as state laws to give an overview of telemedicine across the nation. Evaluating a number of categories, Manatt rated 20 states as “progressive”, meaning laws and policies “enable and incentivize” broad telemedicine usage. Twelve states came out as “restrictive”, meaning laws and policies inhibit telemedicine. The other 18 were rated as mixed or moderate, meaning they either supported telemedicine in some ways and inhibited it in others or they gave qualified or limited support.
“Nearly all state Medicaid programs provide reimbursement for some telemedicine services,” Manatt researchers wrote in a summary of their findings. “Most states allow several types of providers to administer care via telemedicine, and few limit the specific types of services that can be provided through these modalities. While there has been notable progress, some restrictions on the provision of telemedicine services for Medicaid members remain.”
Some of the most restrictive states were in New England and the South, with Massachusetts as the only state to bomb in all six categories Manatt investigated. On the other hand, the Southwest and Northwest made up much of the progressive block, with Colorado standing out as the only state that reimburses for live video conference, phone and email, remote patient monitoring, and store and forward.
Other barriers Manatt points out include the physician-patient relationship requirement, where patients must meet physically with providers before telemedicine care is reimbursable; frequency limits, where Medicaid will only pay for a certain number of telemedicine encounters in a given time frame; and geographic limits, which restrict where the provider and patient can be located in order to be reimbursed.
To the last point, just over half the states (26) now reimburse for telemedicine where the patient is at home.
“A growing body of evidence suggests that telemedicine will be critical to delivering health care in the future, and state Medicaid policies are evolving—in some states more quickly than others—to accelerate adoption of telemedicine models,” analysts wrote. “As technology advances and the evidence base for telemedicine expands, state policy will continue to evolve to integrate telemedicine into payment and delivery reforms that support overarching program objectives related to access, quality, and cost of care.”