The American Telemedicine Association (ATA) has compiled a report listing laws that allows readers to compare telemedicine policies affecting coverage and reimbursement among the 50 states and the District of Columbia (D.C.). The ATA analysis considered policies based on health plan parity and Medicaid conditions of payment. Although it found widespread differences among the states, in particular when it examined 13 additional indicators within the parity and conditions of payment categories, it gave five states and D.C. overall ratings of A. Thirty states received B ratings and 13 received C ratings. Two states–Connecticut and Rhode Island–received grades of F.
Telemedicine parity laws are those that require private insurers to cover telemedicine-provided services comparable to that of in-person services. Twenty-three states and D.C. have full parity laws in effect. Sixteen of those states and D.C. received the highest grades in the private insurance parity category because they provide statewide coverage and do not impose provider or technology restrictions. Forty-eight Medicaid programs provide some type of Medicaid coverage, but only four, along with D.C., received the highest parity grades. Twenty-four states provide some telemedicine coverage under state employee health plans and 21 extend coverage under parity laws. However, 58 percent of the country received failing grades for parity among state employee health plans because they offered no or only limited coverage for telehealth.
Medicaid conditions of payment
Payment for telemedicine services is traditionally conditioned on the services being provided to patients in specific settings or locations, such as physicians’ offices and hospitals, and ignoring more convenient locations such as patient homes, community mental health centers, and federally qualified health centers. However, according to the ATA compilation, 24 states do not condition payment on patient settings or location. In addition to these, 25 states recognize the home as an originating site for telemedicine services; 16 recognize schools and/or school-based health centers as originating sites.
States that cover telemedicine services generally do so when they are provided by a physician. Only 15 states and D.C. did condition payment on a specific provider type. A handful of states covered services provided by podiatrists, optometrists, or behavioral analysts. With respect to physician-provided services, most states cover office visits or consultation, but few cover ultrasounds or echocardiograms.
Eighty-two percent of states cover telemedicine services without geographic or distance restrictions. On the other hand, 57 percent of states received failing scores in the eligible technologies indicator category because they provide no coverage for telemedicine or only cover synchronous technologies, such as videoconferencing that occurs in real time, as opposed to other technologies, such as store-and-forward, in which still images are transmitted. In addition to the policies discussed above, the analysis also looked specifically at policies concerning mental and behavioral health services, rehabilitation services, home health services, informed consent, and the use of telepresenters.
D.C., Maine, New Hampshire, New Mexico, Tennessee, and Virginia received overall grades of A. They were found to offer broad coverage and employ innovative payment or service delivery models. Maine is one of eight states to reimburse for telerehabilitative services within the home health benefit, even though those services are covered when provided in-person. New Mexico offers true parity and is one of only three states to cover services provided by a behavioral analyst, which is necessary in the treatment of autism spectrum disorders. Virginia is one of only three states to have extended coverage to its dual-eligible population through the CMS Capitated Financial Alignment Model for Medicare-Medicaid enrollees. Although Alaska received an overall grade of B, it was the only state to receive the highest ranking for services provided under the home health benefit.
The report cautions that its ranking are based on paper laws through April 2015, and that actual telemedicine practices may differ within the states. The ATA also issued a related report comparing state physician practice standards and licensure.