By David Nunnally, Research Assistant
Bowling Green, Ky. (June 14, 2022) – The Center for Connected Health Policy released its spring 2022 report in May on state telehealth laws and Medicaid program policies. Among other things, the document tracks changes in Medicaid policy that states have enacted since fall 2021.
While the landscape remains largely the same, these advances represent significant progress in expanding telehealth access across the United States.
In the advent of the COVID-19 pandemic, many states adopted temporary telehealth regulations to accommodate the difficult context. These advancements made health care more accessible for millions of Americans. Since fall 2021, many of these policies have become permanent changes.
This article will discuss telehealth as a concept and why it matters, highlight some recent changes in laws concerning Medicaid reimbursement, and propose a path toward further expansion.
Telehealth uses electronic information and telecommunication technologies to provide patients with health care in different physical locations than their providers. However, states construct their legal definitions differently by allowing Medicaid reimbursement for some modalities but not others.
According to the report, all 50 states and the District of Columbia reimburse providers for some form of live video service. Other forms of telehealth, such as store-and-forward, remote patient monitoring (RPM), and audio-only services, receive less institutional support.
Store-and-forward services allow patients to send health information electronically that will be reviewed by a provider at a later time. Twenty-five states restrict this modality by stipulating that health care be administered “in real-time” to be eligible for Medicaid reimbursement.
RPM utilizes new technologies that allow practitioners to monitor their patients without visiting them directly. While 30 states allow RPM to some degree, many also impose restrictions on its use — by only offering Medicaid reimbursement to home health agencies, limiting the clinical conditions that can be monitored, or restricting the type of information that providers can collect.
Audio-only (telephone) services have not traditionally been an accepted modality for state Medicaid reimbursement. However, states increasingly permitted these services during the COVID-19 pandemic because many Americans lack the high-speed broadband internet necessary to engage in video calls. Today, Medicaid programs in 29 states allow for reimbursement in some form, but often only for specific specialties or services.
Why reimbursement matters
Why should we care whether state Medicaid policies reimburse for telehealth services? As the map above illustrates, many parts of the country (especially rural areas) have shortages of health professionals. The scarcity of specialists in these areas can be especially problematic for individuals with chronic illnesses.
Telehealth and its associated technologies allow individuals in these areas to receive treatment from providers in other parts of the state or country — care that they may have otherwise foregone. Telehealth could also accelerate treatment times; if local health care providers are experiencing staff shortages, telehealth represents an avenue whereby residents can receive care without waiting weeks for an appointment. Finally, increased access to preventative care through telehealth reduces the need for expensive emergency room visits down the line.
Since the fall 2021 CCHP report, several states have updated their permanent policies on telehealth. While no new private payer laws have taken effect, several states have altered their policies on telehealth Medicaid reimbursement. Some of these changes pertain to the modalities of care.
Iowa, Massachusetts, and South Dakota all added store-and-forward to their legal definitions of telehealth that are eligible for Medicaid reimbursement. In Virginia and Wisconsin, patients can now receive Medicaid reimbursement for RPM services (albeit with some qualifying conditions). Arkansas, New Mexico, South Dakota, Virginia, and Wisconsin have expanded their definitions of telehealth to include audio-only services.
Lawmakers have also broadened the treatments that Medicaid will cover via telehealth. In Arkansas, patients can now receive reimbursement for physical therapy, occupational therapy, and speech-language pathology services conducted over telehealth. Therapy services via electronic communication now qualify for Medicaid reimbursement in South Dakota and non-rural areas of Minnesota.
Finally, Pennsylvania recently expanded reimbursement to any covered service within the provider’s scope of practice. These states all exemplify steps in the right direction toward expanding telehealth benefits to anyone who could benefit from them.
Closing the Digital Divide in telehealth
The spring 2022 report illuminates two other avenues by which we could make meaningful improvements. First, Medicaid should start reimbursing federally qualified health centers (FQHCs) and rural health clinics (RHCs) for telehealth services. The map above illustrates their locations across the United States. These clinics offer primary health care to all patients regardless of their ability to pay, and often serve areas without robust medical infrastructure.
Allowing Medicaid reimbursement for telehealth services would provide increased access to patients who cannot make it to the physical location for one reason or another. Two states (North Dakota and Texas) have designated them as distant site providers that qualify for reimbursement, while a few others reimburse under certain circumstances. Other states should follow suit.
Finally, some states seem hesitant to expand the audio-only modality of telehealth because video calls provide more information. In their absence, policymakers should advocate for the expansion of high-speed broadband internet to bridge the Digital Divide and make video calls possible for patients in remote areas.
While policy changes since fall 2021 represent meaningful steps toward expanding access to telehealth services across the United States, there is still room for improvement. Connected Nation is committed to working alongside other stakeholders to advocate for the further expansion of Medicaid reimbursement for all forms of telehealth, and coverage for more services.
About the Author: David Nunnally is a Research Assistant at Connected Nation. In this role, he engages in data management, produces research deliverables, and analyzes quantitative data for reports and presentations. To learn more about Connected Nation, head to connectednation.org.
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