Understanding Medicaid Reimbursement Policies for Telehealth Services

Telehealth services reduce operating costs, allow providers to see more patients in less time, and increase access to quality care for those living in rural or remote areas. Providers that offer telehealth services conduct virtual visits from their home or office--neither provider or patient needs to visit a healthcare facility.

During the public health emergency (PHE), providers around the country have utilized telehealth to provide quality care to patients while remaining socially distant and working to control the spread of the coronavirus. Telehealth services allow providers to quickly and efficiently evaluate, diagnose, and treat a wide range of conditions without physical contact. While this provides obvious benefits during the pandemic, providers are starting to realize the long-term benefits of telehealth as well, with many planning to continue offering telehealth services and virtual appointments after the PHE is over.

Medicaid Coverage for Telehealth Service Varies from State to State

Although most providers and patients view telehealth as an important service, it wasn’t until recently that states began expanding Medicaid coverage for telehealth visits. Since the start of the PHE, each state has added and refined telehealth reimbursement policies to increase accessibility and coverage of what is quickly becoming a commonplace service.

Each state has its own laws and reimbursement policies for telehealth services. While the Centers for Medicare & Medicaid Services (CMS) provides guidelines to assist states with the accelerated adoption of telehealth coverage, a recent survey conducted by the Center for Connected Health Policy (CCHP) found that every state handles telehealth differently. This can create confusion for those providing services, especially in multiple states.

Several State Policies Make Telehealth More Accessible

The CCHP Fall 2020 report found that most states are keeping their temporary telehealth COVID-19 emergency policies separate from their permanent telehealth policies. While the report included permanent telehealth policies, it did not include any temporary policies implemented during the COVID-19 emergency.

According to the CCHP report, the largest change in Medicaid reimbursement centered around store-and-forward services. Currently, 18 states provide reimbursement for these types of services. Several states expanded Medicaid coverage to include reimbursement for virtual check-in and e-visits conducted over a secure telemedicine platform. Many states also clarified the location in which patients can receive care. Rather than requiring patients to visit a healthcare facility to receive care through a telemedicine kiosk or cart, patients with Medicaid can now receive telehealth services from their home or school in several states.

Although many states expanded Medicaid reimbursement to include a variety of services and specialties, the most common covered services include behavioral health, substance abuse disorder services, teledentistry, school-based health services, and speech therapy. Another policy change, several states now allow federally qualified health centers (FQHCs) and rural health clinics (RHCs) to qualify for reimbursement as a distant site.

While most states have adopted policies that allow for reimbursement of telephone services during the PHE, a few states have made this expansion permanent, but only for very limited services. Most providers agree that providing care over the telephone simply does not enable the same quality of care as video conferencing software.

HIPAA-Compliant Telehealth Solutions

Let’s Talk Interactive continues to offer innovative telehealth solutions for healthcare providers, including secure video conferencing software. Our user-friendly HIPAA-compliant telehealth software allows providers to improve the quality of care and reach more patients in less time--all while staying compliant with state policies across the U.S.

Please contact us for more information about our telehealth solutions.

Additional Resources

For a fact sheet on the CY 2021 Physician Fee Schedule Final rule, please visit: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

For a fact sheet and frequently asked questions on the CY 2021 Quality Payment Program final rule, please visit: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1207/2021%20QPP%20Final%20Rule%20Resources.zip

For a fact sheet Medicare Diabetes Prevention Program, please visit: https://www.cms.gov/newsroom/fact-sheets/final-policies-medicare-diabetes-prevention-program-mdpp-expanded-model-calendar-year-2021-medicare

To view the CY 2021 Physician Fee Schedule and Quality Payment Program final rule, please visit: https://www.cms.gov/files/document/12120-pfs-final-rule.pdf