ATA Releases 2019 Update of State-by-State Telehealth Report Cards

The American Telemedicine Association has updated its survey of state telehealth coverage and reimbursement policies and laws, which was last issued in 2017.


Four out of every five US states have moved to improve telehealth coverage or reimbursement over the past two years, according to the latest survey of state laws and policies by the American Telemedicine Association.

But like so many other reports issued during that time, the ATA analysis found that each state is doing its own thing with connected care, so that a healthcare provider looking to use telehealth in more than one state faces a confusing array of guidelines.

The 2019 State of the States Report: Coverage and Reimbursement, released this week, does offer good news for virtual care advocates, according to ATA CEO Ann Mond Johnson. As evidenced by the news that 40 states and the District of Columbia have “adopted substantive policies or received awards” to improve their telehealth rules since 2017, it points to a slowly improving landscape and a move toward more coverage and reimbursement.

“This year’s ATA report illustrates the increasing recognition of telehealth, and can guide federal and state lawmakers to identify and address policy gaps,” she said in a press release accompanying the study, which is available to members. “Collectively, states are realizing the many benefits of telehealth and are implementing policies that advance utilization. It’s clear that more states are adopting telehealth solutions, but some lack the authority or resources needed to fully deploy telehealth across the state.”

Highlights from the 50+-page document include:

Patient setting: Ten states and Washington DC have amended their rules on originating sites since 2017 – the last time the ATA issued a report. As of now, 29 states don’t specify where a patient must be in order to receive care via telehealth. Of those that do, 12 states now recognize the patient’s home as an originating site, and 12 states give that same standing to schools.

In addition, some states mandate how far away a patient has to be from a telehealth provider in order to access those services, and some states also mandate that trained staff or providers have to be immediately available to a patient during a telehealth visit.

Technology: Six states and Washington DC have adopted or updated policies concerning what type of telemedicine technology can be used since 2017. So while 16 states limit coverage to synchronous (real-time) technology, 22 states and DC now allow remote patient monitoring and 29 states and DC allow store-and-forward (asynchronous) services.

In addition, several states now cover audio-only telehealth, broadening the playing field for providers and patients who want to connect by phone, particularly in areas where broadband connectivity is challenging.

And while RPM is growing in popularity, some states still restrict how it can be used. Arizona, for instance, limits reimbursement to programs serving patients with congestive heart failure and a specific hospitalization history, while Mississippi and Indiana cover CHF as well as chronic obstructive pulmonary disease (COPD) and diabetes – all with certain hospitalization history requirements.

Provider types: According to the ATA, the eight most common medical specialties allowed by states to use telehealth are physicians, physician assistants, nurse practitioners, licensed mental health professionals, occupational therapists, physical therapists, psychologists and dentists. In all, 26 states don’t restrict telehealth coverage to certain types of providers, and 10 states have a list that includes at least six different provider types.

Medicaid coverage: Some 21 states and Washington DC now mandate that Medicaid offer coverage for telehealth services as they would for in-person services, and 28 states mandate that reimbursement for telehealth be the same as it would be for in-person care. Seven states have adopted or substantially changed their policies since 2017.

Private payer coverage: Some 36 states and Washington DC now regulate private payer coverage for telehealth, with 16 states mandating payment parity. Twelve states have adopted or substantially changed those policies since 2017.

The ATA report also analyzes four innovative payment models for connected health: Managed care organizations, Medicare-Medicaid dual eligible, home and community-based service (HCBS) waivers and Innovation Center models put forth by the Centers for Medicare & Medicaid Services.

According to the report, 36 states offer telehealth services through an innovative payment model that relies on waivers. Four states use HCBS waivers and 13 states use integrated care for Medicare-Medicaid dual-eligibles – but only three cover telehealth. Nine states, meanwhile, don’t have an explicit capitated managed care organization model, though four have unique managed care models or plan to introduce them.

Finally, 16 states and Washington DC have used a total of 12 Healthcare Innovation Awards to push new telehealth programs, and four states have received State Innovation Model grants for telehealth.

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