Telehealth Policy and Reimbursement Vary Widely from State to State, ATA Report Finds


Telehealth adoption is on the rise. And more states are recognizing the services. In fact, a new report from American Telemedicine Association (ATA), “2019 State of the States Report,” revealed that 40 states and D.C. have adopted policies or received awards that improved coverage and reimbursement of telehealth.

Among the states that have not passed laws include New Mexico, South Carolina, West Virginia, Ohio and Michigan.

The most common issues taken up by state legislatures included private payer parity and removing restrictions on patient setting. Currently, 36 states and D.C. have parity policies for private payer coverage. Just 21 states and D.C. have coverage parity policies in Medicaid.

A majority of states adopted policies so their Medicaid program will treat telehealth services and in-person services the same for coverage and payment purposes.

“Our “2019 State of the States Report” is an important tool for our member organizations as well as policymakers, identifying those states that are excelling at advancing telehealth policy, and the barriers and opportunities which vary widely across the policy landscape,” said Ann Mond Johnson, CEO of ATA.

Telehealth Technology

Since its 2017 report, ATA identified six states and D.C. that adopted or updated policies concerning telehealth modalities. Among those include Kentucky, Utah, Maine, Oregon, New Jersey and Massachusetts.

Only 16 states — including Delaware, Florida and Georgia — limit telehealth to synchronous technologies. The majority of the country — including rural areas — recognizes value in other modalities.

Currently, 22 states and D.C. cover remote patient monitoring, while 29 states and D.C. cover store and forward transfer.

But states covering remote patient monitoring vary considerably.

Arizona limits remote patient monitoring to patients with congestive heart failure and require a certain hospitalization history. In Mississippi and Indiana, only patients with congestive heart failure, chronic obstructive pulmonary disease or diabetes with a certain hospitalization history are covered for remote patient monitoring.

Remote patient monitoring is covered for patients in Texas who are pregnant, have cancer, asthma, hypertension or mental illness.

And a Maine law recently advanced remote patient monitoring by creating the Maine Telehealth and Telemonitoring Advisory Group to recommend ways to improve telemonitoring services state wide. The law also prohibits requirements that patients have a certain amount of emergency visits or hospitalizations related to diagnosis to be eligible.

Maine, Alaska, New Hersey and Oregon now reimburse for healthcare services delivered through audio-only technology.

Using Telehealth to Bridge Provider Shortages

States are using telehealth services to fill provider shortage gaps and ensure specialty care access, according to the report.

There are eight more common telehealth provider types:

  1. Physician
  2. Physician assistant
  3. Nurse practitioner
  4. Licensed mental health professional
  5. Occupational therapist
  6. Physical therapist
  7. Psychologist
  8. Dentist

As of 2019, 26 states and D.C. do not have restrictions around eligible provider types and 10 states authorize six or more provider types. Ten states adopted or updated policies concerning types of providers eligible for telehealth reimbursement.

And half the laws pertained to provider types offering mental health services.

Telehealth and Patient Setting

Nearly 30 states did not specify a patient setting as a condition for payment, while 12 recognized the home as the originating site and 12, along with D.C., recognized the school as the originating site.

Since 2017, ATA identified 10 states and D.C. that adopted or updated policy concerning originating sites.

Distance restrictions still affect states like North Carolina, Ohio and Montana. But Indiana and New Hampshire removed geographic barriers to telehealth.

The requirement that trained staff or providers be at least immediately available to a patient during a telehealth visit still remains a barrier for states like Alabama, South Carolina and Virginia. Other states, however, including Illinois and Nevada, adopted policies so providers are not required to be present at the originating site.

“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,” Mond Johnson said. “ATA supports expanding research opportunities to increase innovation and reduce costs to help incentivize states to continue to adopt telehealth services.”

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