The results are in: 80 percent of US states have taken action to improve telemedicine coverage or reimbursement over the last two years, according to the American Telemedicine Association’s latest survey of state laws and policies. However, each state is working alone in implementing these changes, forcing physicians who practice in more than one state to juggle confusing guidelines.
The 2019 State of the States Report: Coverage and Reimbursement, released last month, reveals a landscape that is becoming more receptive toward telemedicine, as signaled by increasing coverage and reimbursement. However, ATA CEO Ann Mond Johnson advises caution; although many states are enacting policies to encourage more adoption of telemedicine, some states may not have the proper authority or resources to fully deploy telemedicine throughout the region.
The report describes changes over the last two years in five key aspects relating to telemedicine:
- Patient setting – More states have relaxed the rules on what constitutes an “originating site”; of those that do still dictate the location, some now recognize the patient’s home and/or school as an authorized setting. Some states impose other regulations: The patient must be beyond a certain distance from a telehealth provider in order to use the service, or trained staff must be immediately available to the patient during a telemedicine visit.
- Provider types – The survey revealed that the eight most common specialties permitted to practice via telemedicine are physicians, nurse practitioners, physician assistants, psychologists, licensed mental health professionals, physical therapists, occupational therapists, and dentists. Half of the US states do not restrict telemedicine coverage to particular types of providers.
- Technology – Several states have adopted or updated policies regarding the type of telemedicine technology that may be utilized. Sixteen states limit coverage to only synchronous (real-time) telemedicine, while 29 states also permit asynchronous (store-and-forward) technology. In addition, 22 states and Washington DC cover remote patient monitoring, although some states restrict its use to chronic disease management.
- Medicaid coverage – Over the last two years, seven states have adopted or significantly changed their policies. Now, 21 states and DC require Medicaid to reimburse for telemedicine services. Twenty-eight states demand that telemedicine be reimbursed at the same rate as in-person care.
- Private payer coverage – More states have become involved in regulating private payer coverage for telemedicine, bringing the total to 36 states and DC. Of these, 16 states mandate payment parity.
The survey provides a solid resource for telemedicine providers to keep abreast of policies in the states where they practice. Considering how quickly regulations regarding telemedicine coverage can change, however, it would be wise to be constantly alert for new developments.
To read the report, visit the American Telemedicine Association (ATA) here.