Reimbursement for telehealth-delivered care remains one of the largest barriers to telehealth adoption, regardless of the form of telehealth.
The Centers for Medicare and Medicaid Services (CMS) and the Medicare program have greatly set the standard for the federal government’s approach to telehealth reimbursement. Among other things, Medicare has maintained narrow restrictions that limit the type of services that can be reimbursed, and the geographic location where services can take place.
Medicare, Medicaid, and Telehealth
While Medicare is a federally administered insurance program for the elderly and disabled, Medicaid is a federal-state assistance program for low income individuals of every age, and the coverage policies vary from state to state. CCHP’s report on Medicaid telehealth policies in the 50 States and DC reveals that telehealth reimbursement policy, related policies, and associated guidelines also vary considerably from state to state. Meanwhile, advocates for telehealth make the case that telehealth is a means of service delivery rather than a separate service, and therefore should be reimbursed at the same rate as any other allowable service.
In some cases, low-income individuals qualify for both Medicare and Medicaid. These individuals are referred to as "dual" or "dual eligible.” The plans that offer this coverage include all Medicare Part A (hospital stay) and Part B (doctor visit) benefits, and Part D prescription drug coverage. For people with limited incomes, these plans may offer better health care coverage than original Medicare and separate Part D plans. Dual eligible individuals tend to be elderly and poor, and result in higher costs of care. The Kaiser Commission on Medicaid and the Uninsured has recently issued a brief that provides a thorough analysis on the issue. The Center for Technology and Aging also released a brief on strategies for incorporating telehealth-based care coordination and management solutions into programs to integrate care for dual-eligible patients.
There are no consistent standards that govern private commercial payers. However, more and more private payers are starting to recognize telehealth’s benefits, and are paying for selected services around the country. As of June 2014, twenty states have laws that govern private insurer reimbursement policies. Public and private managed care plans are also beginning to incorporate telehealth into the services that are covered.
How does your home state approach telehealth use? To view telehealth-related laws, regulations, and Medicaid programs select a state on the map.