The Center for Connected Health Policy (CCHP) has a Telehealth Policy Finder where you can look up all telehealth-related policies and regulations, including those related to Private Payer and Medicaid Reimbursement across all 50 states and the District of Columbia, as well as at the federal level. .
CCHP has also put together the following resources to help you compare and contrast the laws and reimbursement policies for each state, including those related to Private Payer and Medicaid Reimbursement.
- Bi-Annual State Telehealth Laws and Reimbursement Policies Report
Private Payer Reimbursement. Most of the states in the MATRC region have some form of private (commercial) payer parity laws related to telehealth. There are two types of parity laws. One is referred to as coverage or ‘service parity’. Service parity means that commercial health plans may not deny reimbursement for a covered service solely because it was provided via telehealth. This type of parity does not guarantee the same rate of payment. The other type of parity is ‘payment parity’. This requires commercial health plans to reimburse for telehealth services at the same rate as in-person care. These laws generally do not apply to self-insured plans.
Medicaid Reimbursement. States have broad discretion in designing their approaches to telehealth since telehealth is a delivery method, not a benefit type. Telehealth is viewed as an alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient). As such, states have the option/flexibility to determine whether (or not) to cover telehealth; what types of telehealth to cover; where in the state it can be covered; how it is provided/covered; what types of telehealth practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are "recognized" and qualified according to Medicaid statute/regulation; and how much to reimburse for services delivered using telehealth, as long as such payments do not exceed Federal Upper Limits.
- For more information about what State Medicaid programs are able to do from a statutory or regulatory perspective, CMS has developed the following guidance documents:
- Medicaid & CHIP Telehealth Toolkit
- Medicaid & CHIP Telehealth Toolkit Supplement #1
- Medicaid & CHIP Telehealth Toolkit Checklist for States
- Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
- Rural Health Care and Medicaid Telehealth Flexibilities, and Guidance Regarding Section 1009 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act
- Coverage and Payment of Interprofessional Consultation in Medicaid and Children's Health Insurance Program (CHIP)
- All fifty states and the District of Columbia have some form of Medicaid reimbursement for telehealth. No two state Medicaid policies are identical in their requirements and restrictions! CCHP has created this video discussing how Medicaid telehealth policy works:
- For more information about the specific Medicaid Policies found in one or more of the MATRC states, visit Telehealth In My State and then select your state of interest where you will find a section on Medicaid.