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State by State Telehealth Coverage Update

July 17, 2018

Challenges of telemedicine

Insurance companies and CMS will be expanding telehealth coverage, as well as refining the definitions of what constitutes telehealth care and provider qualifications and restrictions based on new laws. Here are some of the latest telehealth changes from state and federal lawmakers:

What telehealth billing and coverage changes are taking place among states?

In 2017, nine states enacted legislation resulting in 11 significant policy changes scheduled to take effect in 2018. Among these were:

Arkansas The AR Telemedicine Act amends telemedicine’s definition, as well as originating site, requirements for a professional relationship when using telemedicine, setting standards for appropriately using telemedicine and establishes insurance overage guidelines for telemedicine.

California – The two bills in California (AB 205 and SB 171) would permit Medi-Cal managed care plans to ask for alternative medicine standards via e-visits or telemedicine.

Colorado Colorado’s SB2017 will create a behavioral health crisis response system, including the walk-in centers mobile response units of crisis service facilities and addresses telehealth’s role in those situations.

Illinois In 2018, two new bills will take effect: HB 2907 permits patients receiving telepsychiatry or similar medical services will not need a physician to be physically present. The new Telehealth Act was created with the passage of SB 1811, which allows healthcare providers to utilize telehealth in a manner consistent with in-person care standards within the scope of his or her practice.

Montana Insurance coverage for teledentistry was mandated by SB 129.

Oregon – Recent legislation to take effect in 2018 permits dental care providers to engage in telehealth when appropriate and within the provider’s scope.

Tennessee The passage of HB 664 allows licensed physicians to practice medicine across state lines as defined in the Interstate Medical Licensure Compact (IMLC) so long as they meet the eligibility criteria, with approximately 80 percent of physicians already doing so.

Texas Definitions of telehealth and telemedicine as well as what constitutes a patient-practitioner relationship for the purpose of telemedicine healthcare services are set forth in HB 1107.

Washington The recent HB 5436 defined where patients may receive telehealth services, as well as expanded reimbursement from private payers.

How will recent federal laws affect telehealth coverage?

There was some positive news coming from Congress in the form of the Bipartisan Budget Act of 2018 and which was signed into law earlier this year. Five ways in which telehealth coverage regulations will change for the better (especially for Medicare Advantage users) are now being implemented by hospitals and clinicians:

1. Beginning on January 1, 2020, a patient’s home now qualifies as an Eligible Originating site for Accountable Care Organizations (ACOs), giving participating physicians and practitioners more flexibility when providing telehealth services.

2. Medicare will reimburse for telehealth dialysis services both at an independent facility as well as at the patient’s home. Effective January 1, 2019, patients with end-stage renal disease (ESRD) now receiving home dialysis may also opt for monthly ESRD oversight visit to their home as long as the patient receives an in-person visit at least once a month during the initial three months of home dialysis. After this period, a face-to-face visit is required at least once every three months.

3. Physicians and other qualified providers can now give free telehealth equipment or other technology to patients receiving at-home dialysis which is reimbursable by Medicare.  As long as the following conditions are met, the Civil Monetary Penalties Law will not have been violated:

  • The telehealth technologies are not part of an advertising or solicitation campaign.
  • The technology is provided for the individual’s ESRD by furnishing telehealth services.
  • The provisions for the telehealth technology meet any other regulations set by the CMS.

4. Some of the most significant changes to telehealth services included in the Bill include expanding coverage for stroke telemedicine, by removing many of the originating site restrictions for telestroke care. Starting January 1, 2019, facility and geography requirements for originating sites will not apply for evaluation, diagnosis or treatment of acute stroke symptoms if delivered at certain sites, such as a hospital, critical-access hospital, mobile stroke units or other sites determined appropriate by the Health and Human Services Department (HHS). The patient’s own home is under consideration as an originating site as well.

5. Historically, Medicare Advantage (MA) providers have not been as quick to cover telehealth to the extent offered by some other managed plans. This will soon change as MA plans will be able to now offer telemedicine benefits beyond what would be payable under Medicare Part B.

Telehealth survey updates and takeaways

According to a recent survey update by Epstein Becker Green, CMMS reported a 28 percent increase in Medicare payments for ntelehealth services. Following additional telehealth private payer legislation in 31 states as well as the District of Columbia, leads HHS to estimate that 61 percent of healthcare institutions and providers are using some form of telemedicine services.

The report also mentioned that five states in particular, including New Jersey, New York and West Virginia, had expanded telepsychiatry services. These included expanded access to mental and behavioral medications, clarification of telemedicine mental health services (New York) that expanded statements on the state’s health department website into new rulings. 

One important note: providers practicing in more than one state need to be especially aware of each state’s licensure, insurance and telehealth / telemedicine laws, including prescriptions, to ensure full regulatory compliance.

How can a medical billing service help with telehealth billing?

Since 2002, M-Scribe has helped practices improve their reimbursement revenues through experienced staff working with the latest technology. Always on top of the latest regulations and trends, we can work with whichever software your practice uses.

Because telehealth billing is evolving and will continue to do so as technological advances change the face of medical care delivery, partnering with M-Scribe is one of the smartest moves a practice can take. Contact us at 888-727-4234 or email for a free analysis of your practice’s needs and revenue goals.


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