Telemedicine in Sexual and Reproductive Health
Appendix 1
| Reimbursement Requirements for Medicaid Programs and Private Payers Vary Widely State to State | |||||||
| Medicaid reimburses for the following telemedicine services… (Restrictions on services, conditions, providers and sites apply) |
Private payers reimburse (Restrictions apply) |
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| Live Video? | Store and Forward? | At-home Remote Patient Monitoring? | Email Phone Fax? | Home as originating site? | For some telemedicine services? | Telehealth at same rate as in-person care? | |
| AL | ✓ | X | ✓ Only for DM & CHF | X | X | X | X |
| AK | ✓ | ✓ | ✓ | X | X | X | X |
| AZ | ✓ Includes OBGYN, excludes abortion | ✓ Excludes OBGYN & primary care | ✓ For CHF | X | X | ✓ Excludes abortion | X |
| AR | ✓ Excludes abortion | X | X | X | X | ✓ Excludes abortion | ✓ |
| CA | ✓ | ✓ | X | Some | ✓ | ✓ | ✓* |
| CO | ✓ | Dental | ✓ | X | ✓ | ✓ | ✓ |
| CT | ✓ Behavioral health only | ✓ Provider to provider only | X | Some | X | ✓ | X |
| DE | ✓ | X | X | X | ✓ | ✓ | ✓ |
| DC | ✓ | X | Xb | X | X | ✓ | X |
| FL | ✓ Behavioral health only | X | X | X | X | ✓ | X |
| GA | ✓ | ✓ Ultrasound, X-ray, dentistry only | X | X | X | ✓* | ✓* |
| HI | ✓ | X a | X b | X | ✓g | ✓ | ✓ |
| ID | ✓ Includes primary care | X | X | X | X | X | X |
| IL | ✓ | X | ✓ Uterine monitoring and BP in pregnancy | X | X | ✓ | X |
| IN | ✓ Excludes abortion | X | ✓ | X | X | ✓ Excludes abortion | X |
| IA | ✓ Excludes abortion | X | X c | Some | X | ✓ Excludes abortion | X |
| KS | ✓ Excludes abortion | X | ✓ | X | X | ✓ Excludes abortion | Xd |
| KY | ✓ | Radiology only | X | X | ✓ | ✓ | ✓ |
| LA | ✓ | X | ✓ | X | X | ✓ | X |
| ME | ✓ | X | ✓ | Some | X | ✓ | Xd |
| MD | ✓ | ✓ | ✓ | X | ✓ | ✓ | X |
| MA | ✓ Behavioral health only | X | X | X | X | ✓ | X |
| MI | ✓ | X | X | X | ✓ | ✓ | X |
| MN | ✓ | ✓ | ✓ | X | ✓ | ✓ | ✓ |
| MS | ✓ | Radiology only a | ✓ | X | X | ✓ | X |
| MO | ✓ | X | ✓ Includes pregnancy | X | X | ✓ | X |
| MT | ✓ | X | X | X | ✓ | ✓ | X |
| NE | ✓ | Radiology only | ✓ | X | X | ✓ | X |
| NV | ✓ | ✓ | X | X | ✓ | ✓ | X |
| NH | ✓ | Xa,e | Xe | X | ✓ | ✓ | X |
| NJ | ✓ Behavioral health only | X a | Xb | X | ✓ | ✓ | ✓ |
| NM | ✓ | ✓ | X | X | X | ✓ | ✓ |
| NY | ✓ | ✓ | ✓ | X | ✓ | ✓ | X |
| NC | ✓ | X | X | X | X | X | X |
| ND | ✓ | X | X | X | X | ✓ | Xd |
| OH | ✓ | X | X | X | ✓ | ✓ | Xf |
| OK | ✓ | X | X | X | X | ✓ | X |
| OR | ✓ | Dental | ✓ | Some | X | ✓ | X |
| PA | ✓ | X | X | X | X | X | X |
| RI | ✓ | X | X | X | X | ✓ | X |
| SC | ✓ | X | ✓ | X | ✓ | X | X |
| SD | ✓ | X | X | X | X | ✓ | X |
| TN | ✓ Crisis-related only | ✓ | X | X | X | ✓ | X |
| TX | ✓ Excludes abortion | ✓ Only w/ real-time audio | ✓ Includes pregnancy | X | ✓ | ✓ Excludes abortion | X |
| UT | ✓ | X | ✓ | X | X | ✓ | X |
| VT | ✓ | X | ✓ For CHF | X | ✓ | ✓ | X |
| VA | ✓ Includes OB ultrasound | ✓ Excludes OBGYN & primary care | ✓ Includes DM in pregnancy | X | X | ✓ | X |
| WA | ✓ Behavioral health & dentistry | ✓ Excludes OBGYN & primary care | ✓ | X | ✓ | ✓ | X |
| WV | ✓ | X | X | X | X | X | X |
| WI | ✓ | X | X | X | X | X | X |
| WY | ✓ | X | X | X | ✓ | X | X |
| Total states | 50 + DC | 14 | 22 | 5 | 19 | 41 + DC | 10 |
| NOTES: Telemedicine services must typically be shown to be equivalent to in-person services to meet reimbursement requirements. CHF= Congestive heart failure *Law exists but not currently in effect.| a HI, MS, NH, NJ have laws requiring reimbursement for store and forward in Medicaid, however are not in effect or do not have corresponding policy indicating enforcement. b DC, HI, NJ have laws requiring reimbursement for remote patient monitoring in Medicaid, however are not in effect or do not have corresponding policy indicating enforcement. c Iowa supposed to start remote patient monitoring program in July 2019 for Medicaid Managed Care plans. d Reimbursement has to be determined “in a manner consistent with” in-person services, but does not mention that the payment needs to be the same. e NH voted to expand Medicaid coverage to store and forward and remote patient monitoring, effective in 2020. f Ohio recently passed HB 166 recently passed on 7/18/19, telemedicine services be reimbursed at the same rate as equivalent in-person services, for health benefit plans issues or renewed as of 2021. g In statute, HI includes a patient’s home as eligible originating site, but not included in Administrative Rules. SOURCE: Center for Connected Health Policy. Current State Laws & Reimbursement Policies. Updated Oct 15, 2019. |
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