Medicaid Reimbursement For Telehealth Services Is Expanding

Medicaid Reimbursement For Telehealth Services Is Expanding

Medicaid Reimbursement For Telehealth Services

While telehealth for Medicaid patients isn’t a new tool, the delivery methods are certainly changing as access to technology increases. For many years, most Medicaid plans followed CMS guidelines that required that patients present to an “originating site” or a healthcare facility to connect with a remote provider. A recent evaluation of Medicaid plans throughout the country, however, indicates a major shift toward home-based care. While Medicare still strictly enforces originating site restrictions as well as restrictions for rural areas, many Medicaid plans are taking a more forward-thinking approach.

What Is An Originating Site?

An originating site is a medical office, hospital or affiliated site that facilitates telemedicine care for patients who can present in person. While originating site-based telemedicine can be valuable for increasing provider availability and delivering specialty care into underserved areas, it does not bridge what is often the largest barrier in access to care-transportation. Patients still struggle to present to the originating site, and they are often required to rely on transportation services with limited availability that can only transport the patient. By switching to home-based care delivery, patients are able to bypass transportation barriers while still receiving high-quality care for many diagnoses.

Changes To State Rules Have Made It Possible

According to the Center For Connected Health Policy’s State Telehealth Laws and Reimbursement Policy publication, Medicaid plans in 10 additional states now recognize the home as a valid originating site. Colorado, Delaware, Maryland, Michigan, Minnesota, Missouri, New York, Texas, Washington and Wyoming have all opted to forego facility-based care and enable patients to receive care in the home when medically appropriate.

Still a Long Way To Go

While the change is big move in the right direction, there are still many states who don’t allow care in the home for this often-underserved population. The report provides hope but notes that there is a long way to go to realizing full parity for all payers across the country. Some of this is significantly limited by state law while others still report significant disparity for reimbursement due to a lack of payment parity.

Schools Are Now An Option

One indication that we are moving toward more patient-focused care is the intermediate step of offering school-based telemedicine for students. According to the report, 16 states have now include schools as valid originating sites. One of the biggest barriers in providing school-based care, however, is the access to consent from parents and custodial adults. Telemedicine care often cannot be provided in school if there is no signed consent on file. By working with a solution like Mend, providers and schools can communicate seamlessly with parents to receive updates and request consents without the parent leaving work or being there in person. While school-based telemedicine does not apply to all patients or providers, it does provide a huge option to treat often underserved children in a location where they are already present. There is evidence to support improved treatment of chronic disease in children due to school-based telemedicine, and state Medicaid plans do appear to be shifting to accommodate this.

Telemedicine In The Home Is Becoming More Prevalent

While it’s not a perfect landscape, the access to telemedicine-based care in the home for patients with Medicaid is progressively getting more realistic. The increase in coverage and reduction in states with strict originating site requirements makes a large difference in the ability to deliver care. Now that smart phones, computers and high-speed internet connections can deliver low-cost internet into homes, patient not only have access to communication, but they are emerging as an appropriate, targeted group for telehealth in the home. As this innovation continues, we can expect more states and more payers to accept low-cost telemedicine alternatives to in-person care.


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