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Improving Systems, Practices, and Outcomes

Reimbursement for Remote Service Delivery

The resources below provide information from national and state policies on tele-intervention/telehealth reimbursement. Telehealth is the most common term when it comes to reimbursement under Medicaid and private health insurance plans. However, states should contact their state Medicaid agency and the agency that oversees private health plans regarding billing and reimbursement requirements and guidelines.

All fifty states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service.

Some states set limits by:

  • type of service
  • type of provider or practitioner
  • location of patient (family)

Policy Trend Maps

The Center for Connected Health Policy (CCHP) — National Telehealth Policy Resource (NTPR) Center provides interactive policy maps that link to the policies for each state reimbursement for telehealth.

Telepractice for Part C Early Intervention Services: Considerations for Effective Implementation and Medicaid Reimbursement

This document, compiled by ECTA and DaSy in collaboration with ITCA, can support states in securing Medicaid coverage for telepractice as a method of service delivery beyond the public health emergency of the COVID-19 pandemic. To plan for the continued successful use of telepractice, states will need to:

  1. make decisions based on all available data,
  2. explore state and federal policies and requirements,
  3. consider and respond to issues related to Medicaid reimbursement,
  4. develop policies, procedures, and
  5. provide information and supports for families, providers, and state staff.

States can use the state examples, resources, and information in the four appendices to develop their own state-specific policies, procedures, and written guidance for using Medicaid dollars to reimburse for telepractice.

in collaboration with:

  • The Center for IDEA Early Childhood Data Systems (DaSy)
  • IDEA Infant and Toddler Coordinators Association

See also: Building the Case to Expand Medicaid and Private Insurance for Early Intervention

State Medicaid and CHIP Telehealth Toolkit Policy Considerations for States Expanding Use of Telehealth-COVID-19 Version

The Centers for Medicare and Medicaid Services' (CMS) April 2020 toolkit helps states identify policies that may impede the rapid deployment of telehealth when providing care. It provides issues for states to consider as they evaluate the need to expand their telehealth capabilities and coverage policies, such as telehealth eligibility for patient populations, providers and practitioners; coverage and reimbursement policies; technology requirements; and pediatric considerations.

COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children's Health Insurance Program (CHIP) Agencies (2021)

This CMS document answers questions about Medicaid and CHIP ranging from emergency preparedness to flexibilities in eligibility and enrollment, benefits, cost-sharing, managed care and health information exchange. On pages 73–76, questions 7–11 under telehealth may be particularly relevant to Part C and 619 programs concerning EPSDT, schools, and IFSPs/IEPs.