Reimbursement for Remote Service DeliveryUpdated December 3, 2021, 11:28 AM
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.
See also: Use of Tele-Intervention in Early Intervention (IDEA Part C): Strategies for Providing Services Under the COVID-19 Public Health Emergency
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All fifty states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service. Some states have certain limits whether by type of service, type of provider/practitioner, or location of patient (family) – originating site.
The Center for Connected Health Policy (CCHP) – National Telehealth Policy Resource (NTPR) Center provides an interactive map that links to the Medicaid policies for each state reimbursement for telehealth.
Thirty-four states reimburse either a transmission, facility fee, or both. Of these, the facility fee is the most common. Some state policy includes that the reimbursement rate be equal to the amount that would have been reimbursed had the same service been delivered in-person.
The NTPR Center also includes a list of COVID-19 Related State Policy Actions related to telehealth, including expansion of the home being considered the originating site, allowing use of the telephone (not just video) and relaxing consent requirements. NTPR Center has produced a Webinar on State Telehealth Policy and COVID-19.
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:
- make decisions based on all available data,
- explore state and federal policies and requirements,
- consider and respond to issues related to Medicaid reimbursement,
- develop policies, procedures, and
- 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:
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.
See also: Additional Resources on Telehealth and Telepractice
COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children's Health Insurance Program (CHIP) Agencies (CMS, 2021)
This 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.
Forty states and DC currently have a law that governs private payer telehealth reimbursement policy. The Center for Connected Health Policy (CCHP) – National Telehealth Policy Resource (NTPR) Center website includes an interactive map to link to the private payor policies regarding each state's reimbursement for telehealth. The map below from CCHP shows the states that currently have private payor laws regarding telehealth.