Policy trend maps

Much of CCHP’s work is dedicated to identifying and tracking how different definitions of telehealth influence policy across the US. This is a snapshot of some of our findings. Please note: there are nuances in many of the policies. To fully understand a specific policy and all its intricacies, the full language of it must be read.

Out-of-State Telehealth Provider Policies

CCHP has attempted to organize out-of-state telehealth provider policies by state into two main categories as a starting point in understanding the primary types of licensure policies that may allow out-of-state telehealth provider practice: Limited Licensure Exceptions and Telehealth License/Registration Processes. The map below also notes the states that fall into both categories. Limited Licensure Exceptions capture any kind of exception, no matter how limited or specific, including provider-to-provider consultation exceptions as well as broader allowances related to established relationships, infrequent interactions, and/or certain types of care. In addition, Telehealth License/Registration processes may not always be active, but some type of authority or process was found to exist in state policy. The map is not meant to be definitive and it is important to look at each state law closely to determine how to meet their particular requirements. This information is based on the latest updates to CCHP’s Policy Finder made between May 2024 and September 2024. Note that most states also participate in interstate licensure compacts, which also allow practice across state lines. Please view CCHP’s Licensure Compacts page to view state compact membership.

No out-of-state licensing policies found (states may still participate in Compacts)
Limited Licensure Exceptions
Telehealth License/Registration Process
Both Limited Licensure Exceptions AND Telehealth Licensure/Registration Process

Live Video Medicaid Reimbursement

Fifty states, Puerto Rico, and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. The Virgin Islands do not indicate they reimbursement for live video in their Medicaid programs. The most predominantly reimbursed form of telehealth is live video, with every state offering some type of live video reimbursement in their Medicaid program. However, what and how it is reimbursed varies widely with some Medicaid programs limiting the types of reimbursable services and placing additional requirements and restrictions such as provider type and originating site stipulations. Map based on research conducted between late May to early September 2024.

No live video reimbursement
Live video reimbursement

Store and Forward Medicaid Reimbursement

Thirty-seven state Medicaid programs reimburse for store-and-forward.  This number does not include states that only reimburse for teleradiology. Of those states that do reimburse for store and forward services, some have limitations on what qualifies for reimbursement. The states that only allow store-and-forward reimbursement through CTBS are identified with the color purple in the map. Map based on research conducted between late May to early September 2024.

No reimbursement for Store and Forward
Reimbursement for Store and Forward
Store and Forward only reimbursed through CTBS

Remote Patient Monitoring Medicaid Reimbursement

Forty-two state Medicaid programs provide reimbursement for RPM. Many of the states that offer RPM reimbursement also have a multitude of restrictions associated with its use.  The most common of these restrictions include only offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected. States that only allow remote patient monitoring through CTBS are identified with the color orange in the map. Map based on research conducted between late May and early September 2024.

No reimbursement for Remote Patient Monitoring
Remote Patient Monitoring only reimbursed through CTBS
Reimbursement for Remote Patient Monitoring

Telephone Medicaid Reimbursement

Forty-five states and DC Medicaid programs reimburse for audio-only telephone in some capacity; however, often with limitations.  Sometimes Medicaid programs only reimburse specific specialties such as mental health, or for specific services such as case management. Map based on research conducted between late May to early September 2024.

No reimbursement for telephone
Reimbursement for telephone

Facility Originating Site Restrictions

Restricting reimbursable telehealth services to only rural or underserved areas is decreasing, but it’s still fairly common for state Medicaid programs to limit the type of facility that may be an originating site, which can either include or exclude the home or school as a reimbursable site. Currently, 15 states and DC have a specific list of sites that can serve as the originating site for a telehealth encounter. Map based on research conducted between late May to early September 2024.

 

No specific originating site list or restriction
Has a billable originating site list or restriction

Transmission & Facility Fees

Thirty-four states will reimburse either a transmission, facility fee, or both. Of these, the facility fee is the most common. Policies often stipulate a specific list of facilities eligible to receive the facility fee. Map based on research conducted between early May and late September 2024.

Does not reimburse
Transmission / facility fee reimbursed

Private Payer Laws

Telehealth private payer laws is one of the areas of telehealth policy that has seen the most growth since our first report in 2012.  Though no new states have added private payer laws since Fall 2022, a few states did make adjustments to their existing private payer laws. Forty-four states, Puero Rico, the District of Columbia and Virgin Islands have a private payer law that addresses telehealth reimbursement. Additionally, twenty-three of these states have an explicit requirement for payment parity within the law. States with payment parity are identified in the map with the color green. Map based on research conducted between late May and early September 2024.

Private payer law does not exist
Explicit payment parity for at least one specialty
Private payer law exists

Consent Requirements

Forty-seven states, the District of Columbia and Puerto Rico include some sort of informed consent requirement in their statutes, administrative code, and/or Medicaid policies. This requirement can sometimes apply to the Medicaid program, a specific specialty or all telehealth encounters that occur in the state, depending on how and where the policy is written. In Medicare this requirement is exclusive to communication technology-based service (CTBS) codes where the patient needs to be made aware of any cost sharing responsibility. Map based on research conducted between late May to early September 2024.

No Requirement for a Telehealth Specific Consent
Requirement for Telehealth Specific Consent