Medicaid Pays for Home Telehealth

According to the official line of the Centers for Medicare and Medicaid Services (CMS), the Medicaid program and Medicaid law do not recognize telemedicine as a distinct service. (See the telemedicine page, at: http://www.cms.hhs.gov/Telemedicine ) The CMS web site notes, however, that “Medicaid reimbursement for services furnished through telemedicine applications is available, at the state’s option, as a cost-effective alternative to the more traditional ways of providing medical care.” And it is noted on the CMS site that at least 18 states are allowing reimbursement for services provided via telemedicine. However, in fact, few of these states are reimbursing for home telehealthcare under Medicaid. Currently, only 2 U.S. states are allowing home healthcare providers to bill for telemedicine/telehealth services— Kansas and Minnesota.

We are only at the beginning of this story, though. Other researchers following the question of which U.S. states are paying for home telehealth note that Utah, for one, currently has a 2-year pilot for home telehealthcare underway, while a number of other states are close to implementing payment for Medicaid home telehealth in the next year or two: Arkansas, Colorado, New York, Pennsylvania, and South Dakota. Other states, such as North Carolina, are currently initiating pilot studies to compare the costs and effectiveness of conventional home care versus telehomecare. Iowa currently has a partial reimbursement plan through durable medical equipment home health providers operating in the state.
[This information has been generously provided by Mark Ross, CMS Medicaid offices; Robert J. Waters, Esq.; Sylvia Talkington, RN; and Lise Youngblade, Ph.D.]

How well are these and other U.S. states doing? Hard to say! Few providers/home health agencies have published details on their work in offering home telehealthcare under Medicaid. Anecdotally, one senior nurse at Gateway Health Plan, in Pennsylvania, notes that Medicaid patients using home telehealth are more truthful in reporting symptoms and status changes to their nurses and that more illiterate people have done well with the technology than was the case before use of telehealth.

However, beyond these generalities, good as they are, documentation of progress or good outcomes is out of reach. Tracking progress being made by states in their use of telehealth services is complicated by many factors. According to Dr. Lise Youngblade and her research team at the Institute for Child Health Policy, University of Florida, U.S. states vary in how they identify telemedicine services in their documentation, for which they use a combination of CPT codes and modifiers. In addition, these researchers note, coding inconsistencies make it difficult to track telemedicine utilization and expenditures. (See their publication: Institute for Child Health Policy (July 2005), Telemedicine for CSHCN [Children with Special Care Needs]: A State-by-State Comparison of Medicaid Reimbursement Policies and Title V Activities. Gainesville: Institute for Child Health Policy, University of Florida.)

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