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An OPEN MINDS Market Intelligence Report

Telehealth is a term used by many, but in different ways. The definition can vary between payers and organizations, but generally, telehealth is defined as the methods and technologies used to deliver health care services in a virtual environment. Telehealth as a means of service delivery is reimbursed by all payers in some form or another. However, the restrictions, rules, and requirements vary by payer and by state.

In the past, telehealth has been primarily delivered through the “hub and spoke” model, which uses two-way audio and video communication between health care sites. This can include video conference between patient and health care provider for assessments and history taking, teleconference between individuals or groups exchanging health services or health education, and transmission of medical data for diagnosis. Although this model is still widely useful, the use of other types of telehealth technologies are gaining prominence. These technologies can include remote monitoring technologies, use of health, mobile apps and services, robot-delivered assistance, and telehealth kiosks at pharmacies and other locations.

Which telehealth services are covered and how they are reimbursed depends on the payer. The rules governing telehealth policy for Medicare fee-for-service (FFS) plans in the 48 continental states are fairly strict and very specific about where and how telehealth can be utilized. The other three Medicare financing models—lift some of the restrictions to allow for easier access to telehealth. On the other hand, state Medicaid programs have the ability to choose whether or not to reimburse for services covered via telehealth. States choose what services can be delivered via telehealth. States choose what services can be delivered via telehealth, where telehealth services can be delivered, and who can deliver telehealth services. Restrictions on the services that can be delivered via telehealth varies greatly from state to state. Some states will reimburse for nearly all services under the state plan while some states only allow very specific services to be reimbursed.

OPEN MINDS’ research team reviewed payer policies and how telehealth is defined. The report specifically assesses policies put in place by Medicare and Medicaid to reimburse telehealth services.

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