CCHP: Telehealth Flexibilities Continued in the Spring of 2023

A new report from the Center for Connected Health Policy (CCHP) found that various changes in telehealth policies related to Medicaid reimbursement, private-payer laws, and professional requirements occurred at the state level in 2023.

Encompassing the period of January to March 2023, this spring report followed the standard process of organizing information under three headings: Medicaid reimbursement, private payer laws, and professional requirements. CCHP also noted the possibility of a state passing legislation following the composition of the report. In this case, the upcoming fall report will consider changes.

This report highlighted the changes in reimbursement for telehealth. In many states, Medicaid programs cover services besides live video visits, such as audio-only services. Although this growth has been ongoing for two years, many state Medicaid programs are now making coverage of audio-only services permanent. This often occurs through the addition of the 93-modifier, which proves the use of this modality.

In Nevada, for example, the state Medicaid program announced the allowance of audio-only care regardless of the state of the public health emergency. This flexibility only applied to specific telephone evaluation and management codes.

Various Medicaid programs also began using new telehealth services for certain situations. Nebraska Medicaid, for example, began covering continuous glucose monitoring for beneficiaries with diabetes on January 1, 2023.

Another common change relates to policies and billing practices. Given that the billing process can be complex, Medicaid programs began providing instructions for navigation.

An example occurred in Indiana, where Medicaid adjusted its Telehealth and Virtual Services Manual. These changes included adding assistive tools for billing federally qualified health centers (FQHCs) and rural health clinics (RHCs), among other tasks.

The report also detailed the general growth of telehealth regulations across state professional boards. As providers continue to discover ways to leverage telehealth technology, they adopt regulations. The Maine Board of Dental Practice, for example, adopted a new rule related to teledentistry.

The report described that cross-state licensing challenges are often addressed through interstate licensure compacts. Since fall 2022, various compacts related to audiology, counseling, and occupational therapy have gained member states. Through legislation, several states have also piloted new compacts.

As of the composition of this report, fifty states and Washington DC reimburse some form of live video in Medicaid fee-for-service. Also, although no additional states have engaged in reimbursement for remote patient monitoring since the fall of 2022, 34 state Medicaid programs continue to do so.

Amid the constant evolution of telehealth, CCHP composes summaries of ongoing state-level activities on a bi-annual basis. Although the organization intends to transition to an annual release beginning in the fall, a spring release provided information regarding telehealth progress in early 2023.

Prior research has also indicated that telehealth use often varies based on regional factors.

A study published in the American Journal of Managed Care in March, for example, found that telehealth use in mental healthcare facilities varies across states.

Researchers made this conclusion after reviewing data from the 2019 and 2020 Substance Abuse and Mental Health Services Administration National Mental Health Services Survey. With respondents coming from various US regions, researchers noticed inconsistencies in telehealth offerings across facilities. Those located in the West and South had a higher likelihood of offering telehealth compared to facilities in the Northeast and Midwest.

Although organizational characteristics likely had a marginal effect on telehealth adoption, these inconsistencies along with those across states also suggested disparities.