34 States, DC Offer Some Reimbursement for Audio-Only Telehealth

According to a recent report from the Center for Connected Health Policy (CCHP), various changes in telehealth policies have occurred since spring 2022, including five states adding Medicaid reimbursement for audio-only services, which brings the total number of states and territories paying for this modality to 35. 

Recently, the rise in demand for telehealth services amid the COVID-19 pandemic resulted in several policy changes at the federal and state levels. To track these changes, CCHP reviews state telehealth laws and Medicaid program policies several times a year.

In the report from the fall of 2022, CCHP found several changes that occurred since the spring of 2022. All data in the report came from an examination of state laws, state administrative codes, and Medicaid provider manuals from July to early September 2022.

The report noted that states continue to have varied telehealth policies.

For example, Medicaid telehealth policies differ among states with regard to service requirements. In some states, the delivery of any type of Medicaid service through telehealth is permitted. However, other states have a stricter approach and only allow certain types of services to occur virtually.

The report also provided details regarding Medicaid reimbursement policies, many of which changed due to the COVID-19 pandemic.

CCHP found that the Washington Medicaid program reimburses speech language pathology under Applied Behavioral Analysis. In the past, this state reimbursed live video telehealth; however, covering this particular service is new.

In addition, the report shows that 34 states and the District of Columbia Medicaid programs reimburse for audio-only telehealth services, with some limitations. The number of states reimbursing for audio-only services increased by five since spring 2022.

While all 50 states and D.C. provide Medicaid fee-for-service reimbursement for some form of live video, only 25 reimburse for store-and-forward telehealth and 24 for remote patient monitoring.

Further, only 17 state Medicaid programs reimburse for all four modalities — live video, store-and-forward, remote patient monitoring, and audio-only — though there may be some limitations. 

The report also stated that telehealth policy changes within Medicaid were more common than in private payer laws. Forty-three states, D.C., and the Virgin Islands have a private payer law for telehealth reimbursement, but only 24 have explicit payment parity provisions.

Another significant concept noted in the report was the growing adoption of cross-state licensure exceptions, with 10 states adding policies since the spring of 2022. For example, in Illinois, services related to social work now have a licensing exception that allows nonresidents to receive these services through telehealth. However, this comes with a time limit of five days in any one-month or 15-day period in a year, along with the requirement of a previously existing relationship between the patient and provider.

Amid evolving state and federal telehealth policies, healthcare organizations have pushed for permanent regulations that increase access to virtual care.

For example, in September, 375 organizations submitted a request to Congress for a telehealth policy extension. Composed by the American Telemedicine Associated and ATA Action, the letter urged the US Senate to allow for a two-year extension of telehealth flexibilities and waivers.