Medicaid Guidance from the Centers for Medicare and Medicaid Services
For purposes of Medicaid, telemedicine seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.
Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy, and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, states may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service.
CMS continues to issue and update guidance for states seeking to expand telehealth for Medicaid in response to the COVID-19 public health emergency. It is important to note that this guidance does not create new policy, but reminds states about the flexibility that exists in the Medicaid program. While Medicaid is jointly funded by federal and state governments, states have flexibility in designing and administering their program. This flexibility has created a great deal of variation in telehealth laws and reimbursement policies.
Recent federal guidance on teleheath in Medicaid:
- FAQs for State Medicaid Agencies and CHIP Agencies – Updated May 5
- Telehealth Toolkit to Accelerate State Use of Telehealth in Medicaid and CHIP – Updated December 6
- April 2 Rural Health Medicaid Telehealth Flexibilities and Medicaid SUD Treatment via Telehealth Guidance
- March 17 Medicaid Telehealth Guidance
- General Medicaid Telehealth Guidance
Please note that the Alliance has several pages devoted to state policy that may be relevant to Medicaid, including: