Tag Archives: medicare

New Medicaid Rules Support Telemedicine


The Centers for Medicare & Medicaid Services have issued a decisive rule that collates the policies related to the responsibilities of the state Medicaid agency in practicing and supervising access to innovative methods of healthcare.

According to the rule, states are required to come up with an access-monitoring plan, so that proper access to particular health care services can be ensured. The rule further corroborates that the plan must comprise numerous points the states use to examine access to healthcare, including needs of patients, time, distance and accessibility of telemedicine.

The CMS has now made it mandatory for states to craft a complete access-monitoring plan by July 1, 2016. The rule clearly states that the plan must elaborate the method states will use to oversee adequate access of patients to a primary set of telemedicine services as a starting point. It also requires states to evaluate performance of these services after every three years. The plan would also be left open for public opinions and suggestions before submitting it for approval.

According to CMS, telemedicine is comparatively an affordable option for the provision of healthcare services that states must bring under Medicaid. It is worth mentioning here that the federal Medicaid statute does not deem telemedicine as a separate service.

So, after this rule is executed, patients would be able to access health care across state lines. This would not only improve healthcare services, but also provide patients easy access to highly talented specialists across state lines, and then get reimbursed for it. Likewise, physicians can get benefit of the plan by being reimbursed for remote patient services.

The Medicaid rule has made it obligatory for all service providers to operate telemedicine under the range of their State Practice Act. It is pertinent to note that some states require telemedicine service providers to get a license in the state where the patient is located before providing telemedicine services there.

In order to get reimbursed for Medicaid covered services, providers are also required to meet federal requirements of proficiency, affordability and excellence of healthcare. Moreover, states are supported to come up with groundbreaking payment gateways for telemedicine services. For instance, a state can reimburse the doctor or service provider at the remote location and reimburse the facility the patient used to access telemedicine.

States can also repay extra expenditures like the technical support and equipment used during the service in addition to the communication fees. These additional charges can be integrated into the service charges or billed and repaid as administrative fees. When they are billed and reimbursed independently, the cost would fall under the covered Medicaid services.

Medicare application form with stethoscope and paperwork

Does Medicaid and Medicare Cover Telemedicine?

Telemedicine, the remote delivery of healthcare services, is growing in popularity. It is vital and a cost-effective way to deliver care to homebound senior citizens and others who have limited access to a doctor due to being in remote locations or other constraints. It can eliminate the hassle of filling prescriptions and diagnosing common illnesses that can take up valuable physician time.

Today, many private insurance companies offer coverage for telemedicine services, and the number is growing daily. If you are on Medicare or Medicaid, you may be wondering if these services are available to you. The answer varies depending on where you live.

If you are on Medicare, the answer is yes, under certain circumstances. There are many telemedicine services including pathology, radiology, cardiology, and others that are covered under the umbrella of “physician services.”

For people who live in rural areas, Medicare will cover physician services using telemedicine, including video-conferencing for a traditional fee for service basis. For the 14 million people who are a part of the Medicare Advantage plan, there is quite a bit of flexibility in using telemedicine as long as this service is offered by their provider.

As of now, the American Telemedicine Association (ATA) is pushing the federal government, the Centers for Medicaid, and Medicare to remove all restrictions that limit telemedicine coverage.

If you are on Medicaid, almost every state provides for some type of telemedicine services. But available services can vary greatly from state to state. As of now, the ATA is also pushing each state to fully cover telemedicine services as a way to increase coverage and reduce overall costs.

Click here to see a state by state analysis of telemedicine gaps, coverage, and reimbursement. If you need more specific information on telemedicine for the state you live in, click here.

In conclusion, the answer to whether Medicaid and Medicare cover telemedicine is a tentative yes, depending on where you live. If you have a policy with a private insurance firm in addition to Medicaid and/or Medicare, 24 states plus the District of Columbia require these insurance companies to cover telemedicine services the same as they would an in-person visit to the doctor. (Ask your benefits manager of your insurance policy to find out if you have this benefit).

There is hope for those who like to look forward, as current Democratic front-runner Hillary Clinton has come out in support of telemedicine, so help for those who lack coverage may soon be on the way.