Exploratory Study of Telemedicine Medicaid Reimbursement Status : Participating and Non-Participating States and Its Impact on Idaho's Policy Making Process
Type of Culminating Activity
Master of Health Science Health Policy
Sarah Toevs, Ph.D.
Uwe Reischl, Ph.D, M.D.
Beth Hudnall Stamm, Ph.D.
Diane Yarrington, MHSA
Although Medicare is currently reimbursing for services provided through telemedicine, advocates are struggling to increase reimbursement through state Medicaid agencies. Those advocating for Medicaid telemedicine reimbursement have been active forming a statewide network in the state of Idaho. They have been working with policy makers to establish a good working relationship, providing information and support during the process. With the developing interest in the technology in the academic, private, and legislative community, a window of opportunity has opened and allows for minimal movement in a positive direction.
A common practice in the state of Idaho is to research what other states are doing before significant policy changes are made. As a result, a literature review was conducted, and although an abundance of information was found, it was mostly informational. The Centers for Medicare and Medicaid Services (CMS) web site provided information on what other states were doing, but the information was outdated. Telehealth is a relatively new technology and has experienced rapid change in both the clinical and policy end.
In an effort to gather current information on the direction of policy decisions in state Medicaid agencies, a policy survey was conducted. Electronic surveys were sent to participating and non-participating states to explore telemedicine Medicaid reimbursement status. Reponses were received from 10 of the 25 states providing Medicaid telemedicine reimbursement and 17 of the 25 states and one US territory, not providing reimbursement. Data gleaned from participating states concerned providers, reimbursement, allowable services, and modification of reimbursement codes. Data gleaned from non-participating states indicated an interest in reimbursing for telemedicine and a need to enhance advocate and state Medicaid agency relationships. In addition, results demonstrated the need to provide evidenced-based information on cost benefit analysis of the viability of Medicaid reimbursement.
The information gathered from the research was used to develop Idaho’s Interactive Video Telemedicine Protocols. These protocols were based on the major barriers and fears that were identified in the research of Medicare reimbursement (lack of reimbursement, licensure across state lines, provider credentialing/certification, malpractice, fraud and abuse, quality of care, outcomes, standards of care, cost effectiveness, safety of telemedicine, patient privacy—HIPAA, technology changes, focus on technology vs. patient care) and the additional major issue identified for state Medicaid agencies (budgetary concerns).
Gray, Gayle A., "Exploratory Study of Telemedicine Medicaid Reimbursement Status : Participating and Non-Participating States and Its Impact on Idaho's Policy Making Process" (2003). Boise State University Theses and Dissertations. 1204.