Legislative Variations in Telehealth Reimbursement Across U.S. States

As an increasing number of countries incorporate telemedicine reimbursement into their legislation, the United States is also set to make significant adjustments in 2016 to its laws governing anticipated reimbursements and insurance policies.

To date, 29 states and the District of Columbia have enacted legislation requiring private insurers to provide reimbursement for telemedicine services on par with that for in-person medical care, provided such care is deemed medically necessary. Many of the laws passed in 2015 will take effect in January 2016.



Over the past year, 42 states have introduced more than 200 pieces of legislation related to telemedicine. Although there are significant differences among these 200+ bills, four common telemedicine services are being considered for inclusion in legislation by most states:

1. Synchronize audio and video

Due to telemedicine reimbursement policies and practice guidelines, real-time audiovisual communication is considered an essential component of telemedicine services. In practice, however, most states accept asynchronous transmission of interactive audio along with patients’ medical information data. In many cases, synchronous audiovisual interaction is neither feasible nor necessary for medical care (for example, both telehealth and telemedicine employ asynchronous technologies). Nevertheless, even for synchronous audiovisual communication, there are variations among states regarding when, where, and how these services are covered. For instance, some states allow patients to receive video consultations from any location, while others restrict coverage to eligible local patients or those in remote rural areas. The prevailing trend, however, is to eliminate these artificial barriers to equity by reimbursing telemedicine consultations regardless of the patient’s location.

2. Remote Patient Monitoring

In essence, remote patient monitoring (RPM) is not equivalent to in-person services. Consequently, few states include RPM in their commercial insurance laws, with the exceptions of Delaware and Mississippi. Similarly, fewer than 24 states offer RPM services under Medicaid fee-for-service (FFS) plans. Entering 2016, as taxpayers and providers recognized the significant cost-saving benefits of telehealth for patients with chronic diseases, there was momentum to promote the development of telehealth and the diffusion of home health care models. Therefore, it is certain that more legislative mandates requiring coverage for RPM will emerge in the future. Another point worthy of attention is that states with outdated telehealth reimbursement laws may see providers advocating for updates to legislation that includes RPM. A comprehensive overview of each state’s telehealth regulatory framework is detailed in the July 2015 report by the Center for Health Policy.

3. Asynchronous (Store-and-Forward)

Only a few states permit the storage, forwarding, and dissemination of electronic medical information, including pre-recorded videos, images, and documents, because in most states, telemedicine is defined as “occurring in real time” or “using live video.” Fewer than 12 states explicitly require commercial insurance laws to allow reimbursement for store-and-forward telemedicine services.

4. Interstate Services

Another constraint on the expansion of telemedicine is state physician licensing requirements, which prohibit physicians from practicing across state lines without formal authorization. Whether state licensing truly constitutes a barrier to the development of telemedicine remains to be seen, as many healthcare institutions have already established (or are in the process of establishing) robust multi-state collaborative telemedicine services, operating under professional licenses in the states where patients are located. Currently, 11 states have adopted the Interstate Medical Licensure Compact developed by the Federation of State Medical Boards (FSMB), with legislation pending in nine additional states. Although its effective date remains undetermined, change is underway. In conjunction with revised Medicare regulations, favorable state laws, and medical board rules, it is expected that the United States will see a significant increase in the accessibility and practical utility of telemedicine in 2016.

Compiled by: Chen Kun

Editor: Zhang Nan