Last Modified: 02/13/2017
VIII Reimbursement Issues for Ti
Given the rapid adoption of telehealth and tele-intervention, reimbursement for this mode of delivery also is rapidly changing. The typical sources of reimbursement for early intervention services are Medicaid, private insurance, and Part C. This section provides links to further information to pursue reimbursement from these sources.
Telehealth Resource Centers
Telehealth Resource Centers (TRCs) assist organizations, providers and communities in implementing cost effective and sustainable telehealth programs. TRCs are HRSA- designated focal points for information and resources to advance the use of telehealth, including issues regarding reimbursement. The Telehealth Resource Centers are supported by grants from the Office for the Advancement of Telehealth.
You can also contact any of the regional centers listed below:
- California Telehealth Resource Center
- Phone: 877.590.8144
- Great Plains Telehealth Resource & Assistance Center
- Phone: 888.239.7092
- Heartland Telehealth Resource Center
- Phone: 877.643.4872
- Mid-Atlantic Telehealth Resource Center
- Phone: 855.628.7248
- Direct: 434.906.4960
- National Telehealth Policy Resource Center
- Phone: 877.707.7172
- Direct: 916.285.1860
- National Telehealth Technology Assessment Resource Center
- Phone: 877.885.5672
- Direct: 907.729.4703
- Northeast Telehealth Resource Center
- Phone: 800.379.2021
- Northwest Regional Telehealth Resource Center
- Phone: 888.662.5601
- Pacific Basin Telehealth Resource Center
- Phone: 808.692.1250
- South Central Telehealth Resource Center
- Phone: 855.664.3450
- Southeast Telehealth Resource Center
- Phone: 888.738.2210
- Southwest Telehealth Resource Center
- Phone: 520.626.4498
- TexLa Telehealth Resource Center
- Phone: 877.391.0487
- Direct: 806.743.4440
- Upper Midwest Telehealth Resource Center
- Phone: 855.283.3734
The Northwest Regional Telehealth Resource Center has a useful article discussing how one state was able to get a telehealth parity law passed.
Learn the steps [PDF]
As an example of information offered by these telehealth centers, The California Telemedicine and eHealth Center has published a report entitled: Telemedicine Reimbursement: A National Scan of Current Polices and Emerging Initiatives [PDF]. This report provides an overview of telemedicine reimbursement across the country from both private and public insurance programs.
- The Center for Connected Health Policy helps you stay informed about telehealth-related laws, regulations, and Medicaid programs. They cover current and pending rules and regulations for the U.S. and all fifty states. Find up-to-date state-specific information at their website.
- State Telehealth Laws and Reimbursement Policies: A Comprehensive Scan of the 50 States and the District of Columbia, by the Center for Connected Health Policy [PDF]
The Centers for Medicare and Medicaid Services Facilitates Reimbursement
The Centers for Medicare and Medicaid Services (CMS) recently issued official written guidance announcing that states can unilaterally reimburse for telemedicine without the need for further approval by the CMS. This guidance is significant because now states can easily access federal education funds through a simple regulatory change at the level of their Medicaid department, making telemedicine services more accessible and affordable to students and schools in need.
"Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states can choose to cover under Medicaid.” This definition is modeled on Medicare's definition of telehealth services (42 CFR 410.78). Note that the federal Medicaid statute does not recognize telemedicine as a distinct service. Learn more at Medicaid.gov.
Northwest Telehealth Resource Center
The Northwest Telehealth Resource Center has several documents that provide guidelines for requesting reimbursement from Medicare and Medicaid, such as the “ATA Strategies for Medicaid Reimbursement.”
Private Insurance Reimbursement
State legislation can also help ensure that private insurance covers tele-intervention. For example, advocates in Maine recently worked to ensure the passage of legislation to ensure private coverage for telepractice.
Part C Reimbursement
Each state’s Part C Early Intervention program determines their policies regarding the reimbursement of direct services, and this holds true for the reimbursement of tele-intervention services as well. It is important that new programs about to embark on tele-intervention communicate with their state’s Part C program to ensure their approval of providing TI and their provision of reimbursement for direct services. A recent publication summarizing state Part C coordinators that reported the implementation and reimbursement of tele-intervention [PDF] is provided here.