Telemedicine, often called telehealth, is defined as a two-way, real-time, audio and video connection between a patient and a healthcare provider.

 

Definitions:

Hub and Spoke - A telemedicine connection where the originating site is a health care facility. Typically this is a patient and health care provider in one clinic that connect with an additional provider in another.

Facility to Field - A telemedicine connection where the originating site could be anywhere, but there is some sort of health care provider or telepresenter with the patient.

Direct Connection - A telemedicine connection where the originating site could be anywhere, and there is no health care provider or telepresenter presence required.

 

Private Insurer Parity - Full parity is classified as comparable coverage and reimbursement for telemedicine-provided services to that of in-person services.

Originating Site - Where the patient is located.

Distant Site - The remote location of the provider the patient is communicating with.

Telepresenter - A qualified person who must be present with the patient at the originating site.


Connecticut 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Connecticut Medicaid program will cover telehealth services that the commissioner determines are (1) clinically appropriate to be provided by means of telehealth, (2) cost effective for the state, and (3) likely to expand access to medically necessary services for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.


Maine

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Maine Medicaid places no limits on patient setting, covered services, or eligible providers. However, providers must receive pre-authorization from MaineCare for telehealth services.


Massachusetts

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

Medicaid in Massachusetts offers telemedicine coverage under select managed care plans but not under Fee For Service.


New Hampshire

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoNoYes
Direct ConnectPartialPartialYes

New Hampshire Medicaid follows Medicare telehealth reimbursement policies.


New Jersey

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoNoNo
Direct ConnectPartialNoNo

New Jersey Medicaid only covers telepsychiatry. The originating site must be a mental health clinic or outpatient hospital, and the only eligible providers are psychiatrists and psychiatric advanced nurse practitioners.


New york

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoNoYes
Direct ConnectPartialPartialYes

New York Medicaid limits originating sites to approved facilities, but has a provision allowing for remote patient monitoring. New York Medicaid will reimburse for live video services for medically necessary services provided to patients in:

  • Hospitals (emergency room, outpatient department, Inpatient) established under Article 28 of the New York Public Health Law

  • Diagnostic and Treatment Centers (D&TCs) established under Article 28 of the New York Public Health Law

  • FQHCs that have "opted into" NY Medicaid Ambulatory Patient Groups (APG)

  • Non-FQHC School Based Health Centers (SBHCs)

  • Practitioner offices

  • Article 28 facilities providing dental services

Providers who may deliver telemedicine services include:

  • Physician specialists, including psychiatrists

  • Certified Diabetes Educators (CDEs)

  • Certified Asthma Educators (CAEs or A-ECs)

  • Clinical psychologists

  • Dentists

  • Psychiatric Nurse Practitioners

  • Genetic Counselors

  • Licensed Clinical Social Workers (LCSW) and Licensed Master Social Workers (LMSW) only when employed by an Article 28 clinic.  LCSWs and LMSW can only provide services to Medicaid enrollees under age 21 and pregnant women up to 60 days post-partum.

For the Home Telehealth program, a telehealth provider is:

  • Licensed physician

  • Licensed physician assistant

  • Licensed dentist

  • Licensed nurse practitioner

  • Licensed registered professional nurse

  • Licensed podiatrist

  • Licensed optometrist

  • Licensed psychologist

  • Licensed social worker

  • Licensed speech language pathologist or audiologist

  • Licensed midwife

  • Certified diabetes educator

  • Certified asthma educator

  • Certified genetic counselor

  • Hospital

  • Home care services agency

  • Hospice

  • Or any other provider as determined by the Commissioner.

New York’s private insurer parity law does not have originating site restrictions, allowing for much greater freedom in offering telemedicine services.


Pennsylvania

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoNoNo
Direct ConnectPartialNoNo

Pennsylvania Medicaid only reimburses for mental health services and services provided by:

  • Physicians

  • Certified Registered Nurse Practitioners

  • Certified Nurse Midwives

A telepresenter is required, ruling out direct connections.


Rhode Island

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialYes
Direct ConnectPartialPartialYes

Rhode Island Medicaid has included coverage for the following billable telehealth codes in the fee schedule: G0406 - G0408, and G0425 - G0427.


Vermont

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

Vermont Medicaid places no restrictions on the originating site, but requires documentation for the reason the service is being provided via telemedicine. Only services regarded as Primary Care, as defined by the state, are covered. Vermont’s private insurer parity law limits telemedicine coverage to services provided in health care facilities only.