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.


Delaware 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Medicaid in Delaware covers any service included in the plan the same as a face to face visit, however, detailed guidelines have been created for 2017.


Florida

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesNo
Facility to FieldNoYesNo
Direct ConnectPartialYesNo

Florida Medicaid includes coverage for all licensed providers within their scope of practice. There are no restrictions on patient setting.


Georgia

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Georgia Medicaid imposes restrictions on the patient settings, covered services and designates eligible distant site providers and provider settings as a condition of payment. Medicaid also places frequency limits on some covered telemedicine services. Requires written informed consent and a provider on the premises.

Eligible services:

  • Office visits

  • Pharmacologic management

  • Limited office psychiatric services

  • Limited radiological services

  • A limited number of other physician fee schedule services

  • Mental health services for residents in nursing homes via telemedicine (although not available in all areas of the state) for dual eligibles (Medicaid and Medicare)

  • Nursing facilities and community behavioral health rehabilitation (CBHRS) service providers can arrange for the provision of specialized services to residents either in nursing facilities, via telemedicine or at the CBHRS location for residents in the Preadmission Screening and Resident Review Serious Mental Illness and dually diagnosed populations.

Eligible originating sites:

  • Provider offices

  • Hospitals

  • Critical Access Hospitals (CAH)

  • Rural Health Clinics (RHC)

  • Federally Qualified Health Centers (FQHC)

  • Skilled nursing facilities

  • Community mental health centers

  • GA public health clinics

  • School-based clinics

Eligible distant sites:

  • Provider offices

  • Hospitals

  • Critical Access Hospitals (CAH)

  • Rural Health Clinics (RHC)

  • Federally Qualified Health Centers (FQHC)

  • Skilled nursing facilities

  • Community mental health centers

  • GA public health clinics


Maryland

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Maryland Medicaid specifies limited types of originating sites and limited types of providers that can be reimbursed for telemedicine. Eligible Distant Site Providers:

  • Free standing renal dialysis centers

  • Federally Qualified Health Centers

  • Hospitals, including EDs

  • Local health departments

  • Nursing facilities

  • Physicians

  • Nurse practitioners

  • Nurse midwives

Providers at both the originating site and the distant site must have formal agreements on how care is to be provided.


North Carolina

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialNoNo

North Carolina Medicaid imposes restrictions on the patient settings, covered services and

designates eligible distant site providers as a condition of payment. A provider is also required to be on the premises with the patient, ruling out direct connections. Eligible medical providers:

  • Physicians

  • Nurse practitioners

  • Nurse midwives

  • Physician’s assistants

Eligible tele-psychiatry providers:

  • Physicians

  • Advanced practice psychiatric nurse practitioners

  • Advanced practice psychiatric clinical nurse specialists

  • Licensed psychologists Ph.D. level

  • Licensed clinical social workers (LCSW)

  • Community diagnostic assessment agencies

Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and tele-psychiatry. Providers must submit:

  • Prior approval request

  • All health records and any other records to document that the patient has met the specific criteria for telemedicine services

  • If the patient is under age 21, information supporting that all Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) criteria are met, and evidence-based literature supporting the request, if available.


South Carolina

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialNoNo

South Carolina Medicaid imposes restrictions on the covered services, patient settings and designates eligible distant site providers as a condition of payment. A telepresenter is required, ruling out direct connections.

Eligible services:

  • Office or other outpatient visits

  • Inpatient consultation

  • Individual psychotherapy

  • Pharmacologic management

  • Psychiatric diagnostic interview examination and testing

  • Neurobehavioral status examination

  • Electrocardiogram interpretation and report only

  • Echocardiography

Eligible originating (referring) sites:

  • Practitioner offices

  • Hospitals (inpatient and outpatient)

  • Rural Health Clinics

  • Federally Qualified Health Centers

  • Community mental health centers

Distant-site eligible, reimbursed providers:

  • Physicians

  • Nurse practitioners

  • FQHC

  • RHC


Virginia

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Virginia Medicaid requires the originating site to be a healthcare facility. Eligible provider types are limited as well. Virginia Medicaid also requires the provider to be physically present in the state when providing care.

Eligible services:

  • Office visits

  • Individual psychotherapy

  • Psychiatric diagnostic interview examinations

  • Pharmacologic management

  • Colposcopy

  • Obstetric ultrasound

  • Fetal echocardiography

  • Cardiography interpretation and report only

  • Echocardiography

  • Speech therapy services

Eligible providers:

  • Physicians

  • Nurse practitioners

  • Nurse midwives

  • Clinical nurse specialists

  • Clinical psychologists

  • Clinical social workers

  • Licensed professional counselors

  • Speech pathologists (speech therapy only)


Washington D.C.

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Medicaid in D.C. covers and reimburses for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person. Originating sites are limited to:

  • Hospital;

  • Nursing Facility;   

  • Federally Qualified Health Center (FQHC);

  • Clinic;

  • Physician Group/Office;

  • Nurse Practitioner Group/Office;

  • DCPS;

  • DCPCS;

  • Core Service Agency (CSA)


West Virginia

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialPartialNo

West Virginia Medicaid coverage is limited to originating sites located state-wide for services listed under the physician benefit. School-based speech therapy via telehealth is also covered for limited services.