Reimbursement By Region - South Central

Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, Texas

 

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.


Alabama 

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialNo
Facility to FieldNoPartialNo
Direct ConnectPartialNoNo

Alabama’s Medicaid program covers telehealth in limited patient settings. Hub and spoke settings include hospitals, physician’s offices, federally qualified health centers, critical access hospitals, rural health centers, and community mental health centers.  Facility to field connections are only covered under the Health Home program for remote patient monitoring. Eligible distant site providers:

  • Physicians

  • Physician assistants

  • Nurse practitioners


Arkansas

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialPartial
Facility to FieldNoNoPartial
Direct ConnectPartialNoNo

Medicaid in Arkansas has limits on telemedicine service coverage, frequency, patient settings, and eligible distant site providers. An in-person visit is required before a telemedicine encounter, and a telepresenter must be present with the patient for the encounter, ruling out direct provider to patient connections.

Eligible Originating Sites:

  • In-patient or non-emergency hospital

  • Physician office or clinic

  • Ambulatory surgical center

  • Federally Qualified Health Center

  • Emergency department

Covered visits:

  • Consults

  • Fetal echography and echocardiography

  • Non-emergency visits in a physician’s office, a clinic or a hospital outpatient department

  • Inpatient hospital visits

  • Federally Qualified Health Centers (FQHC) encounters

Private insurer parity requirements match the Arkansas’ Medicaid limitations.


Kentucky

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Medicaid in Kentucky covers any service included in the plan the same as a face to face visit. Providers must be approved through the Kentucky e-Health board and KY telehealth network.


louisiana

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesPartial
Facility to FieldNoYesPartial
Direct ConnectPartialYesPartial

Medicaid in Louisiana places no limits on patient setting, covered services, or eligible providers, but only reimburses the distant site provider. Louisiana’s private insurer parity law requires parity only for physician provided services.


Mississippi

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Mississippi Medicaid covers any service included in the plan the same as a face to face visit. Medicaid places no restrictions on the patient setting for telemedicine coverage, but will only    pay the originating site fee to the following types of facilities:

  • Provider’s office

  • Outpatient hospitals

  • CAHs

  • RHCs

  • FQHCs

  • CMHCs

  • Therapeutic group homes

  • IHS clinics

  • School-based clinics


oklahoma

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialNoYes

Oklahoma Medicaid places no limits on the originating site. Telemedicine providers are limited to physicians and certain other practitioners.

Eligible distant-site providers:

  • Physicians

  • Advanced registered nurse practitioners

  • Physician assistants

  • Genetic counselors

  • Licensed behavioral health professionals

  • Dieticians


Tennessee

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesYesYes
Facility to FieldNoYesYes
Direct ConnectPartialYesYes

Tennessee Medicaid covers telemedicine provided services the same as if they were face to face.


Texas

MedicareMedicaidPrivate Insurer Parity
Hub and SpokeYesPartialYes
Facility to FieldNoNoYes
Direct ConnectPartialNoYes

Texas Medicaid makes a distinction between telehealth and telemedicine, with different services and provider types specified for each. In both cases Medicaid requires the originating site to be an established medical health site. Schools and state supported living facilities are also included. A telepresenter is required at the originating site, except in some mental health scenarios.