A Primer on Medicaid Telepractice Reimbursement Will Medicaid reimburse you for your telepractice services? It all depends on your state. Bottom Line
Bottom Line  |   December 01, 2014
A Primer on Medicaid Telepractice Reimbursement
Author Notes
  • Cheris Frailey, MA, CCC-SLP, is ASHA director of state education and legislative advocacy. cfrailey@asha.org
    Cheris Frailey, MA, CCC-SLP, is ASHA director of state education and legislative advocacy. cfrailey@asha.org×
Article Information
Practice Management / Telepractice & Computer-Based Approaches / Bottom Line
Bottom Line   |   December 01, 2014
A Primer on Medicaid Telepractice Reimbursement
The ASHA Leader, December 2014, Vol. 19, 30-31. doi:10.1044/leader.BML1.19122014.30
The ASHA Leader, December 2014, Vol. 19, 30-31. doi:10.1044/leader.BML1.19122014.30
Medicaid reimbursement for telepractice is evolving as state Medicaid plans work on how to incorporate telepractice into speech-language services. States govern their own Medicaid plans, and some states also have telepractice boards or networks that approve sites, equipment and providers. Although some states have statutes or regulations indicating that Medicaid-covered services may be delivered through face-to-face or remote encounters, state Medicaid plans may not have the infrastructure to accept this platform for treatment.
Because state provisions differ, there are no nationwide rules for speech-language services provided remotely. However, here is some general guidance for private practitioners, hospitals and school districts seeking Medicaid reimbursement for telepractice.
What’s the difference between telepractice, telemedicine, telerehab, telehealth, teleaudiology and telespeech?
These terms all describe the remote provision of services. Typically, providers in health care settings use “telehealth” and “telemedicine.” Telerehabilitation, a broad generic term, includes speech-language pathology, occupational and physical therapy, and other rehabilitation disciplines.
ASHA uses the term “telepractice,” rather than the often-used “telemedicine” and “telehealth,” to avoid the misperception that services are only health-care–based.
How does Medicaid define and interpret telepractice?
Medicaid models its definition of telepractice after the Medicare definition: a means to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the distant-site practitioner via a telecommunication system.
Medicaid supports telepractice as a cost-effective alternative to face-to-face medical care. Each state can choose whether or not to cover telepractice under Medicaid.
Which states reimburse for telepractice and in what settings?
Medicaid telepractice coverage varies by state, and it can be challenging to locate the information. States may list coverage under statutes or acts or include it in regulations or codes, a provider manual, technical assistance guides, or the state plan. Medicaid providers should contact their state Medicaid offices directly to request written information regarding coverage, including how to reflect telepractice services in billing documentation. See the sidebar below for general information on which states cover telepractice in what settings.
Although telepractice may be allowed by law, reimbursement is not always that simple. Many state plans have not fully implemented the program; policies are left up to interpretation; and some practitioners fail to bill properly.
What code do I use to bill Medicaid for telepractice?
Each state determines appropriate procedure codes and modifiers for billing. Contact your state plan for its specific requirement
What are the Medicaid telepractice guidelines for providers and facilities?
Medicaid requires all speech-language pathologists to provide services within their scope of practice as defined by ASHA and each state’s practice act. If the patient and practitioner live in different states, some licensing boards require the practitioner to hold a license in both states.
What can I do to advocate for Medicaid telepractice reimbursement in my state?
First, determine if your state has any statutes or regulations regarding telepractice. If there are none, and you want to advocate for their inclusion, you should gather support for a strong proposal for reimbursement—essential to a successful meeting with Medicaid. You will need data on, for example, the types of patients who can be served and types of services that can be delivered through telepractice; clients who show positive outcomes from telepractice; the number of clients who would benefit from telepractice services and why; and potential cost savings. ASHA and your state association can provide guidance and resources, but Medicaid wants to hear from the practitioners who are trying to provide telepractice.
Data will come from private practitioners, school-based clinicians, academicians researching telepractice, and clinicians providing telepractice services in a variety of settings. Enlist your state association to help with member surveys. Consider working with occupational and physical therapists as well as their associations to gather a larger voice. Verify that the state association is following any proposed telepractice-related state legislation. ASHA’s state advocacy team works closely with state associations to track new legislation and can help individual members as well (800-498-2071).
Many states have laws or regulations that allow telepractice reimbursement, and not all state Medicaid plans oppose it. Implementation, however, is taking time, and many states want the research to support the practice. Many state Medicaid plans are beginning to reimburse—starting with physicians and psychologists—and adding additional providers as they work through the process.
Medicaid Reimbursement for Telepractice
Speech-Language Pathology and Audiology
Virginia and Ohio: Approved for Medicaid-eligible children in the schools.
Missouri: SLPs are included as participating providers in health care settings, based on the originating site, under specific stipulations and with technology preapproved by the telehealth network.
California: Reimburses all licensed providers.
Maine and Colorado: Reimburse under broad provisions.
Kentucky: Services provided by SLPs employed by a physician, hospital outpatient department, home health agency or nursing facility. A provider must be an approved member of the Kentucky Telehealth Network and comply with standards and protocols established by the Kentucky Telehealth Board. Because there are no stipulations on the location of the client—per the Telehealth Network and Board—there is potential for hospital-based SLPs who have a school contract to provide services to eligible children and bill Medicaid.
New Mexico: Reimburses for health care and is including school-based speech-language pathology, but manual updates are still in process.
Minnesota: Reimburses in schools if the provider meets all service requirements of the student’s Individualized Education Program.
*State statutes, regulations or manuals indicating Medicaid reimbursement for telepractice do not guarantee reimbursement.
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December 2014
Volume 19, Issue 12