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US Telemedicine Policy : American Telemedicine Association


American Telemedicine Association: A Prspective on Telemedicine policy in 50 states across the United States


In February 2017, the American Telemedicine Association released the "Analysis of the Distance Medical Gap in the 50 States of the United States" report, which reported the coverage and reimbursement of telemedicine in various states in the United States with informative data. Although some states have made slow progress, the implementation of tele medicine across the country is improving.


Telemedicine refers to the long-distance diagnosis, treatment and treatment of patients in remote areas with poor medical conditions, relying on computer technology, remote sensing, telemetry and remote control technology to give full play to the advantages of medical technology and medical equipment in large hospitals or specialist medical centers. Counseling is a new medical service designed to improve the level of diagnosis and medical care, reduce medical expenses, and meet the health needs of the general public. 
Telemedicine was first applied by American scholars in the late 1950s. It has been going through 60 years of development, and the United States is also one of the most developed countries in the world. In all parts of the world, the maturity of telemedicine is a necessary condition for the development of a national strategy for grading diagnosis and treatment.

National 50 State Telemedicine Gap Analysis

In February 2017, the American Telemedicine Association (ATA, American Telemedicine Association) released the "National 50 State Telemedicine Gap Analysis" report, which reported the coverage and reimbursement of telemedicine in various states in the United States with informative data. Although some states have made slow progress, the implementation of telemedicine across the country is improving.

American Telemedicine Association (ATA)

Founded in 1993, the American Telemedicine Association (ATA) is a non-profit membership association located in Washington, DC. ATA is a telemedicine leader that aims to improve health care by improving the quality, equity and affordability of healthcare worldwide, with a network of more than 10,000 industry leaders and healthcare professionals.
ATA hosts leading telemedicine conferences, as well as technology innovations and networked trade shows.

The ATA report revised the state's two policies to determine the gaps in telemedicine coverage, reimbursement, doctor practice standards, and practice licenses.

The report uses 13 indicators related to coverage and reimbursement, stating that “although clinical empirical research has yielded positive and significant results over the decades and increased the utilization of telemedicine, the country’s medical policy is unstable.”

Latoya Thomas, director of the ATA National Policy Resource Center, said in a statement "This is an exciting news for patients, suppliers and businesses that use telemedicine and other digital health platforms.
These reports show that insurance companies, National legislators and medical aid agencies see telemedicine and other digital health platforms as affordable and convenient solutions for patients to bridge the gap between suppliers and improve access to quality health care."

1. Executive Summary on Tele medicine

Payment and coverage of telemedicine services is one of the biggest challenges in telemedicine applications. Complex insurance policies and a variety of payment processes often become the main resistance for patients and medical providers to use telemedicine.

The American Telemedicine Association (ATA) collects 50 different complex telemedicine policies in 50 states across the United States and converts them into a simple, easy-to-use format.
The report also analyzes the gaps in telemedicine across states, including state practice standards and licenses, state teleheal coverage, and reimbursement standards. The core issues that the report is addressing are:

• How does the state's policy for telemedicine applications compare to other states?

• “How should the state improve its policy for promoting telemedicine applications?”

This report divides the data related to coverage and reimbursement into 13 categories of indicators. Through analysis, it reveals the development and stagnation of remote medical care under different policies in different states.

Since the initial release of the ATA report in September 2014, all types of medical assistance organizations in the United States have adopted some type of telemedicine coverage. In addition, since the 2016 report, seven states have adopted policies to improve telemedicine coverage and reimbursement. Two other states and Washington, DC have opted to reduce telemedicine coverage or adopt policies that further limit telemedicine coverag.

When we classify the data into 13 indicators. The data between states shows a greater difference.

• Since the first report in 2014, 10 states have enacted the Telemedicine

 Equality Act. Of the 31 states that have passed the telehealth private insurance equality clause, 24 states and Washington, DC have the highest scores, indicating that their equality policy has covered the state and there are no restrictions on suppliers or technolo. Less than half of the states (20 states) are ranked lower and fail to score, which can be attributed to their lack of equality laws or the setting of numerous human barriers. This is a major step forward in the adoption of the Equality Act. Arkansas’s rating is still unsuccessful because it is the only state in the Equality Act that requires patients to be consulted in person.

• Telemedicine is already operational in Medicaid

 Medicaid programs in 50 states across the United States cover certain types of telemedicine services. Eleven states have provided telemedicine services with virtually no barriers through more comprehensive telemedicine coverage and scored high on the overall score.
Connecticut, Florida, Hawaii, and Iowa have ensured equal coverage of telemedicine through reforms, leaving little or no mission-restricted telemedicine applications, and Rhode Island has covered its Medicaid program. Some telemedicine services.
The Arterial Network found that New Hampshire was the only state to rank lower in New England and scored a failing grade because the state’s telemedicine regulations in Medicaid adopted similar restrictions to those in Medicare. Wording.

 • Another area of ​​improvement

Other improvement is telemedicine coverage and reimbursement under the State Employee Health Plan. Twenty-six states have introduced one or more state employee health plans covering some type of telehealth insurance.
Most states have self-insurance for their state employee health plans, so the traditional private insurance company's equality clause does not automatically affect it. Due to partial coverage or lack of coverage of telemedicine, approximately 50% of states in the United States have lower rankings and fail to score.

With regard to Medicaid, states continue to move away from the traditional “central radiation” model and allow the application of a variety of new medical technologies. The 28 states did not use the patient's medical treatment as a condition for telemedicine payment.
 In addition, 40 states recognize families as initial medical visits, while 23 states and Washington, DC-approved schools and/or school-based health centers are initial medical sites.

More states, including Hawaii, Louisiana, and Nebraska, are enabling legislation to remotely monitor chronic disease management for health coverage through legislation or federal exemptions. 
Now, 21 states have covered remote patient monitoring, and 15 states have covered storage and transfer technologies.

About half of all states in the United States are ranked lower and fail to score because they only cover and reimburse telemedicine services that use synchronized platforms.

In addition, although smartphones are already popular throughout the United States, Idaho, Missouri, New York, North Carolina, and South Carolina still ban the use of “mobile video” to promote telemedicine applications.

There is also a national trend to focus not only on rural areas or on designated mileage requirements, but to allow telemedicine to be covered in state-level health insurance plans. This is consistent with expectations before the arterial network.

States are also increasingly using telemedicine to fill gaps in supplier shortages to ensure that patients have access to special medical services, including treatment and counseling for dental and substance abuse.
For telemedicine payments, 19 states did not specify a specific telemedicine provider type, and because only nine or fewer telehealth supplier types were authorized, 16 states and Washington, DC were ranked lower, Failed to score. Montana is the only state that only authorizes doctors as qualified telemedicine providers.

In general, telemedicine professional services under Medicaid cover different states, but no two states are exactly the same

• 13 states scored high on coverage of physicians providing telemedicine services, while most states only covered outpatient consultations or consultations, and telemedicine services such as ultrasound and echocardiography were more widely covered in these states.

• For mental and behavioral health services, mental health assessment, personal treatment, psychiatric diagnosis, and medication management are generally the most widely covered telemedicine services. The coverage of telemedicine services in the psychological and behavioral health categories in the 15 states is high.

States with higher scores, such as West Virginia, encourage institutions to use telemedicine to provide mental health services. In terms of mental health services, the last state in the state is New York, as the state has introduced restrictions on telemedicine services.

• Although the scope and scope of policy vary from state to state, there are still three states that extend the coverage of telemedicine to remote rehabilitation.
It is known that 25 states are reimbursed for remote rehabilitation services, and 14 of these states rank higher in the coverage of treatment services for telemedicine.

• Alaska and Hawaii are the states with the highest scores in the telemedicine category under Family Health Benefits. In this case, 70% of the states in the United States fail to score due to the lack of coverage of telemedicine services under family health benefits.

Finally, the Arterial Network found that 27 states and Washington, DC, had special patient informed consent requirements for telemedicine use (Figure 16). More states are planning to revise requirements for "remote assistants." The 34 states do not need to have a “remote assistant” device in the telemedicine process or in the service facility.
United States Telemedicine Policy American Tele medicine Association

2. Purposes of Remote Medicine

Patients and health workers in the United States want to know that their state is superior to other states in terms of telemedicine. Although there is a lot of information detailing the details of telemedicine policies in each state, there is currently no literature comparing the states one by one. As a result, ATA has created a tool to clarify policy gaps between states, hoping that states will make policies more streamlined to accelerate the development of telemedicine and to improve health care quality and reduce healthcare costs.

This report fills this research gap by answering the following questions:


• How does the state's telemedicine policy compare to other states?

• Which states have the best coverage of telemedicine services?

• Which states have the most barriers to telemedicine access for patients and suppliers?

It is worth noting that this report is not a “guideline” on how telemedicine should be reimbursed, but a tool that can serve as a reference for all parties and provide information for future policy development. The results presented in this report are based on information collected from state regulations, regulations, Medicaid manual/announcement/cost schedules, state employee handbooks, and other federal and state policies, and are ATA's understanding and interpretation of state policies.

3. Overview of Policies making about Tele Doctor

Legislatures in all states are paying more and more attention to how telemedicine will serve its people. Policymakers are always working to reduce health care delivery, control costs, improve care coordination, and reduce supply shortages, and many states are using telemedicine to achieve these goals.

In the past 5 years, the number of telemedicine-equitable states has also doubled; in these states, private insurers can achieve the same coverage of telemedicine services as face-to-face clinics. In addition, Medicaid agencies are developing innovative payment and delivery methods for telemedicine to enable Medicaid institutions across the United States to cover certain types of telemedicine services.

The use of legislation to allow access to health care through telemedicine and the revision of existing policy implications is an important force driving telemedicine applications.

Both patients and medical providers benefit from policy improvements such as the introduction of the Telemedicine Equality Act, the expansion of telemedicine coverage, and the elimination of statutory and regulatory barriers to telemedicine.

Although some states have introduced demonstration telemedicine policies, they still lack relevant law enforcement and general awareness, which has led to a lagging participation of suppliers, which ultimately makes it difficult to develop these telemedicine reforms potential.

The report also focuses on situations that are limited by policy or prevent suppliers and patients from using telemedicine and benefit from it, especially geographical discrimination, restrictions on the types of providers and patients' medical treatment and telemedicine.

4. Evaluation methods of Doctor Online

Score: This report is divided into the following two categories to comprehensively evaluate the telemedicine coverage and reimbursement policies of each state:

  1.  Equality of health plans
  2.  Payment terms for Medicaid

The above two categories will be measured using 13 indicators. The choice of indicators is based on the latest, open and accessible information available to the public compiled and published by the state's public sector.
 Based on this information, we assign qualitative values ​​based on the scope of telemedicine services, supplier and patient qualifications, technology types and payment terms, etc.

In addition, we also rate the states based on the effectiveness of the relevant indicators and use this score to rank and compare the metrics for each state. 

Among the two categories, there are three indicators for the equality of health plans, and there are 10 indicators for the payment of Medicaid.

Each indicator has a score ranging from 1 to 35, and the overall rating is A, B, C and F. The report also includes a category that records telemedicine innovative payment and service delivery models implemented in each state.
In addition to state-supported online professional care and corrections organizations, the report also documents federal subsidy programs and exemptions available to states to enhance access to telemedicine services.

5. Indicators


(1) Equality


A. Private Insurance

The Full Equality Act is a sign that telemedicine services have the same coverage as face-to-face services. Currently, the Arterial Network has learned that 31 states and Washington, DC have enacted laws that are fully equal in telemedicine. However, Alaska and Arizona issued a partial equality law, which still provides specific provisions for the coverage of telemedicine, which limits the coverage and reimbursement of telemedicine services to a pre-designated list. 

Since the beginning of our report, some states’ equality laws have included restrictions on where patients seek medical care. Therefore, this report uses “equality” as one of the methodology of this study and continues to measure other aspects of state policy that can advance or hinder the equivalence of telemedicine services in private insurance.

The state with the highest score on telemedicine private insurance equality provides nationwide coverage and no restrictions on suppliers, technology, or patient care settings.
Rhode Island passed its 2016 Equality Act and jumped to one of the higher-ranking states. Among other states that have enacted equality laws, Alaska and Vermont scored more mediocre (C) because Alaska's Equality Act only covers mental health services, while Vermont legislators make patient visits. The limit.

While removing the rural-only provisions and starting to provide statewide telemedicine, the state continues to limit telemedicine practices, covering only interactive audio and video delivery, and only in certain types of services and Under the conditions to get coverage. 

Although Arkansas enacted an equality law in March 2015, it still failed in the scoring of this report because it imposes many restrictions on the location of patients and the types of suppliers, and requires patients to visit in person to establish supply. Business-patient relationship.
The arterial network found that 44% of the states in the report failed the grade (F), and the proportion decreased compared with the initial report.

B. Medicaid Program

In the United States, state-sponsored Medicaid programs are based on their assessment of medical services and restrictions on where patients seek medical care. In addition, the report reviews state regulations on supplier qualifications and technology types to determine whether the state has the ability to leverage telemedicine to overcome barriers to service delivery and to measure other states' policies that can advance or hinder telemedicine. The content of services that are equal in the Medicaid program.

Certain types of telemedicine services are covered in the state's Medicaid programs.

Telemedicine services in 11 states have higher ratings in Medicaid. New Hampshire ranks bottom and fails to score (F) because it still imposes restrictions on geographic location, scope of service, supplier qualifications, and patient visits. Connecticut, Florida, Hawaii, Idaho, Utah and West Virginia improved and expanded the coverage of telemedicine in Medicaid.
Rhode Island ranks high as the state has added telemedicine to the coverage of Medicaid and reimbursed some initial and follow-up telemedicine services.

C. State Employee Health Plan

We measured other stats in state policies that could advance or hinder the harmonization of telemedicine services across state employee health plans. Most states have self-insurance employee health plans, so the equality clauses of traditional private insurers do not automatically affect them. With the exception of Oregon, the state has amended its Equality Act to include a self-insurance state employee health plan.

Twenty-six states have provided partial coverage for telemedicine under the state employee health plan, based on the expansion of telemedicine coverage through the Equality Act. The North Dakota Equality Act covers only state employee health plans. About 50% of the states have lower grades and failed grades because they have partial or no coverage of telemedicine.

(2) Medicaid program service coverage & payment terms


D. Patient medical treatment

In telemedicine policy, the location of a patient's medical service is referred to as the initial location (corresponding to the location of the supplier is referred to as the remote location). The patient's location is a controversial part of telemedicine coverage. 
Traditional telemedicine coverage is defined by the need for patients to receive medical care in a particular type of medical facility, such as a hospital or doctor's clinic. 
With the development of remote computing capabilities (such as cloud processing) and mobile communication technologies (5G wireless), current telemedicine can cover patients in all locations, whether they are at home, at work or at school.

 In this report, we measured the relaxation or restrictions on telemedicine coverage and payment terms in the state of medical care for patients in each state's Medicaid. The following qualified patient sites for this observation:

• Hospital

• Doctor clinic

• Other supplier clinics

• Dental clinic

• Family

• Federal Qualified Health Center (FQHC)

• Acute and Critical Hospital (CAH)

• Rural Health Center (RHC)

• Community Mental Health Center (CMHC)

• The only community hospital

• School/headquarters at the School Health Center (SBHC)

• Auxiliary Living Facilities (ALF)

• Professional Nursing Agency (SNF)

• Stroke Center

• Rehabilitation/food therapy institutions

• Outpatient surgery center

• Residents Treatment Center

• Health department

• Dialysis Center

• Rehabilitation Center

• Pharmacy

If the state authorizes one of the above various patient locations as an eligible initial location, you will receive 1 point. If a state does not specify a specific initial location, the highest score is 21 points.

Among them, 28 states did not specify a specific patient's place of treatment or location. 
In addition, 40 states allowed the family to be the initial location for patients to seek medical care, and 23 states and Washington, DC admitted that the school and or SBHC were the initial location for patients to seek medical care. Illinois, New Jersey, and North Dakota are the lowest ranked and failing grades (F) because they have fewer than six initial locations.

E. Eligible Technology

Telemedicine involves the use of many technologies to transfer medical information from one location to another through electronic communication. These technologies related to telemedicine services include video conferencing, still image transmission (also known as store and forward), remote patient monitoring (RPM) for vital signs, and telephone conversations.
In this report, we measured whether state subsidy policies allow for the coverage and/or reimbursement of telemedicine using these technologies.

In the ranking of this indicator, 12 states scored above average, and Alaska and Arizona scored the highest. Alaska's technology covers interactive audio and video, storage and forwarding, remote patient monitoring, and more, as well as audio conferencing for certain telemedicine services.

Arizona allows a variety of technologies, including telephony, video or store-and-forward, to enable remote patient monitoring services. Alaska, Arizona, Hawaii, Minnesota, Mississippi, Nebraska, Texas, and Washington all cover telemedicine using synchronization technology, store-and-forward technology, and remote patient monitoring to some extent.

The Arterial Network also found that less than 50% of states in the United States have lower rankings and fail grades (F), either because they only cover synchronization techniques or because they do not provide any coverage for telemedicine at all.

In addition, Idaho, Missouri, New York, North Carolina, and South Carolina prohibit the use of "mobile video" or "video telephony" to implement telemedicine services.

F. Distance or geographic restrictions

The measurement of distance limits in this report is measured in miles and specifies the necessary distance between the remote supplier and the patient to form a telemedical payment condition.
Geographical restrictions are defined as rural, urban, metropolitan statistical areas (MSA), specific population sizes, or areas of medical professional shortage (HPSA).

We measured the distance or geographic conditions applicable to telemedicine coverage and payment in the Medicaid policy.

In the past year, states have made significant efforts to lift the distance requirements in telemedicine services. Hawaii, Idaho, and West Virginia are now providing telemedicine services throughout the state.

New Hampshire passed a legislation that gives telemedicine similar geographic restrictions as federal health insurance. Indiana legislation removes distance requirements for all remote suppliers, but still imposes mandatory distance measures for some eligible suppliers.

The Medicaid program in Ohio approved coverage of telemedicine services, but also chose to join the 5 mile limit as a payment terms.

90% of states do not specify distance/geographic restrictions on telemedicine. This result breaks the limitations of telemedicine that is only suitable for rural applications.

G. Eligible Suppliers

This report measures whether state subsidy policies allow coverage and/or reimbursement of telemedicine services provided by the following telemedicine providers. The following are professionals who provide telemedicine services:

• Doctors (MD and DO)

• Podiatrist

• Masseur

• optometrist

• Genetic counselor

• Dentist

• Assistant physician (PA)

• Nurse practitioner (NP)

• Registered nurse

• Licensed nurse

• Certified midwifery nurse

• Clinical Nursing Specialist

• Psychologist

• Marriage and Family Therapist

• Clinical Social Workers (CSW)

• Clinical consultant

• Behavioral analyst

• Drug abuse/addiction experts

• Clinical therapist

• Pharmacist

• Physiotherapist

• Occupational therapist

• Language pathologists and audiologists

• Registered dietitian/nutrition expert

• Diabetes/Asthma/Nutrition educator

• Family Medical Assistant

• Family Medical Institution (HHA)

• FQHC

• CAH

• RHC

• CMHC

• SNF

The designated doctor gets 2 points and the other qualified suppliers get 1 point. If the state does not impose any restrictions on suppliers that provide telemedicine services, the highest score is 35 points.

Other trends worthy of attention include:

• Dental services are becoming more widely available. Denso services provided by dentists will be covered in Arizona, California, Colorado, Minnesota, Missouri, New York, and Washington.

• Alaska, California, Colorado, Illinois, Minnesota, Missouri, and Washington State cover the services provided by podiatrists. Alaska, California, and Kentucky cover the services provided by Moss.

• Only California, Kentucky, Missouri, and Washington State cover the services provided by optometrists.

• Arizona, New Mexico, Oklahoma, and Washington State only cover services provided by behavioral analysts in telemedicine. This trend is worthy of attention because such experts are critical to the treatment of autism.

• Other behavioral health trends include New Mexico, Oklahoma, Virginia, West Virginia, Wyoming, and Washington, DC, which allow coverage of services provided by drug abuse or addicted experts in telemedicine.

More states are adding qualified supplier categories to promote telemedicine applications than previous reports.
The 14 states are ranked lower and scored as failing (F) because they only authorized fewer than nine types of healthcare providers.
Montana's ranking bottom: The state's supplier type only covers doctors.

H. Telemedicine services provided by doctors

Telemedicine services provided by doctors are usually covered and reimbursed by Medicaid. However, some programs specify specific health conditions on coverage, or limit the location of patients and suppliers, or limit the frequency of telemedicine use, or exclude services provided by other medical professionals.

In this report, we measured the coverage of telemedicine under the Medicaid policy and the restrictions on payment terms for medical professionals.

Some states rank higher on this indicator. These states do not have a range of services or additional terms for services provided via telemedicine.
In addition, these states also allow assistant physicians and/or senior practice nurses to be qualified telemedicine providers.
In addition, most states cover outpatient and counseling, while ultrasound and echocardiography have the lowest coverage.

The ratings for Connecticut, Florida, Hawaii, and Utah were promoted to “A” because they changed the policy and removed related restrictions, thereby expanding the coverage of telemedicine services.

I. Mental and behavioral health services

According to ATA's Remote Mental Health Practice Guide, remote mental health services include psychologists using video conferencing remotely. Arterial Network has learned that telemedicine can be used to deliver mental health services, including but not limited to: mental health assessment, substance abuse treatment, psychological counseling, drug management, education, supervision, and collaboration.
Each state covers a range of telemedicine services that provide mental health in the form of video conferencing. Although telemedicine applications in the mental health sector have increased in various states, we should note that the policies of the states in this area vary widely.

In this report, we measured the limitations of telemedicine services in the areas of mental and behavioral health under the Medicaid policy, and the types of suppliers that states are allowed to provide in this area.

In general, telemedicine mental services that are often covered by Medicaid include mental health assessments, individualized treatments, psychiatric diagnostics, and drug management. As can be seen from few states ranked higher in this area because none of these states set minimum conditions for service coverage or payment for services provided through telemedicine.

In addition, these states have authorized at least one other type of medical professional (such as an assistant physician and a senior practice nurse) to be an eligible telemedicine provider.

A common practice in the states is to allow psychiatrists, senior practicing nurses with clinical expertise, and psychologists to engage in remote mental health services. However, there are also many states that allow non-medical institutions to provide telemedicine services and reimburse them:

• Alaska, Arizona, Arkansas, California, DC, Delaware, Hawaii, Indiana, Kentucky, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Mexico, New York, North Carolina Telemedicine services provided by licensed social workers are available in Ohio, Ohio, Oklahoma, Texas, Virginia, Washington, West Virginia, and Wyoming.

• Alaska, Arizona, Arkansas, California, DC, Delaware, Indiana, Kentucky, Minnesota, Missouri, Nevada, New Mexico, Ohio, Oklahoma, Texas, Virginia, Washington, West Virginia and Wyoming cover telemedicine services provided by licensed professional consultants.

• In addition, only Arizona, New Mexico, Oklahoma, and Washington State provide coverage for telemedicine services provided by behavioral analysts. This trend is very interesting because behavioral analysts are critical to the treatment of autism.

New York, which ranks low and scores only C, has restrictions on the technology, suppliers, and places of care for mental health services. Connecticut, Florida, Hawaii, and Utah scored "A" because they reformed policies, removed existing restrictions, and expanded telemedicine coverage in this area.

J. Rehabilitation services

ATA's Remote Rehabilitation Guide defines remote rehabilitation as follows:
“It is a delivery of rehabilitation services using information and communication technologies. In clinical terms, this term covers monitoring, prevention, intervention, supervision, education, counseling, etc. in rehabilitation services. Counseling and so on."
Relevant professionals who use remote technology to provide rehabilitation services include neuropsychologists, speech language pathologists, audiologists, occupational therapists, physiotherapists, and more.

In this report, we measured the coverage and payment for telehealth services under the Medicaid program, as well as restrictions on the type of service, type of supplier, patient or supplier location.

Only 37 states entered the rankings in this indicator because rehabilitation services were not included in the Medicaid programs in the other 13 states.

The policies vary from state to state, with 26 states already reimbursed for remote rehabilitation services in Medicaid, 14 of which are ranked high.

In addition, 29 family health benefits cover the state of telehealth, only Alaska, Colorado, Florida, Hawaii, Iowa, Kentucky, Maine, Nebraska, Nevada, New Mexico States such as Tennessee, and Utah can reimburse remote rehabilitation services under family health benefits.
US Telemedicine Policy issued American Tele medicine Association

K. Family medical services

A proven form of telemedicine is remote patient monitoring, including continuous remote monitoring of vital signs or medication management provided by telemedicine providers via video or audio, and volumetric measurements taken automatically or by telephone. Each patient's remote monitoring method should be tailored to meet the patient's needs and coordinate the patient's care plan.

In family medical services, audio and video interviews can be used for skilled care, physical therapy, occupational therapy or speech therapy clinics.

In this report, we measured the restrictions on the types of types of services and types of services provided by Medicaid under the Medicaid program.

Hawaii and Utah and Alaska have arrived, becoming the top three states in this indicator.

In addition, among the 29 states that include telemedicine in family health benefits, only Alaska, Colorado, Florida, Hawaii, Iowa, Kentucky, Maine, Nebraska, and Nevada, New Mexico, Tennessee and Utah are able to reimburse remote rehabilitation services in family medicine.
In addition, only Pennsylvania can reimburse telemedicine services provided by caregivers in the home.

The range of telemedicine services covered in Arizona's Family Health Benefits includes audio and video, storage and forwarding, and remote patient monitoring coverage.
Seventy percent of the states in the US are ranked lower in this indicator and fail to score (F) because telemedicine services are not covered in their family health benefits.

L. Informed consent

In this report, we measured the limitations of the Medicaid program and the patient's informed consent in telemedicine applications in each state.

Of the 27 states that have requirements for informed consent, 18 state requirements are issued by the state's medical committee.
For Rhode Island and Connecticut, although the two states' Medicaid programs now cover telemedicine, their medical committees still require informed consent from patients.

M. Remote Assistant

In this report, we measured whether the state's Medicaid and Medical Committee policies have implemented stricter requirements for telemedicine than face-to-face consultations. The ratings for each state come from whether the state requires a remote assistant or medical provider to be present.

Alaska, Florida and Oklahoma scored to "A" because they had reformed their policies and removed many requests for remote assistants.
However, Alabama, Georgia, Iowa, Maryland, Minnesota, Missouri, New Jersey, North Carolina, and West Virginia only require medical providers not to be co-located with patients during telemedicine.
The State of New York requires remote assistants for psychiatric remote services.

(3) Innovative payment or service delivery model

This report also includes a record of the state's innovative payment and service delivery models. In addition to state networks in professional care and orthodontic care, the report includes states that use federal funding and exemptions to improve access and use of telemedicine.

Managed Medical Organizations (MCOs)

Over the years, states across the United States have increasingly adopted Managed Medical Organizations (MCOs) to create payment and delivery models that involve people, provide better care and follow-up services to patients, and control medical costs.
This type of payment method and operational details are numerous and can be used as a reference for specifying long-term medical delivery models.
MCOs that are constantly experimenting with innovative delivery models also include telemedicine coverage because it can help reduce emergency room use and hospitalization costs.

Twenty-four states have covered telemedicine in Medicaid. It is worth noting that Massachusetts and New Hampshire can provide coverage for the specified Medicaid program, but not in the service charge (FFS) model.

Federal Affordable Care Act (ACA)

The Federal Affordable Care Act (ACA) provides states with the financing and freedom to expand their Medicaid program and integrate the dual beneficiaries of the state's Medicare and Medicaid programs (“double compliance”).

States such as Michigan, New York, and Virginia have expanded the coverage of telemedicine services and the duality of the state's population through Medicare and Medicaid Services Centers (CMS).

ACA also offers a Healthy Family Program to better coordinate primary, acute, behavioral, chronic, and social service needs for a wide range of people. Chronic diseases include mental health, substance use disorders, asthma, diabetes, heart disease, overweight (BMI over 25), and other CMS-specified conditions.

The 19 states have approved the CMS Health Family Plan Amendment. Alabama, Iowa, Maine, New York, Ohio, and West Virginia include some form of telemedicine service in approved health family programs.

The Medicaid program includes several options that cover remote patient monitoring, often in the form of federal exemptions. States can apply for such exemptions in families and communities with long-term care services.
Kansas, Louisiana, and Pennsylvania use exemptions to provide home telemedicine services to beneficiaries, especially remote patient monitoring.



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Doctor Shawna Reason, Virologist
Dr. Shawna Reason
Name: Shawna Reason

Education: MBBS, MD

Occupation: Medical Doctor / Virologist 

Specialization: Medical Science, Micro Biology / Virology, Natural Treatment

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  Allergy Symptoms Introduce you to the symptoms of allergies, especially the early symptoms of allergies. What are the manifestations of allergies? What happens if I have an allergy?   Allergy symptoms Typical symptoms: erythema-like rash, light allergy, drug allergic reaction, systemic allergy and fever rash arthralgia, food allergy, allergic dermatitis, itching, skin allergies caused by sunlight, wheal, systemic allergic reaction, artificial urticaria, redness itch.   Related symptoms: Erythema-like rash Photo-allergy Drug allergic reaction Systemic allergy and fever rash Joint pain Food allergy Allergic dermatitis Itching Itching caused by sun exposure Skin allergies Systemic allergic reaction Artificial urticaria Redness and itching   Diagnosis of allergy symptoms   Common types of allergies:   1. Allergic purpura   A vascular allergic bleeding disease. The body has allergic reactions to certain substances, causing widespread small vasculitis, inc