CMS Clarifies Telemedicine Reimbursement Under Medicaid

The Centers for Medicare and Medicaid Services (CMS) recently clarified their requirements for state amendments for telemedicine services.

According to CMS, states need not submit plan amendments for telemedicine coverage under Medicaid if they intend to pay for services provided via telemedicine in the same way they reimburse in-person visits. CMS approval is only needed if payment amounts differ.

CMS Approach to Reviewing Telemedicine State Plan Amendments (SPAs):

  • States are not required to submit a separate SPA for coverage or reimbursement of telemedicine services, if they decide to reimburse for telemedicine services the same way/amount that they pay for face-to-face services/visits/consultations.
  • States must submit a separate reimbursement (attachment 4.19-B) SPA if they want to provide reimbursement for telemedicine services or components of telemedicine differently than is currently being reimbursed for face-to-face services.
  • States may submit a coverage SPA to better describe the telemedicine services they choose to cover, such as which providers/practitioners are; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telemedicine be placed in an introductory section of the State Plan and then a reference made to telemedicine coverage in the applicable benefit sections of the State Plan. For example, in the physician section it might say that dermatology services can be delivered via telemedicine provided all state requirements related to telemedicine as described in the state plan are otherwise met.

Click here for more information on Medicaid reimbursement for telemedicine.


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