Medicaid payment for telerehabilitation1,

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Abstract

Palsbo SE. Medicaid payment for telerehabilitation. Arch Phys Med Rehabil 2004;85:1188–91.

Objective

To assess current payment practice for telerehabilitation in state Medicaid programs.

Design

Telephone survey.

Setting

State Medicaid programs.

Participants

State Medicaid directors.

Interventions

Not applicable.

Main outcome measure

Descriptive.

Results

Half of the 35 state Medicaid programs contacted reimbursed at least some telemedicine services other than radiology in 2002. The primary reason for reimbursing for telemedicine is to make services available when there is no local practitioner. Consultation and evaluation and management services were most likely to be reimbursed (12 states). Seven state programs reimbursed telepsychology, and 4 states reported reimbursing for telespeech and language pathology, physical therapy, or occupational therapy.

Conclusions

Telemedicine helps Medicaid programs deliver specialized care to locations with provider shortages. Telerehabilitation is not yet widespread, despite its potential benefit to people with disabilities who cannot travel to a clinic for rehabilitation therapy. Most Medicaid programs calculate the financial costs and patient benefits when considering payment policies, and about half of states require a state law to allow payment for telerehabilitation. Minnesota, Hawaii, and Nebraska, among the responding states, currently reimburse for telerehabilitation. Research is needed to evaluate the appropriateness of telerehabilitation for Medicaid beneficiaries.

Section snippets

Methods

A survey was developed with the input of advisors who had conducted state inventories in the past or who were providing telerehabilitation. The present survey asked whether the state Medicaid program currently (in 2002) reimbursed for any telemedicine and, if so, under what circumstances. If a state paid for any service, additional questions were asked about payment for specific visit and PM&R procedure codes. Because I was interested in how receptive Medicaid programs may be to using

Overview of medicaid telemedicine reimbursement

Of the 51 Medicaid programs for which contact was attempted, 35 completed the survey, yielding a 69% response rate (table 1). Seven Medicaid programs that reimburse for telemedicine did not respond (Arizona, Colorado, Georgia, Iowa, Montana, South Dakota, Utah). This report presents results only from the responding programs.

In 2002, 16 respondents (ie, excluding the 7 nonrespondents with known programs) paid for at least 1 telemedicine service. Of these 16 states, 9 have specific statutes

Discussion

The official policy of the Centers for Medicare and Medicaid Services is to encourage states to incorporate telemedicine technology into their Medicaid programs to improve beneficiary access, quality of care, and clinician-patient communication. However, only 21 Medicaid programs (16 of whom responded to this survey) reimbursed for telemedicine in 2002, suggesting limited acceptance of telemedicine as a delivery modality. Even fewer states have reimbursement structures in place to pay for

Study limitations

In some states, it was very difficult to find someone highly knowledgeable about Medicaid reimbursement policies and practices for telemedicine. It was even more difficult to find someone who knew much about rehabilitation. Because state laws and Medicaid programs are constantly changing, the specific information in the tables may be outdated. Seven states that pay for telemedicine did not respond to our survey. This may bias the results by understating the actual prevalence of

Conclusions

Most state Medicaid programs are not receptive to telemedicine. Few states other than Minnesota, Hawaii, and Nebraska have considered payment for telerehabilitation. Research on the clinical and cost effectiveness of telerehabilitation is needed so Medicaid program personnel can make informed decisions and provide accurate information to state legislators. The studies should measure how much telerehabilitation improves access to rehabilitation therapy and decreases missed appointments for

Acknowledgements

Cheryl Lacsamana, BS, assisted with data analysis. Donal Lauderdale, MSE, conceived the study and supervised data collection.

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Supported by the National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Research Center, Center on Telerehabilitation, US Department of Education (grant no. H133E990007-00C). This article reflects the opinion of the author and not necessarily that of the federal government, the US Department of Education, the National Rehabilitation Hospital, or MedStar Health.

1

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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