CMS Releases an Updated Medicaid Telehealth Toolkit

The Centers for Medicare & Medicaid Services (CMS) have released a Medicaid & CHIP Telehealth toolkit (PDF, 900.6 KB) to help states accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) emergency. 

This toolkit provides states with statutory and regulatory infrastructure issues to consider as they evaluate the need to expand their telehealth capabilities and coverage policies.  

As such, this guide will describe each of these areas and the challenges they present including:

• Patient populations eligible for telehealth
• Coverage and reimbursement policies
• Providers and practitioners eligible to provider telehealth
• Technology requirements
• Pediatric considerations

The toolkit also includes a compilation of frequently asked questions (FAQs) and other resources available to states.

• Medicaid & CHIP Telehealth Toolkit Checklist for states (DOCX, 47.36 KB)

CMS developed this supplement to the toolkit (PDF, 1022.8 KB) to provide additional support to state Medicaid and CHIP agencies in their adoption and implementation of telehealth as they begin to plan beyond PHE flexibilities.  

States may use this supplemental toolkit to help think through how they will explain and clarify which policies are temporary or permanent, when flexibilities will expire, which services can be accessed through telehealth, which providers may deliver those services, the modality they may use to deliver telehealth services, and the circumstances under which telehealth can be reimbursed.  Several state profiles are included in this toolkit.

What Is Telemedicine? 

For purposes of Medicaid, telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. 

This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states can choose to cover under Medicaid. This definition is modeled on Medicare's definition of telehealth services (42 CFR 410.78). Note that the federal Medicaid statute does not recognize telemedicine as a distinct service.