Telehealth is the use of communications technologies to provide health care from a distance. These technologies may include computers, cameras, videoconferencing, the Internet, and satellite and wireless communications. Some examples of telehealth include:

• A "virtual visit" with a health care provider, through a phone call or video chat
• Remote patient monitoring, which lets your provider check on you while you are at home. For example, you might wear a device that measures your heart rate and sends that information to your provider.
• A surgeon using robotic technology to do surgery from a different location
• Sensors that can alert caregivers if a person with dementia leaves the house
• Sending your provider a message through your electronic health record (EHR)
• Watching an online video that your provider sent you about how to use an inhaler
• Getting an email, phone, or text reminder that it's time for a cancer screening

Telehealth is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration, according to the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth applications include:

• Live (synchronous) videoconferencing: a two-way audiovisual link between a patient and a care provider
• Store-and-forward (asynchronous) videoconferencing: transmission of a recorded health history to a health practitioner, usually a specialist.
• Remote patient monitoring (RPM): the use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
• Mobile health (mHealth): health care and public health information provided through mobile devices. The information may include general educational information, targeted texts, and notifications about disease outbreaks.

Hearing a lot about telehealth lately? It’s not a coincidence. Telehealth is a great way to get the health care you need while still practicing social distancing.

What is telehealth?

Telehealth is the use of electronic information and telecommunication technologies to extend care when you and the doctor aren’t in the same place at the same time. If you have a phone or a device with the internet, you already have everything you need to do telehealth – you may be able to:

• Talk to your doctor live over the phone or video chat
• Send and receive messages from your doctor using chat messaging, email, secure messaging, and secure file exchange
• Use remote patient monitoring so your doctor can check on you at home. For example, you might use a device to gather ECG or other vitals to help your doctor stay informed on your progress

What types of care can I get using telehealth?

You might be surprised by the variety of care you can get through telehealth. Your doctor will decide whether telehealth is appropriate for your health needs.

If you need care — especially during the COVID-19 emergency — it’s worth checking to see what your telehealth options are.

For example, you may be able to get:

• General health care, like wellness visits
• Prescriptions for medicine
• Dermatology (skin care)
• Eye exams
• Nutrition counseling
• Mental health counseling
• Urgent care conditions, such as sinusitis, back pain, urinary tract infections, common rashes, etc.

Get tips for finding a doctor who provides telehealth.

Disclaimer: The reference to named video- and text-based communications software for telehealth is informational and not intended as an endorsement of those services.

Sometimes people use the term telemedicine to mean the same thing as telehealth. Telehealth is a broader term. It includes telemedicine. But it also includes things like training for health care providers, health care administrative meetings, and services provided by pharmacists and social workers.

Some of the benefits of telehealth include:

• Getting care at home, especially for people who can't easily get to their providers' offices
• Getting care from a specialist who is not close by
• Getting care after office hours
• More communication with your providers
• Better communication and coordination between health care providers
• More support for people who are managing their health conditions, especially chronic conditions such as diabetes
• Lower cost, since virtual visits may be cheaper than in-person visits

Some of the problems with telehealth include:

• If your virtual visit is with someone who is not your regular provider, he or she may not have all of your medical history
• After a virtual visit, it may be up to you to coordinate your care with your regular provider
• In some cases, the provider may not be able to make the right diagnosis without examining you in person. Or your provider may need you to come in for a lab test.
• There may be problems with the technology, for example, if you lose the connection, there is a problem with the software, etc.
• Some insurance companies may not cover telehealth visits

Have you used a computer, smart-phone, or tablet to talk with a doctor? This is called telemedicine. A study suggests that in-person doctor visits provide better care for children with certain infections.

Researchers used claims data from a health plan to look at visits for children with respiratory illnesses. These included colds, sore throats, and ear infections. More than 5,000 children received care via telemedicine. About 88,000 visited an urgent care clinic. More than a million saw primary care doctors.

The team counted the antibiotics prescribed within two days for each type of visit.

Children were given antibiotics most often after telemedicine visits. They received these drugs after 52% of telemedicine, 42% of urgent care, and 31% of primary care visits.

The team looked at whether doctors followed guidelines for giving antibiotics. These drugs can treat bacterial infections like strep throat. But they can’t treat viral infections like colds and flu.

Only 59% of telemedicine visits met the guidelines, compared with 67% of urgent care visits and 78% of primary care visits.

“As a pediatrician and a parent, I understand the appeal of telemedicine when a child is sick, since it offers the promise of connecting with a doctor in a way that is convenient and timely,” says Dr. Kristin Ray at the University of Pittsburgh. “But it is important to make sure that the quality of care that children receive remains high.”

The types of care that you can get using telehealth may include:

• General health care, like wellness visits
• Prescriptions for medicine
• Dermatology (skin care)
• Eye exams
• Nutrition counseling
• Mental health counseling
• Urgent care conditions, such as sinusitis, urinary tract infections, common rashes, etc.

For telehealth visits, just like with an in-person visit, it is important to be prepared and have good communication with the provider.

If you have a doctor, start by calling their practice.

Even if your doctor didn’t previously offer telehealth, doctors of many specialties are now integrating telehealth into their practice during the COVID-19 pandemic.

Here are some questions to ask when you call:

• Are you offering telehealth?
• If yes, how will you keep my health information secure?
• Is a telehealth visit a good choice for my health condition?
• How do I schedule a telehealth visit?

Check with your insurance company.

Your health insurance company can help connect you to care when you need it. They can also help you get care without leaving your home — either from a doctor or through a telehealth company.

Many health insurance companies offer:

• A free health advice line, which members can call to speak with a nurse
• Health information
• Price estimates
• Quality indicators

Some companies even offer telehealth through web-based portals or apps that can be downloaded onto your phone. To find out about your options, check your insurance company’s website — or give them a call.

Tip: Search your app store to see if your insurance company has a mobile app.

If you don’t have health insurance, you still have options.

There are several companies that offer a range of telehealth services for an out-of-pocket charge even if you don’t have insurance. To find a telehealth doctor:

• Search online - There are a few telehealth marketplaces that let you search for a telehealth provider based on the service you are looking for.Use a search engine to find these marketplaces or explore telehealth provider options independently.
• Digital health directory — Curated list of Telemedicine services available to patients and providers — set your filter to ‘Patient’ when you explore this directory. This directory is a voluntary effort by Consumer Technology Association (CTA) and American Telemedicine Association (ATA).
  • Disclaimer: This list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products.

Federally Qualified Health Centers

Some health centers offer health care over the phone or video. Use this tool to find a health center near you, and ask if they provide telehealth.

Other emergency hotlines

• For help with mental and/or substance use, visit the SAMHSA Helpline or call 1-800-662-HELP (4357).
• For help if you’ve swallowed, splashed, or gotten stung by something, visit the Poison Control Hotline or call 1-800-222-1222.

To have a telehealth visit that includes video, all you’ll need is a smartphone or a device with an internet connection and audio-video capabilities, like a tablet or computer.

What should I expect from a video visit?

If you’ve never had a health care visit that wasn’t in-person, it might be hard to picture what the visit will be like.

A video visit is the closest option to an in-person visit. And the goal is to make the telehealth visit as much like an in-person visit as possible.

Tip: To learn more about what a telehealth visit is like, watch this video.

How do I set up for a video visit?

If you’re using video to talk with a doctor, there are a few things you can do ahead of time to help the visit run smoothly.

• Choose a spot with plenty of light. If you’re using the camera on your phone, try turning on the flash if necessary.
• Make sure the camera is steady. This will be easier if you’re using a computer or laptop. To keep a phone steady, prop it up on a desk or table.
• Get comfortable. You’ll have an easier time focusing on the visit if your body is comfortable. This is another reason to prop up your phone — your arm will get pretty tired if you’re trying to hold the phone out in front of you the whole time!
• Wear loose clothing. If you’ll need to show the doctor something on your skin or a specific part of your body, wear something that’ll be easy to move so that the doctor can see clearly.
• Reduce background noise. This can be tricky when there are a lot of people in the house! But if you can, find a quiet activity for the kids — or your roommates — in a separate room.
• Close other applications. Some applications will slow down your internet connection. And even if they don’t, closing them will cut down on distractions.

Telehealth and COVID-19

It is important to protect yourself and your health care provider during the COVID-19 public health emergency. Telehealth can help you get access to your provider without spreading or getting COVID-19.

If you are having a medical emergency, call 911.

I am interested in the COVID-19 vaccine

The COVID-19 vaccine is the best way to protect yourself and others from getting the virus. Use these resources if you have questions about the COVID-19 vaccine, where to get one, or how to make an appointment:

• Talk to your health care provider.
• Learn more about the COVID-19 Vaccine from the CDC.
• Have you already received a COVID vaccine and it has been a least six months since you received your final dose? That means you are eligible for a vaccine booster, which can give you additional protection.

Tip: The COVID-19 vaccine is free of charge to everyone regardless of income, immigration, or health insurance status. Health care providers’ office visit fees may still apply.

I am worried that I have COVID-19

It is extremely important that you self-isolate if you think you may have COVID-19 or have been exposed. That means staying home from work or school and distancing yourself from friends and family, even the people who live in your home.

Follow these steps to get the care you need.

Start by using a COVID-19 self-assessment tool

Use an online COVID-19 self-assessment tool before you contact your health care provider. This protects everyone’s health and safety and reduces the burden on our health care system.

This self-assessment tool was developed based on information from the Centers for Disease Control and Prevention (CDC).

A self-assessment tool will ask you a few questions about:

• Symptoms you have
• Whether you have been in close physical contact with someone who has been diagnosed with COVID-19
• Whether you live in a community where many people have been diagnosed with COVID-19
• Any medical conditions that put you at high risk for complications if you get COVID-19

Know your telehealth options

Many health care providers now provide telemedicine services. Contact your provider or health insurance company to ask about your options.

There are also health centers and on-demand telehealth services available to everyone, including people who do not have health insurance.

Did you know?

Patients can maximize cost savings on internet bills. Learn more by visiting GetInternet.gov. The Affordable Connectivity Program (ACP) and Lifeline are federal government programs that help eligible households pay for internet services and internet connected devices. Eligible families who pair their benefit with one of the partnered internet providers can receive high-speed internet at no cost.

Eligibility for ACP and Lifeline programs is based on income or meeting other criteria. For the Affordable Connectivity Program, eligible households can enroll through a participating broadband provider or using an online or mail in application. To apply for Lifeline, households can apply online, by mail, or through a phone or internet company.

Before you meet with your health care provider online

Your health care provider will need several important pieces of information when you schedule a telemedicine visit to discuss COVID-19. Consider writing down this information before your virtual visit:

• Your symptoms — What are they and when they started
• Your health — Any other health conditions you have and how you have been managing them during the pandemic
• Exposure to COVID-19 — If you have definitely been exposed, how, and when
• Your questions — If there is anything specific you want to know about your health or the health of other people in your home

I have COVID-19 symptoms 4 or more weeks after infection

Some COVID-19 patients continue to have symptoms four or more weeks after they are diagnosed. They have what’s called long COVID, or Post-Acute Sequelae of SARS-CoV-2 infection (PASC) Even people who did not have symptoms in the first days or weeks after they were infected can have a post-COVID condition.

Post-COVID health symptoms include:

• Tiredness or fatigue
• Difficulty concentrating or “brain fog”
• Headache
• Loss of smell or taste
• Dizziness on standing
• Fast-beating or pounding heart
• Chest pain
• Difficulty breathing or shortness of breath
• Cough
• Joint or muscle pain
• Depression or anxiety
• Fever
• Symptoms that get worse after physical or mental activities

How telehealth helps people with long COVID

Telehealth can help you get the care and monitoring you need without having to leave the comfort of your own home.

There are several ways you may be able to receive care for long-term COVID-19 symptoms:

• Talk to your health care provider about telehealth options for follow-up care after leaving the hospital or their office
• Use remote patient monitoring devices so your health care provider can check on you at home. For example, these devices might check your blood sugar or blood pressure
• Get support for specialty care faster via telehealth than waiting to see a health care provider in person
• Meet with your health care provider during a telehealth appointment to discuss lab test results to clearly understand how your symptoms are affecting your body
• Take time during your telehealth appointment to ask your health care provider about medications or treatments that can help manage your symptoms
• Use telehealth as a bridge between your in-person appointments. While telehealth is a convenient way to access fast, quality health care, your health care provider may want to examine you in person from time to time.

Tip: Are you new to telehealth? Get tips and information on the basics of telehealth.

I have a health issue that is not related to COVID-19

It is important to take care of yourself, especially during a pandemic. Stress and anxiety can make other health problems even harder to manage.

Do not ignore health concerns. Contact your health care provider for their advice.

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.

Telemedicine Terms

Distant or Hub site: Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system.

Originating or Spoke site: Location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service.

Asynchronous or "Store and Forward": Transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not be considered telemedicine but may be utilized to deliver services.

Medical Codes: States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.

Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.

Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service, such as laboratory service, x-ray service or physician services (under section 1905(a) of the Social Security Act).

Provider and Facility Guidelines

Medicaid guidelines require all providers to practice within the scope of their State Practice Act. Some states have enacted legislation that requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the state are binding under current Medicaid rules.

Reimbursement for Telemedicine

Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. ;For example, states may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service.

State Flexibility in Covering/Reimbursing for Telemedicine Services and the Application of General Medicaid Requirements to Coverage of Telemedicine Services

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). As such, states have the option/flexibility to determine whether (or not) to cover telemedicine; what types of telemedicine to cover; where in the state it can be covered; how it is provided/covered; what types of telemedicine practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are "recognized" and qualified according to Medicaid statute/regulation; and how much to reimburse for telemedicine services, as long as such payments do not exceed Federal Upper Limits.

If the state decides to cover telemedicine, but does not cover certain practitioners/providers of telemedicine or its telemedicine coverage is limited to certain parts of the state, then the state is responsible for assuring access and covering face-to-face visits/examinations by these "recognized" practitioners/providers in those parts of the state where telemedicine is not available.

Therefore, the general Medicaid requirements of comparability, statewideness and freedom of choice do not apply with regard to telemedicine services.

CMS Approach to Reviewing Telemedicine 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.