Almost every state now allows payment for telehealth services in workers’ compensation, according to an updated study from the Workers Compensation Research Institute.

WCRI on Tuesday released the latest version of its medical cost containment inventory, which outlines state-by-state strategies to control expenses in state and federal workers’ compensation programs.

The study relies on state-reported data as of Jan. 1. It features lists of statutes, administrative rules and guidelines that each state uses to regulate comp system costs, which became a major focus for many jurisdictions beginning in the 1990s, according to the study.

“Cost containment strategies have to balance ensuring access to quality medical care for workers against limiting the cost of services and avoiding inappropriate treatment,” WCRI Executive Vice President and Counsel Ramona Tanabe said in a statement. “Though they go about it differently, all the state and federal programs are trying to do the same thing. This report pulls all that information together to allow policymakers and other stakeholders to make more sense of what they might be seeing in their own state and across the country.”

The study was last updated in 2018, and only the District of Columbia did not respond to survey requests for the most recent version, WCRI said.

WCRI said the latest version includes data on four new medical cost issues that have “received a great deal of attention since the last edition.” These include payments for telehealth services, air and ground ambulance transportation, and surgical implants. 

One year after the pandemic began, nearly every state allows its workers’ comp system to pay for telehealth services, and many states expanded access for injured workers in response to COVID-19, according to the study.

“In the last decade, telehealth was used more frequently for treatment in workers’ compensation,” WCRI Research Analyst and study author Karen Rothkin wrote. “In spring 2020, when many medical practices were physically closed and offering only remote care, some state agencies expanded the use of telehealth for workers with injuries.”

Only Arkansas explicitly states that telehealth visits are not payable under workers’ comp, while Iowa and South Carolina have no regulations concerning the relatively new practice, according to the study. 

Hawaii allowed temporary general expansions of telehealth during the pandemic’s duration, and virtual visits are covered under workers’ comp in New Jersey depending on the carrier.

Of the states that expanded telehealth in response to the pandemic, nearly all did so by some sort of statute or order, according to the study. Minnesota, Montana, New York, Ohio, Rhode Island, Texas, Utah and Washington also included sunset clauses for orders expanding telehealth services. 

Other states, such as North Dakota and Georgia, allow the governor or a state workers’ comp board to end the expansion and their discretion.

Additionally, more than 30 states have included procedural codes for telemedicine in their workers’ comp fee schedules.

Aside from telehealth, comp stakeholders also have recently been concerned about the cost of ambulance transportation, specifically air ambulance, according to the study.

About half of all states’ ground ambulance services are subject to fee regulation, and states differ on how to calculate maximum permitted fees.

While states such as Alaska, Georgia and Washington rely on fee schedules and mileage rates using the Healthcare Common Procedure Coding System, other jurisdictions such as California, Oklahoma, South Carolina and Tennessee set fees at a percentage of what Medicare pays.

When it comes to air ambulance services, states that have regulations differ even more significantly. Nearly half have no explicit agency regulations for approving payments for air ambulance services, according to the study.

States that have defined regulations for reimbursing both emergency and non-emergency air ambulance services include Alabama, Alaska, Georgia, Kentucky, Louisiana, Maine, Ohio and Tennessee.

In states such as Oklahoma, whether air ambulance services are reimbursed depends on the situation. Air transport there is covered only if several conditions are met. The worker has to be taken to an acute care hospital and his condition must require “immediate and rapid” transport that a ground ambulance couldn’t provide, according to the study.

Alternatively, services can be covered if a pickup point is not accessible by ground ambulance or there is “unreasonable distance or other obstacles” preventing personnel from transporting the worker to the nearest treatment facility in a timely manner.