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Telehealth Payer Laws: Impact and Issues


telehealth payer lawsBoth Becker’s Hospital Review and FierceHealthCare identified the shortcomings of telehealth legislation. Payers interested in the market potential of under-served rural populations long for consistent options for offering affordable policies without provider network limitations. The language policymakers use in telehealth legislation may deter provider networks from offering remote services and tying the hands of payers looking to broad service options, according to a the Center for Connected Health Policy (CCHP). The CCHP, with funding from the Milbank Memorial Fund, released a report covering the current state of telehealth payer laws. Excepts from the full report continue below.

Telehealth Payer Laws

Health systems across the country face increasing pressure to expand access to care, while improving the efficiency and quality of care in the face of limited resources. Consequently, state policymakers have shown a growing interest and receptivity to the use of telehealth technologies to help meet these demands.

Telehealth is defined as the use of electronic technology to provide diagnostic and treatment services, enhanced communication and care coordination, patient monitoring, and education from a distance. This virtual communication can be between two health care providers or between the health consumer and the care provider using one of the following modalities: “real-time” live video; asynchronous or “store-and-forward” communication, which uses a secure e-mail platform and is not in real time; or through remote patient monitoring (RPM).

Telehealth care has existed for decades and, with the rapid advances in technology and electronic communications, its use has proven to be as effective in many situations as in-person care. While a substantial body of literature and evidence for telehealth exists, its ubiquitous use remains elusive.

The passage of the Affordable Care Act (ACA) in 2010 and Medicaid expansion have resulted in millions of Americans having the ability to seek care, yet access to needed care remains a challenge for many due to the shortage of primary and specialty care services and facilities in much of the country. This factor, coupled with increased access to affordable high-speed broadband and wireless communications, has created a perfect storm that has motivated state policymakers to consider telehealth as a viable option to address the health care needs of their constituents.

Private Payer Interviews

To gain a deeper understanding of the impact of the private payer parity laws among the states, CCHP conducted interviews with selected commercial health plan executives. The representatives of the plans included medical officers, vice presidents, counsel, and designated telehealth policy representatives. The interviews were conducted to determine how the telehealth private payer laws affected these plans, how they developed the plans to be in compliance with the law, and how some of the factors identified in the previous section on the payment policies of health plans influenced the plans.

Key Takeaways from Private Payer Interviews

  • Most interviewees limited telehealth reimbursement to services provided via live video.
  • Most interviewees limited the types of services they will reimburse if provided via telehealth.
  • Policies from other sectors such as licensing boards affected the payers’ policies on telehealth.
  • Most of the interviewed payers were paying the same amount for telehealth services that they would if the service was delivered in person.
  • At least initially, both patients and providers were reluctant to utilize telehealth.
  • Telehealth was greatly underutilized.
  • Both patients and providers had a lack of understanding/awareness that the plan would pay for telehealth-delivered services.
  • While supportive of telehealth, the interviewees noted that they would need to be convinced that expanding payment for services and/or use of other modalities to deliver care was beneficial.

Medicaid

Center for Connected Health Policy (CCHP) also conducted interviews with representatives of Medicaid programs in each of the six sample states to see if the private payer laws affected their programs in any way. Unless there was some specific factor in the private payer law that was directed at the Medicaid program, no significant impact was reported. Most of the Medicaid programs studied were already reimbursing for some form of telehealth before their state private telehealth payer laws were enacted.

Key Takeaways from Medicaid Interviews

  • Private payer laws have little impact on Medicaid telehealth policies unless they are explicitly written into the law.
  • Some Medicaid programs have defined lists of services and providers for which they will reimburse, while others have broader policies.
  • Providers face challenges in implementing telehealth programs, such as cost of equipment and understanding how to bill.
  • Other sectors’ policies, such as licensing boards’ requirements, affect the spread of telehealth.
  • Most Medicaid programs pay the same for telehealth-delivered services as they do for in-person services.

Conclusion

Telehealth-delivered care continues to have great promise to contribute to the Triple Aim of better health outcomes, improved patient and provider experiences, and increased efficient use of resources to lower costs. But numerous state policy obstacles inhibit health systems and payers from achieving the full potential of these technologies.

This study makes clear there is broad misconception that because private payer laws are in place in many states around the country, telehealth is achieving its promise of parity of benefits and payment with in-person care. The reality is that lack of clarity and clauses that impede the expansion of telehealth-delivered services weaken many of these laws. More careful crafting of the language for these laws and a more comprehensive implementation plan that includes the voice of payers, providers, and consumers will be needed to achieve greater adoption of telehealth-delivered care in the future. Further analysis should be considered to assess the impact of specific payment parity laws in the three states identified (Delaware, Hawaii, and Minnesota) after they have been in place for at least three years.

Considerations for Policymakers

  • Consider using explicit language in private payer laws that details the exact intent of policymakers, such as ensuring all modalities are to be reimbursed by private payers.
  • Ensure that payment parity language is included in the laws if it is the intent of policymakers to have telehealth reimbursed at the same rate as in-person services.
  • Consider inclusion of some type of education component for both providers and consumers.
  • Consider a robust, comprehensive telehealth policy within the state Medicaid program.
  • Work with state licensing boards to create telehealth policies that allow licensees the flexibility to utilize technologies in delivering care but still take into consideration the safety of the patient.


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