Telehealth and technologies enabling digital health continue to gain acceptance among patients and healthcare professionals. Meanwhile, more organizations are launching virtual care programs to supplement traditional in-person offerings.
A recent report from law firm Foley and Lardner reveals 22 states that have updated provisions that address payment and reimbursement rates for telehealth services, including requiring commercial insurers to pay providers the same rate for services delivered via telehealth as in person. The following information has been pulled from the report to provide a quick overview of the topic.
22 States with Reimbursement Provisions for Telehealth
While telehealth coverage has expanded there are still limitations for reimbursement/payment parity.
Currently, 22 states maintain laws expressly addressing reimbursement of telehealth services (an increase from 16 states in 2019), and 14 of those offer true “payment parity” (an increase from 10 in 2019), meaning that providers outside those 14 states may find they receive lower payment for telehealth-based services compared to in-person services (i.e., same service code, but different reimbursement rates).
Here are the 22 states whose law has a reimbursement provision for telehealth, according to the report:
- New Hampshire
- New Jersey
- New Mexico
- North Dakota
States with Telehealth Payment Parity Laws
States with payment parity laws are:
Offering Telehealth in Massachusetts
The new Massachusetts law provides true payment parity, but only for behavioral health services.
Massachusetts also temporarily extended payment parity for the following:
(i) primary care & chronic disease management services via telehealth over the next two years, and
(ii) all other health care services, which have been temporarily mandated by a gubernatorial Executive Order, for 90 days beyond the end of the COVID-19 state of emergency.
Commercial Health Insurance Law for Telehealth Reimbursements
Some other limitations on telehealth commercial insurance reimbursement continue to exist in various states. However, the trend is towards equal treatment for telehealth.
For example, only one state (Tennessee) still maintains some restrictions on the patient’s originating site. 30 other states have cost shifting protections, which prohibit a plan from charging a patient a deductible, co-insurance, and/or co-payment for a telehealth consultation that exceeds what the insurer would charge for the same service if it were provided during an in-person consultation.
There has also been an increase for coverage of asynchronous telehealth and remote patient monitoring. The demand from both patients and providers for more virtual care services as well as health plans are driving more meaningful coverage of these modalities.
More than half of the states (27 states) mandate coverage for store-and-forward/asynchronous telehealth. And 17 states require commercial health plans to cover remote patient monitoring services. These laws benefit patients by increasing access and availability to health care services, and catalyze the growth of telehealth technologies throughout the country.
Read Foley & Lardner’s full report on 50-State Survey of Telehealth Commercial Insurance Laws here.