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.
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:
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Telehealth Changes in Response to Covid-19
As the explosive growth of telemedicine continues, and as many would expect, state laws and regulations affecting the provision of telemedicine services will continue to expand and contract after the COVID19 public health emergency.
New Federal Developments
Telehealth Extension and Evaluation Act (Introduced on Feb. 7, 2022)
This will allow Medicare and the Medicaid Service Center (CMS) to increase Medicare payments for a variety of telemedicine services and outsource investigations into the impact of pandemic telemedicine flexibility.
CY2022 Telehealth Update Medicare Physician Fee Schedule (Released on Jan. 14, 2022)
This update to Medicare Physician’s pricing is primarily targeted at recent extensions of telemedicine mental health care. Telemedicine is activated at the end of the Federal Public Health Emergency (PHE), where the temporary PHE exemption expires.
Two Letters Sent to Congress Urging Telehealth Reform (Released on Jan. 28 and 31, 2022)
A group of 45 legislators, led by US Sens. Brian Schatz and Roger Wicker, sent a letter to the leaders of the Senate and House urging them to include an extension of the telehealth authorities enacted during the COVID19 pandemic in the government funding legislation in February.
A second letter that was sent to Congressional leaders on Jan. 31, was signed by 336 organizations (coled by Alliance for Connected Care, ATA, and HIMSS) that urged federal lawmakers to undertake permanent telehealth reform.
New State-Level Developments
January 31, 2021: Florida updated the definition of telemedicine and passed Senate Bill # 312, which allows healthcare professionals to use telephone visits for virtual care.
February 7, 2022: the State of Wisconsin passed Senate Bill # 309, giving the term “telemedicine” to medical support programs, safety and professional services departments, and relevant review and certification committees. I requested to define and use it as follows: Provides healthcare, diagnosis, counseling, treatment, or transmission of medical-related data by voice, video, or data communication that is used to transmit medical-related data during or through the patient’s examination or examination. Practice.
February 4, 2022: Illinois renewed the Governor’s Declaration of Disaster, extending public health emergencies by 30 days.
February 1, 2022: Indiana passed Presidential Decree 2201 and extended the public health emergency to March 4.
February 3, 2022: Virginia renewed the State of Emergency and extended the public health emergency to February 15.
State-by-State Telehealth Private Insurance Laws
State-by-State Coverage and Payment Parity Requirements
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 in 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 is 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 the 50-State Survey of Telehealth Commercial Insurance Laws here.