‘For 50 different states, there are going to be 50 different sets of rules’
By Kathy Dion, Managing Editor
YARMOUTH, Maine – Telemedicine parity laws are making news across the country, but the implementation of such directives can be a double-edged sword, say industry watchers.
Jim Reilly, vice president of telehealth for ConnectAmerica, believes that telemedicine parity laws are a good thing but there’s a weak link.
“For 50 different states, there are going to be 50 different sets of rules,” he said. “Everyone is not as motivated to comply as the next person, and when everyone is not motivated the same way, patients lose.”
Telemedicine parity laws like the ones recently adopted in the District of Columbia, Hawaii and Rhode Island (see below) provide payers with the opportunity to analyze the benefits of telemedicine. Rather than looking at the laws as an obstacle, they are realizing that telemedicine can save money and bring improved patient-member satisfaction.
Reilly believes that Medicare rules regarding telehealth have helped motivate other payers to see its benefits.
“The government is saying that they’re paying money for providers to take care of people,” said Reilly. “They are basically saying they don’t care how providers do that, but they want to see the outcomes.”
Reilly said that just visiting the employment section of any large private insurer, for example, shows that a rising number of jobs available have more to do with data analytics than clinical roles.
“CMS rules are trimming the herd and redesigning the model,” he said.
Nate Lacktman, a partner and healthcare lawyer at Foley & Lardner in Tampa, Fla., said telehealth policy offers widespread benefits: patients get increased access to care, providers have more opportunities to treat patients with insurance coverage, and health plans increase care management access to their members.
“As an ancillary benefit, telehealth coverage laws promote innovation in the private sector by catalyzing healthcare providers and plans to invest in and use the powerful health technologies available in the marketplace,” said Lacktman.
“I’ve got to tip my hat to the states for aligning themselves with the government,” said Reilly, “but there’s a lot more that needs to be done. We need to give the power back to the patient.”
Telemedicine updates in DC, Hawaii, Rhode Island
The District of Columbia recently released guidance on Medicaid fee-for-service coverage and reimbursement. The first official rules published by the Department of Health since its 2014 Telemedicine Policy, the guidance directs Medicaid to cover services including evaluation and management, behavioral healthcare services and speech therapy.
Hawaii has enacted another law to improve telemedicine there since its first parity law in 2014. The new law will remove telepresenter requirements, as well as geographic and site restrictions under Medicaid fee-for-service and managed care. The law extends coverage to include remote patient monitoring, store-and-forward, and mobile health.
Rhode Island, one of a handful of states to hold consistently low rankings in the country for telehealth coverage policy, recently enacted a telemedicine parity law to take effect in 2018. The new law places no restrictions on the patient or provider setting, and will permit coverage for real time audio/video and store-and-forward. The law does not require health plans to pay providers at the same or equivalent reimbursement rate for identical in-person or telemedicine-based services, and insurers will be able to execute telemedicine agreements as a condition of coverage and payment.