Telehealth Parity Laws Leave Plenty of Room for Interpretation

The number of states that have healthcare parity laws continues to increase as the technology, and its proponents, experience wins. There are currently just eight states without parity laws, while (as of this writing in 2017) eight are considering laws to create parity payments for telehealth services. The remainder of the Union’s geographies each have some sort of insured coverage for the service caregivers provide through telehealth means. However, just because there are payment laws in place, nuances within the language of those laws have stymied telehealth adoption, and many of these laws are open to interpretation (as laws should be).

According to a brief composed by Center for Connected Health Policy in regard to the changing landscape of telehealth, the organization clearly states the trouble with the sector’s payment problems:  “There is a broad misconception that, because telehealth private payer laws are in place in many states around the country, telehealth is achieving its promise of providing the same patient benefit and payment as in-person care. The reality is that many private payer laws have been weakened by their lack of clarity and often contain clauses that may negate much of the intent of the legislation.”

Thus, accordingly, some reimbursement laws restrict telehealth live video, and in some cases, the language of the law doesn't include succinct language for payment parity, as mentioned above. For example, in some cases, insurers are cutting telehealth reimbursements by as much as half of those offered for in-person care. One example of this is pointed out by Fierce Healthcare, where in New York, Excellus BlueCross BlueShield told providers telehealth services would be reimbursed at half the rate of an in-person visit.

The authors of the Center for Connected Health Policy opined as to whether this action could be “the start of a new trend.” Since the start of the decade, the growth in states to offer telehealth services has nearly tripled, but the limits are concerning for those who are seeking to provide care through these vehicles – especially in rural areas. As much as the sector grows and as caregivers jump on board, these laws are what they are and allow for massive swings in interpretation, including services provided; the type of telehealth modality used; location of service; and type of provider who can offer the service.

“Many state health policy leaders are interested in telehealth—the use of technology to deliver health care to patients in a setting different from that of the provider—as a way of expanding patient access to care, especially in rural areas,” the authors noted. “State health policy leaders have been looking at ways to expand and clarify telehealth reimbursement policies, especially as they relate to private payers.

The solution? Explicit language to ensure reimbursement for all modalities and limit reimbursement confusion. Despite all this, the uptick in use of telehealth services continue, primarily so providers won’t be left behind in the event that the there’s an even more significant push to put more of the technology in practice.  

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Scott Rupp

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Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

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