What you need to know about telehealth parity laws

telehealth parity laws

Telehealth is more popular than ever these days, mostly due to COVID-19 and more and more patients feeling uneasy going to the hospital or doctor’s office and preferring to have their appointments conducted virtually from the comfort of their own homes. This article will go over telehealth parity laws and how it impacts you when practicing remotely.

What is telehealth?

Telehealth is defined as the use of technology to deliver health care, health information or health education at a distance. It allows for increased contact between patients and providers without the need for physical contact or in-person visits. These visits can be done virtually via video chat, over the phone or even through text messaging. Perhaps one of the greatest advantages of telemedicine is it makes healthcare accessible to communities that are underserved, for example, rural communities where patients would have to travel long distances to get access to quality care of the specialist visits they need. Due to the distance, patients often go without care, which is detrimental to their health.

But, when it comes to paying for telemedicine, very few states require healthcare plans cover the cost the same way they do for in-person care. This is what’s known as telehealth payment parity. Learn more about telehealth parity laws below.

Hurdles of paying for telemedicine

Currently, there is no consistent, streamlined legal approach for telehealth and how it’s paid for. This causes concerns for reimbursements among private insurers and public programs like Medicaid and Medicare. These concerns cause some insurance providers to limit the coverage and implementation of telemedicine services.

Another big hurdle is how states define telehealth for purposes of insurance coverage. For instance, does telehealth only refer to services received by a healthcare provider? Or does it also include and insurance should cover devices and other technology a patient needs for virtual care.

More states are hopping on the wagon and requiring private insurance to reimburse providers for care that is delivered by telemedicine. But, still there are states that don’t have such laws. The telehealth parity laws are in place to prevent health plans from withholding reimbursement for telemedicine services based on where a patient is located. This means that patients can do telehealth appointments from their office or their home and are not required to travel to a qualified site. Requiring a patient to be in a specific location in order to get reimbursed is an extremely cumbersome requirement.

The federal laws

While there is no federal law governing telehealth and parity laws, the federal government does provide a few incentives through the Affordable Care Act to encourage developing telehealth services, including grants and reimbursement incentives. But still, the federal government leaves most of the decision-making about implementing or reimbursing telemedicine services for Medicaid programs up to each individual state. For Medicare, however, the federal government does play a role in shaping the telehealth services.

Reimbursable services with telehealth parity laws

All states that have telehealth parity laws mandate private pay reimbursement for telemedicine services done via video.

Which providers are eligible?

It’s up to each state with telehealth parity laws to determine which licensed healthcare professionals may practice telemedicine. This decision is often made by the state medical board. The general rule, for reimbursement purposes, is that any provider that can bill for an in-office visit is also able to bill for virtual telehealth visits.

How much is reimbursed?

How much providers are reimbursed for their telehealth services varies by state and what the laws say. Some states have mandated that private payers reimburse the same amount for tele heath as they would for an in-person visit. A lot of states choose to leave this determination up to the payers.

Are there any exceptions?

The majority of the state reimbursement mandates do include exceptions for specific types of insurance. Small group plans and worker’s compensation often have the option to opt out of telemedicine coverage.

Why is there pushbak about telehealth parity laws?

Those who pushback against telehealth argue that the services are not the same as in-person services and should not receive parity to in-person care and reimbursements. They believe that new technology should be approached with caution because it can be unreliable and even lead to incorrect diagnoses. One example is when the American Optometric Association opposed online exams and the parity for reimbursements because they called the methods “substandard.” Another concern from opponents is that the reason telemedicine should not be reimbursed the same as in-person care is because there are already cost-savings that come with telemedicine. Since some may argue that telehealth saves money and is more efficient, then the reimbursement for the services should reflect the savings, they say. Due to the higher risks associated with telemedicine, the possibility of lower quality of care and the cost-savings, some physicians argue that telehealth should not be reimbursed equally to in-person care.

Learn more

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