North Dakota Lawmakers Shoot Down Telehealth Payment Parity Study

North Dakota lawmakers have shot down a pilot project to study payment parity for telehealth services, saying the idea of charging the same rate for virtual and in-person care would be price-setting.

The state’s House and Representatives this week rejected SB 2179 by a vote of 64 to 29, after the bill had been approved by the Senate in February by a 44-3 margin.

The bill would have launched a two-year program to study payment parity for telehealth services, initially for behavioral healthcare. It would have established reimbursement rates at no less than those for in-person care, included audio-only telehealth services in situations where no other means of access was available, and limited deductibles, copayments and cost-sharing to the same level as used in in-person care.

“The study should include input from stakeholders, such as providers, payors, and the insurance department,” the bill stated. “A goal of the study is to encourage providers and payors to collaborate to find a mutually agreeable telehealth reimbursement structure.”

Several states have established payment parity for telehealth services during the public health emergency caused by the coronavirus pandemic, and some have moved to make that permanent. Proponents argue that parity is needed to help healthcare providers embrace connected health and push more patients onto virtual health platforms to boost access to care.

Supporters have also argued that parity needs to be enforced to keep payers from undercutting the value of telehealth services and pushing providers away.

“Rural health care needs this,” State Rep. Greg Westlind, a sponsor of the bill, said during last week’s vote, as reported by local media. “They need to be reimbursed. Currently, they’re not being reimbursed at a fair rate, not very much of a rate at all. It’s not sustainable. So in our rural health clinics, we’re not going to do telehealth unless it comes on board with the insurance companies.”

Opponents – including many in the insurance sector – say strict payment parity is an undue burden on payers, who should be able to negotiate their own rates with providers. Some have pointed out that telehealth services are designed to reduce the cost of care, and should therefore be reimbursed at lower rates.

Those voting against the bill also pointed to a fiscal analysis ordered by the state, which found that the bill would cost the state almost $2.5 million over the next two years. It pointed out that payers currently reimburse at less than that of in-person care and would have to raise their rates to adhere to the pilot program.