Illinois Coalition Urges Lawmakers to Enact Telehealth Payment Parity

A coalition of healthcare organizations is pressuring Illinois lawmakers to mandate payment parity for telehealth services.

The call to require payers to reimburse providers for telehealth services at the same rate as they do for in-person care is part of a 10-part request to make permanent emergency provisions enacted earlier this year to improve connected health access and coverage during the coronavirus pandemic. The request was made in a letter sent last month to every member of the Illinois House of Representatives and several state officials.

“Absent action from the Illinois General Assembly, providers will not have the certainty they need to continue to invest in and utilize new care delivery tools, and Illinois residents will abruptly lose access to the telehealth services they have relied on during the pandemic,” the five-page letter states. “To ensure continued investment in the most effective and efficient technologies and, moreover, patient access to telehealth services, providers, professionals and patients need assurance that key flexibilities authorized during the pandemic will continue beyond its end.”

In response to the COVID-19 public health emergency, many states issues emergency directives aimed at boosting the use of telehealth to supplant in-person care. Some state legislatures have moved to keep those directives in place beyond the pandemic, while others are waiting on the Centers for Medicare & Medicare Services and Congress to decide how telehealth should be covered in the future.

The Illinois coalition doesn’t want lawmakers to wait. And they’re calling payment parity the linchpin to continued momentum for widespread telehealth adoption.

“Payment parity is the linchpin to removing existing barriers to patient access and provider adoption, paving the way for the widespread implementation of telehealth,” the group argues. “By allowing insurers to negotiate separate in-person and telehealth payment rates, particularly as premiums continue to rise, insurers will profit at substantial expense to patients, providers, professionals and employers.”

“Without telehealth coverage and payment parity for Medicaid and commercial insurance, Illinois health plans can reimburse providers at unsustainably low rates or choose not to cover services at all, stifling flexible access to services and investments in virtual technologies that have been rapidly adopted and accepted this year,” the group adds.

Several large payers and some state governments are opposed to long-term payment parity, arguing that payers should be able to negotiate their own reimbursement rates with providers.

That’s the argument being made in neighboring Ohio, where the Buckeye Institute issued a report last month calling on lawmakers there to take payment parity off the board.

“Private insurers have recognized the promise of telehealth and have already shown a willingness to expand telehealth coverage, but they are still learning where the true potential and value for telehealth really lies,” the report said. “A payment parity requirement at this early stage would prematurely signal that telehealth treatment options are interchangeable with in-person visits in terms of cost and quality. Medical studies, however, do not warrant this conclusion or pricing structure inasmuch as there are still many areas in which telehealth’s medical value is not yet established.”

According to the Illinois coalition, prior to the COVID-19 emergency, 16 states mandated payment parity for commercial health plans, and 28 states require parity in Medicaid plans. Some 36 states, meanwhile, require commercial plans to cover the same services via telehealth that are offered in-person, while 21 states require coverage parity in their Medicaid plans.

The group further argues that extending telehealth coverage will improve health outcomes by reducing emergency department visits, hospitalizations and unnecessary transports – thereby reducing mortality rates.

The parity request was included in the coalition’s 10-part Telehealth Principles for Legislative Reform:

1. Patients shall not be required to prove a hardship or access barrier in order to receive telehealth services.
2. Patients shall not be required to use a separate panel of practitioners or providers to receive telehealth services.
3. State regulated public and private health plans shall provide payment and coverage parity for telehealth services in the same manner as for in-person covered services.
4. State regulated public and private health plans shall not:
   1. Negotiate different contract rates for telehealth and in-person services;
   2. Require in-network providers to offer or provide telehealth services;
   3. Require patients to use telehealth services instead of receiving in-person services; and
   4. Place conditions, treatment limitations and requirements on telehealth such as utilization management criteria, documentation or recordkeeping that are more restrictive or stringently applied than those established for in-person services.
5. Providers shall deliver services within the scope of their license or certification, unencumbered by geographic or facility restrictions for any services delivered via telehealth.
6. Providers shall be permitted to provide distant site services as long as they are licensed, registered, certified, or authorized to provide those services in Illinois.
7. Providers, with their patients, shall determine which health care services and modes of virtual communication are most appropriate for delivery via telehealth.
8. Originating site locations, including the patient’s home, shall be permitted.
9. Providers and practitioners shall determine the appropriateness of specific sites and technology platforms/vendors for a telehealth encounter, as long as delivered services adhere to privacy laws.
10. Support investments in telehealth technology by reimbursing a facility fee to a facility or other provider organization that acts as the originating site (location where patient is located) at the time telehealth services are provided.

The coalition consists of the state chapter of the AARP, the American Nurses Association-Illinois and Illinois Society for Advanced Practice Nursing, the Association of Community Mental Health Authorities of Illinois, the Health Care Council of Illinois, the Illinois Association for Behavioral Health, the Illinois Critical Access Hospital Network, the Illinois Health and Hospital Association, the Illinois Health Care Association, the Illinois Occupational Therapy Association, the Illinois Primary Health Care Association, the Illinois Psychiatric Society, the Illinois State Medical Society, the Kennedy Forum and LeadingAge Illinois.