New Bill Looks to Mandate Payer Coverage for Telehealth Services

The latest bill introduced on Capitol Hill aims to level the playing field for payers by ensuring that all telehealth services be covered if those services are also furnished in person.

HR 8308, unveiled last week by US Rep. Dean Phillips (D-MN), wades into a hotly contested arena in connected health legislation: Who gets to decide how healthcare providers are reimbursed for their telehealth services. The bill, which was referred to the House Committee on Energy and Commerce, did not include text or a summary as of September 21.

Payers have long argued that they should be the ones to set reimbursement rates for telehealth services, and in some states they’ve successfully fought back legislative efforts to establish payment parity. In some cases, states have enacted legislation that allows payers to negotiate reimbursement rates with providers.

The ongoing coronavirus pandemic, prompting a surge in telehealth use as providers look to balance in-person and virtual care, is pushing the issue into the spotlight. Congress is under pressure to expand emergency telehealth coverage beyond the public health emergency created by COVID-19, and some states and payers have already made those emergency measures permanent.

On such example is in Tennessee, where BlueCross BlueShield of Tennessee announced in May that it was permanently covering virtual visits with in-network providers. Three months later, lawmakers passed a bill mandating that payers cover telehealth services as they would cover in-person services – though mandating payment parity only up to April 2022. In some instances, like remote patient monitoring, the new law allows payers to negotiate the payment rate with providers now.

Other states haven’t been as successful. In Florida, the state’s largest medical association took the government to task last March for not doing more to encourage telehealth coverage among private payers.

“Uniformity is desperately needed so that all health care providers can comfortably provide telehealth services during the existence of the state of emergency without patients having to worry about their insurer denying coverage for such care,” Florida Medical Association President Ronald Giffler, MD, said in letter to the state’s Insurance Commissioner.

Long before COVID-19 surfaced, payment parity had been a hot topic. Some telehealth advocates have said parity may need to be mandated now to encourage telehealth adoption, then taken off the board later as payers and providers better understand how a telehealth visit compares financially to an in-person visit.

A recent survey by Xtelligent Healthcare Media indicates payer support is one of the top barriers to continued telehealth expansion.

In The Future of Healthcare: Moving Beyond 2020, a survey of some 36s healthcare stakeholders found that while 65 percent said telehealth would be the biggest area of investment going forward, roughly a quarter said private payer support is the biggest challenge to that growth.

“Telehealth is here to stay,” one respondent, an academic health system representative, noted. “But prior to COVID, telehealth was here. Many insurances just didn’t cover it. This has opened the door for insurance companies to see its importance.”