Telehealth Advocates Set Their Sights on Private Payer Coverage

Telehealth advocates are pushing private payers to cover connected health services at the same rate at in-person care during the Coronavirus pandemic.

A House bill filed this past week seeks to ensure that all medically necessary benefits in Employee Retirement Income Security Act (ERISA) plans, including mental health and substance abuse care, are covered via telehealth during the COVID-19 emergency. It would also establish parity between telehealth – including audio-only phone calls - and in-person visits, prevent restrictions on remote management of care and ensure that cost-sharing for COVID-19 treatment can be waived.

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The bill’s sponsors, Reps. Kim Schrier (D-WA) and Phil Rose (R-TN), say they want private payers to operate under the same rules as the Centers for Medicare & Medicaid Services, which last month established telehealth payment and coverage parity for the duration of the emergency.

Some states, like California, have put pressure on private payers to expand telehealth coverage during the pandemic. In Florida, meanwhile, doctors’ groups have lobbied the state’s insurance commissioner – so far unsuccessfully – to mandate payment parity.

“The COVID-19 crisis is unlike anything before seen by our country,” Roe said in a press release. “While (CMS) is doing everything it can to ensure providers are compensated during this uncertain time, many providers are struggling because elective procedures were eliminated.”

“Congress can help these providers by ensuring ERISA health care plans cover all forms of telehealth visits as if they were in-office visits during the current health crisis,” he added. “We must ensure our health care providers are able to survive this crisis, and this small coverage change would go a long way to ensure that survival.”

Among those backing the effort are the American Medical Association and the American Academy of Pediatrics.

“The AMA supports this critical legislation to require ERISA plans to cover telemedicine services for the duration of this pandemic, in line with the guidance that Medicare already has issued to providers,” AMA President Patrice A. Harris, MD, MA, said in a press release.

The bill is called The Health Care at Home Act of 2020.

“Even though COVID-19 is top of mind for everyone right now, people still need to be able to access the everyday health care and medical advice they need,” Schrier said in her press release. “Dr. Roe and I want to make sure that this is done as safely as possible for both patients and doctors. By requiring plans to cover telehealth visits the same way they cover in-person visits, patients can still see their doctors without risking unnecessary exposure to COVID-19. And doctor’s offices can keep their doors open, care for their patients, and ensure they are still there after the pandemic.”