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Legislation Wrap-up: What’s Going on in Telehealth?

Virtual care is seemingly on everyone’s mind these days, and rightfully so. Stakeholders increasingly see the value in providing telehealth services to save costs, provide better patient outcomes and save physicians from burnout.

Lawmakers are finally catching up to the trend by enacting protections for telehealth services. What was once hard to bill is now a regularly covered service by private insurers, Medicare and Medicaid programs.

We still have a long way to go, but changing regulations are promising. Some have even gone as far as calling 2019 the “Year of Telehealth.”

Here’s a rundown of what you need to know for 2019.

States Rule Private Insurers Must Pay

In 2019, the majority of U.S. states now have parity laws in the book, which require private insurers to cover telehealth services that would otherwise be covered if they were performed in-person.

States with telehealth parity laws include: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, Texas, Vermont, Virginia, Washington and also the District of Columbia.

In Massachusetts, Pennsylvania, South Dakota and Alaska, legislators have proposed telehealth parity bills that have not yet been voted into law.

Changes to Medicare Rules Show Important Growth

The Centers for Medicare and Medicaid (CMS) is catching on to the telehealth trend and updating coverage policies to reduce administrative burdens and strengthen relationships between providers and patients.

What’s New: Telehealth Defined

In 2018, CMS clarified what constitutes telehealth. What that means for you: virtual check-ins, remote patient monitoring and physician-to-physician consultations are not considered telehealth and aren’t subject to CMS’s telehealth restrictions.

  • CMS will cover virtual check-in services to evaluate whether office visits are necessary.
  • Remote professional evaluation of patient-transmitted information (from pre-recorded video or images) is not subject to Medicare telehealth restrictions.
  • Inter-provider consults via phone or web are covered under new codes.

What’s New: Accountable Care Organizations

Lawmakers amended the Social Security Act to provide Accountable Care Organizations (ACOs) – groups of providers who come together to coordinate care for Medicare patients – with the ability to offer expanded telehealth benefits.

  • The patient’s home can be treated as an originating site, which is very important to providing easy follow-up for rural or homebound patients.
  • There are no geographic limitations on originating sites. Previously, reimbursement was limited to only include rural locations.
  • For patients using their home as a care site, there will be no facility fee.

CMS Recommends Medicaid Telehealth Benefits

In June 2018, the Centers for Medicare & Medicaid Services (CMS) encouraged states to use telemedicine and telepsychiatry to provide care to Medicaid recipients, specifically as a means to address provider shortages.

According to CMS, the organization is hopeful that states will improve their technological capacity in order to address the opioid crisis and improve health outcomes for Medicaid beneficiaries. Most states – 49, in fact – have enacted policies within their Medicaid programs to reimburse for live video telehealth. Massachusetts is still weighing its options; lawmakers there failed last year to pass the necessary legislation.

Opioids Push Telehealth Changes

Concern over the opioid crisis led several states to look for faster intervention solutions. Indiana, Michigan and Missouri have all introduced legislation to allow for physicians to have the ability to remotely prescribe controlled substances that may be used in the treatment of addiction.

On the national level, President Trump signed into law the SUPPORT for Patients and Communities Act in 2018, which makes it easier for telehealth practitioners to prescribe for medication-assisted therapies.

Telehealth Expands for Stroke Patients

Stroke is the leading cause of long-term disability in the United States. It’s more likely to occur in people over the age 65; as America’s population grows older, stroke care will be increasingly important.

The Bipartisan Budget Act of 2018 removed restrictions on originating sites and geographic locations for acute stroke telehealth services.

Our government is taking notice of telehealth’s rising popularity. Your organization has more telehealth options than ever – do you have the staff you need to take advantage?


The Telehealth Rural Revolution

Telehealth has the power to help underserved communities save on healthcare costs, produce better patient outcomes and keep physicians happy.

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