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Telehealth Reimbursement Growing, but CCHP Argues Policies Need to Improve


"There is a broad misconception that, because telehealth private payer laws are in place in many states around the country, telehealth is achieving its promise..." the report argues.

telehealth, CCHP, telehealth laws loopholes, healthcare analytics news, telehealth laws arizona, telehealth policy

Earlier this week, it was reported that Medicare reimbursement for telehealth services had grown by 28% in 2016 over the previous year. The amount reached nearly $29 million nationwide across nearly 500,000 individual claims, a number which itself represents a 33% increase over the previous year.

Telehealth advocates and providers have seen plenty of positives lately, between growth numbers like those, new companies entering the fray, expansion of telehealth coverage to more often include mental health, and passage of legislation throughout the country to ensure reimbursement.

On that last point, however, there may still be work to do. The Center for Connected Health Policy (CCHP) released a report last week through the Milbank Memorial Fund that highlighted the impacts and issues of such laws. Its major takeaway was that policy obstacles still hinder telehealth’s potential.

“It is clear from this study,” the report concludes, “that there is a broad misconception that, because telehealth private payer laws are in place in many states around the country, telehealth is achieving its promise of providing the same patient benefit and payment as in-person care.”

Too many telehealth laws, the CCHP argues, contain loopholes and limitations, or a lack of clarity that inhibits the full usage of what telehealth can offer. Arizona’s telehealth law that took effect in 2015 limits services to treatment of trauma, burn, cardiology, infectious diseases, mental health disorders, neurological diseases including strokes, and dermatology.

Tennessee’s telehealth law limits reimbursable services to “qualified sites” including only “the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.”

Other state laws also allow health plans the ability to limit reimbursement for telehealth: California’s provides that “no health care service plan shall require that in-person contact occur…before payment is made for the covered services appropriately provided through telehealth,” but then stipulates that that is “subject to the terms and conditions of the contract entered into between the enrollee…and the healthcare service plan.”

Additional problems identified include unequal reimbursement for different modalities of telehealth, such as store-and-forward. When Healthcare Analytics News spoke to CCHP Executive Director Mario Gutierrez in the spring, that was a key point.

“Unless the state is willing to look at all of that rather than just piecemeal it, they’re not going to make much progress…incorporating the ability to pay for not just live video but also store-and-forward and remote monitoring, and eliminating any unnecessary barriers to utilizing telehealth,” were necessary to bring the services to their proper utilization.

The new CCHP report concludes with a list of considerations for policymakers:

  • Consider using explicit language in private payer laws that details the exact intent of policymakers, such as ensuring all modalities are to be reimbursed by private payers.
  • Ensure that payment parity language is included in the laws if it is the intent of policymakers to have telehealth reimbursed at the same rate as in-person services.
  • Consider inclusion of some type of education component for both providers and consumers.
  • Consider a robust, comprehensive telehealth policy within the state Medicaid program.
  • Work with state licensing boards to create telehealth policies that allow licensees the flexibility to utilize technologies in delivering care but still take into consideration the safety of the patient.

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