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Have you ever wondered where your state is on the following questions?

- Does your state have a Telehealth commercial payer statute?

- Does the law have a coverage provision?

- Does the law have a reimbursement provision?

- Does your state have unrestricted originating site?

- Member cost-shifting protections? (deductibles, co-insurance)

- Does your state requires coverage for Remote patient monitoring?

- Does your state requires coverage for asynchronous Telehealth?

The people at Foley & Lardner LLP deserve a shout out for this great resource. Tune in Thursday for the show.

#healthcare #telehealth #cio #cmio #chime #himss #healthIT

Transcript

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 Today in health it, the story is state telehealth reimbursement policies. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current. And engaged. Today, we have no show sponsor. So if you're listening to this, you know that the power of podcasting, our show, which started in on January 4th, has already achieved 1500 downloads, and that number is only going to grow.

In fact, this week it's grown by 500 already. Uh, if you want to get the message out or in front of a targeted healthcare audience, send an email to partner at this weekend, health it.com. Alright, here's the story. You know, we had a fairly sizable legal team at the health system where I was ACIO. I guess you would expect that from a a $7 billion health system.

Uh, they kept me in the loop on most everything I needed to know about the law. Well, I no longer have a legal team, and it occurred to me that many of you probably don't have a legal team either. So I keep an eye out for great content that covers the law, uh, with regard to health it. In fact, if you come across an article and you want me to cover it, just send it over to me at hello at this weekend, health it.com.

I am always looking for great content and if you happen to come across 'em. Love to, love to discuss it on the show. There is a wonderful report out there from Foley, Larner law firm that breaks down the state laws with regard to telehealth. Have you ever wondered where your state is on the following questions?

Does your state have a telehealth commercial payer statute? Does the law have a coverage provision? Does the law have a reimbursement provision? Does the state have unrestricted originating site? Actually, only one, one site has a problem with that. Uh, one state, uh, member cost shifting protections, meaning deductibles and co-insurance to make up for variances in onsite versus telehealth.

Does your state require coverage for remote patient monitoring? Does your state require coverage for asynchronous telehealth still one of the most widely used forms of telehealth out there. Alright, I'm, I'm just gonna go straight to the article. I'm gonna give you a, a lot of the stuff from the executive summary and then come back and talk a little bit about it.

In the time since our 2019 report, the legal landscape for telehealth reimbursement has significantly improved. Currently 43 states and DC maintains some sort of telehealth commercial payer statute with West Virginia joining the list in 2020. Yet the. Quality and efficacy of these laws vary significantly from state to state.

For example, three states have telehealth coverage laws on the books that do not actually mandate health plans to cover services delivered via telehealth. Those are Florida, Illinois, and Michigan. I. And while telehealth coverage has widely expanded, the same cannot be said for reimbursement payment parody.

Currently 22 states maintain laws expressly addressing reimbursement of telehealth services. An increase from 16 states in 2019 and 14 of those offer true payment parody and increase from 10. In 2019, meaning that providers outside those 14 states may find they receive lower payment for telehealth based services compared to in-person services And, and that's even with the same service code, but different reimbursement rates.

States with payment parity laws are. And they list some Arkansas, California, whatnot. Uh, I'm gonna really encourage you to download this, a lot of great graphics. And, uh, you could just look at the, you know, you could read it by pictures. You could read it by words, uh, Massachusetts, uh, also temporarily extended payment parity for primary care and chronic disease management services via telehealth over the next two years.

And all other healthcare services, which have been temporarily mandated by gubernatorial executive order for 90 days beyond the end of the Covid 19 state of emergency. So there's . They go into a lot of detail here. It's really good. I'm gonna keep going here. Other limitations on telehealth? Commercial insurance reimbursement continue to exist in some states, but the trend is towards equitable treatment.

For telehealth, for example, only one state, Tennessee still maintains some restrictions on the patient's originating site. And 30 states have cost shifting protections, which prohibit the plan from charging a patient deductible, co-insurance, and or co-payment for a telehealth consultation that exceeds what the insurer would charge for the same service if it were provided during an in-person consultation.

It goes on. Coverage of asynchronous telehealth and remote patient monitoring has also grown. Patients and providers continue to push for more virtual care. Services and health plans are beginning to offer meaningful coverage of these modalities. More than half of the stage 27 mandate coverage. For store and forward or Async telehealth and 17 states require commercial health plans to cover remote patient monitoring services.

I think that's only gonna grow. But anyway, they go on to say we are pleased to share this 50 state summary of state telehealth commercial payer statutes. Uh, this survey con contains pinpoint citations to the governing statutes or rules, but includes only commercial health insurance laws and does not include Medicaid fee for service rules or Medicaid managed care organization laws.

And rules, which also vary on a state by state basis. You know the, the people at Foley and Larner, LLP deserve a shout out for this great resource. I'm sitting here looking at it now, and it is exceptional state by state breakdown in a chart format. So if you just wanna look real at a glance and see which states have what, they also go into each question in detail.

Does your state have a telehealth commercial payer statute? Whether or not your state has a law addressing commercial health plan coverage? Of telehealth services and it just says yes, no, uh, on a map of the United States. Red, blue, so you can see which ones have the law, which ones don't. Same thing for coverage provision.

Does the state laws expressly discuss coverage Parity, meaning the law requires commercial insured to cover the healthcare service delivered via telehealth if the insurer would cover the same service if it were provided during an in-person consultation. And again, you know they have yes, no limited, not applicable.

And, you know, then you have fewer states. And then does the law have reimbursement provision and you have even fewer states. Uh, the unrestricted originating site, Tennessee has a problem, but, uh, most of the others are, are on board with it. Uh, member cost shifting. Again, a wonderful, wonderful resources. I'm gonna put a link to this.

Out there so you can find it. It will be in the LinkedIn post. It'll also be in the show notes for today. In health it, I think the other thing that's great about this is they go into detail. Each state has two or three pages of detail, so it goes into the exact provisions within the law. And it pulls them out so you can actually read those.

If your state is Arizona, you can see what provisions they have and what the actual wording is. Uh, again, great resource. Glad to share it with you, and that's what we're doing here on today in Health. It making you aware of things that will help you to do your job more effectively. That's all for today.

If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com, or wherever you listen to podcasts. Apple, Google Overcast, Spotify, Stitcher. You get the picture. We're everywhere. We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders, VMware Hillrom, Starbridge Advisors, McAfee and Aruba Networks.

Thanks for listening. That's all for now.

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