Federal lawmakers, states, and private payers have expanded access to telehealth

As Covid-19 cases surge across the country and local lawmakers delay re-openings, people can no longer delay their routine medical care.

by Arielle Kane, Director of Health Care at PPI

CMS issued temporary measures to make it easier for Medicare beneficiaries to receive medical care through telehealth by allowing providers to practice across state lines, deliver care to both established and new patients, and bill for telehealth services (both video and audio-only) as if they were provided in person. CMS also significantly expanded the telehealth-provided services that Medicare will cover. The new services include:

· Emergency department visits

· Initial nursing facility and discharge visits

· Home visits outside of rural shortage areas

· Therapy services

State action to expand telehealth

State laws on telehealth vary dramatically but, prior to the coronavirus pandemic, almost all state Medicaid programs covered some telehealth services provided via live video. However, the coronavirus has pushed many states to change their rules. For example, Maryland is allowing providers to use asynchronous telehealth platforms. This means a doctor can treat a patient through photos and recorded video rather than a live video connection. This type of care is particularly useful for dermatology and ophthalmology care when people may have a question about a rash or mole or need a prescription lens renewal. The laws limited this type of telehealth often stem from scope of practice battles between various types of providers rather than scientific evidence of efficacy and safety.

Private payer expansion of telehealth

States largely set licensure rules which then govern the types of telehealth services private payers can cover. But in light of the novel coronavirus, states like California have pressured private payers to expand telehealth coverage. And other payers have done so without pressure from lawmakers: Humana is waiving all copays for tele-primary care and tele-behavioral health visits for its Medicare Advantage members.

While telehealth will never be a panacea as it is simply a modality of delivering care and not all types of care can be provided remotely, it can help increase access during this time.

Reducing barriers to telehealth could increase access to care and protect people from unnecessary risks during this pandemic.

Require ERISA health plans to cover the same telehealth services being provided by Medicare.

Large group plans are regulated by the federal government — giving states limited authority to increase coverage of telehealth for many employees within their borders. Congress could require, for the duration of the COVID-19 pandemic, all ERISA plans cover the same services as Medicare to expand access to telehealth. Reps. Kim Schrier (D-WA) and Phil Rose (R-TN) introduced a bill that would require private payers to cover the same telehealth services as Medicare for the duration of the public health emergency.

Push for reciprocal licensing agreements

For Medicare and Medicaid patients, CMS temporarily waived requirements that out-of-state providers be licensed in the state where the patient is located. The federal government could push states to do this for patients with private insurance.

Expand broadband access

Telehealth only works when patients can access fast and reliable broadband internet. Though Congress and the FCC have provided assistance through the COVID-19 Telehealth Program and the Rural Digital Opportunity Fund, broadband connectivity still lags in some parts of the country. Structural changes, like reducing the bureaucratic and regulatory obstacles to getting more providers involved, will help more people realize the potential of telehealth.