A summary of 2018 telehealth legislation by the Center for Connected Health Policy finds that states were focused on improving Medicaid coverage and joining interstate licensure compacts. But they weren’t that interested in mandating private payer coverage.

By Eric Wicklund

December 18, 2018 – State legislatures passing new telehealth laws in 2018 focused primarily on expanding Medicaid coverage, approving interstate licensure pacts and establishing guidelines, according to a review by the Center for Connected Health Policy.

On the other side of the connected care checklist, however, the California-based center found that state lawmakers weren’t interested in passing bills improving or defining private payer coverage.

The annual rundown by the CCHP found 65 pieces of legislation on telehealth and telemedicine passed in 39 states and the District of Columbia, a slightly larger number than the 62 bills that became law in 2017. In addition, 38 states finalized regulations related to telehealth.

Medicaid legislation was, perhaps not surprisingly, at the top of the to-do list, as state lawmakers followed the lead of the Centers for Medicare and Medicaid Services (CMS) in expanding opportunities for new telehealth programs and better reimbursement.

“While most states already provide some type of reimbursement for telehealth delivered services, Medicaid telehealth legislation focused on broadening the scope of those services, adding additional professionals and reducing barriers to the use of telehealth,” the CCHP report said, specifically citing new laws passed in California, Illinois, Kentucky and Colorado.

This momentum does come with some criticism. Earlier this year a state-by-state analysis of Medicaid programs by the Manatt legal and consulting firm found that only 40 percent of the nation’s programs were taking a progressive approach toward telehealth, while another 20 percent have restrictive policies in place. More recently, a new non-profit called HealthTech4Medicaid (HT4M), comprised of more than 40 healthcare IT companies, formed to lobby for more Medicaid coverage of telehealth and mHealth programs aimed at the underserved.

“A growing body of evidence suggests that telemedicine will be critical to delivering healthcare in the future, and state Medicaid policies are evolving – in some states more quickly than others – to accelerate adoption of telemedicine models,” Manatt Health executives Jared Augenstein, Jacqueline D. Marks and Randi Seigel wrote in their report. “As technology advances and the evidence base for telemedicine expands, state policy will continue to evolve to integrate telemedicine into payment and delivery reforms that support overarching program objectives related to access, quality and cost of care.”

Coincidentally, both state and federal officials see Medicaid programs as an ideal avenue for tackling the nation’s ongoing opioid abuse epidemic through new telehealth and telemedicine platforms. Expect that trend to continue into 2019.

According to the CCHP report, other active areas of legislation in 2018 included bills defining which healthcare providers (such as social workers and advanced practice nurses) could use telehealth and telemedicine, and those allowing states to join telehealth-friendly interstate licensure compacts for physicians, nurses, physical therapists and psychologists.

“On the regulatory side, adopted regulations were heavily concentrated in the professional regulatory board’s topic area, due to the high number of professional boards adopting or revising their telehealth practice standards,” the report noted. “As reimbursement for telehealth in certain professions has become more prominent, telehealth practice standards in turn are being adopted on a much faster pace than in years past.”

According to the CCHP, practice standards generally establish a definition for telehealth, require a provider to be licensed in the state and stay within one’s scope of practice, set guidelines for establishing the provider-patient relationship and stipulate that virtual care adhere to the same standards as in-person care.

Not all the news was good for telehealth legislation in 2018. According to the CCHP, there was a sharp drop in states passing laws governing how private payers should embrace telehealth. Only Kansas and Iowa, in fact, passed anything comprehensive.

“Despite a small surge of bills introduced in 2017 that explicitly required insurers pay the same amount for telehealth delivered services as they do for in-person services (“payment parity” bills), CCHP did not find any such bills that passed in 2018 with a requirement for payment parity,” the report noted.

That finding falls in line with a separate report issued by the CCHP earlier this month. That report – an analysis of payer compliance with Texas’ telehealth and telemedicine law – found that many of the state’s insurers aren’t being transparent about what they do and don’t cover. And it suggested that this lack of transparency could be contributing to the low telehealth adoption rate by providers.

“If the information is not clearly available on their website or elsewhere in their provider manuals, a provider may be given the impression that the issuer does not support telehealth and choose not to take advantage of its benefits,” the report concluded. “Policies that explain reimbursement eligible services, locations and healthcare professionals, clarify for providers whether the program they choose will be covered by the issuer. The more difficult it is to find this information, the fewer the number of providers that will pursue this type of service delivery. Additionally, the law does not specify any penalty or entity to enforce the requirement to display a telehealth policy online. Without enforcement of any kind, it is less likely to see issuers work to remain in compliance.”

Finally, the CCHP analysis cited two federal bills passed this year – the Bipartisan Budget Act of 2018 and the SUPPORT for Patients and Communities Act (H.R. 6). Both “will impact telehealth across the nation moving forward.”

In its conclusion, the CCHP foresees a busy year ahead for telehealth policy.

“In addition to the federal changes previously mentioned, Medicare has also incorporated major telehealth policy changes into their Calendar Year 2019 Physician Fee Schedule, which communicates a new interpretation by CMS of the applicability of their statutory requirements for reimbursement of remote communication technology as separate from telehealth and adds new services, such as virtual visits, asynchronous remote evaluation and interprofessional internet consultation,” the center reported. “This may open the door for more expansive reimbursement moving forward for services not explicitly defined in statute.  It could also have a trickledown effect on the state, and even private payer policy levels where other payers may start to consider reimbursement for these other types of services as well.”

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