New Telehealth Bills Address Coverage, Store-and-Forward, RPM

New Mexico joins a growing number of states contemplating new laws or amending old ones to address telehealth coverage, asynchronous or store-and-forward telemedicine and remote patient monitoring.

By Eric Wicklund

February 12, 2019 – Lawmakers in several states are pushing forward with bills to amend existing telehealth and telemedicine rules – most notable changing them to improve payer coverage and include remote patient monitoring and asynchronous (store-and-forward) platforms.

The latest state to join the effort is New Mexico, where the state Senate’s Public Affairs Committee was scheduled today to review SB 354.

The bill, titled “Health Coverage for Telemedicine” and filed on January 25, aims to hold payers to the same coverage standards for telemedicine as they do for in-person care. It would prevent payers from imposing any “unique restrictions” on telehealth, including originating site restrictions, and would compel them to reimburse providers “on the same basis and at least the same rate” for comparable in-person care.

It would also enable payers to charge a deductible for virtual care as long as the deductible, co-payment or co-insurance doesn’t exceed that charged for in-person care, and it would prevent payers from setting an annual or lifetime dollar cap on telehealth coverage “other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the health insurance plan, policy or contract.” Also, the bill would prohibit payers from limiting that coverage to providers who are part of the health plan’s provider network.

As with several other states, the New Mexico bill redefines telemedicine to include RPM and store-and-forward services, two platforms newly included for reimbursement in the Centers for Medicare & Medicaid Services 2109 Physician Fee Schedule and Quality Payment Program.

As proposed, telemedicine would be defined as “telecommunications and information technology to provide clinical health care at a site distinct from the patient.”

“’Telemedicine’ allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications and information technology in real time or asynchronously, including the use of interactive simultaneous audio and video or store-and-forward technology, or remote patient monitoring and telecommunications in order to deliver health care services to a site where the patient is located, along with the use of electronic media and health information,” the bill states. “’Telemedicine’ allows patients in remote locations to access medical expertise without travel.”

In Virginia, meanwhile, SB 1221 and HB 1970 both recently passed in their respective chambers and will be combined and sent to Gov. Ralph Northam’s desk for a signature. That bill would amend the Commonwealth’s current telehealth laws to include payer coverage of remote patient monitoring services, defined as “the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other condition-specific data; medication adherence monitoring; and interactive video conferencing with or without digital image upload.”

The bills drew praise from Nathaniel Lacktman, a partner in the Foley & Lardner law firm and chairman of its Telemedicine Industry Team.

“Remote patient monitoring is positioned to become the next big thing in patient-centered digital health care,” Lacktman – who has helped some state legislatures in drafting their bills – said in a recent blog. “User-friendly software and equipment already exist; there simply has been little third party reimbursement historically to drive adoption. This is quickly changing however, led by CMS’ addition of three new remote patient monitoring codes for 2019. In addition to the three new codes, Medicare also covers a fourth remote patient monitoring code.

“Ensuring that payers and health insurance plans pay for remote patient monitoring as a covered member benefit will incentivize providers to invest in these technologies,” he added. “This will equip them to better monitor and manage patient care needs, allowing patients to avoid unnecessary hospitalizations, and more proactively manage chronic conditions.”

Arizona is currently reviewing a bill, SB 1089, that would follow along the path that New Mexico is taking, while lawmakers in North Dakota recently amended a proposed bill to include store-and-forward telehealth. And Maryland’s Board of Physicians is reportedly finishing up a year’s worth of work on new telehealth regulations that would, among other things, set the ground rules for telemedicine in establishing a doctor-patient relationship.

According to the Center for Connected Health Policy, roughly 90 bills currently before state lawmakers address regulatory, licensing and advisory board oversight of telehealth laws. Another 31 bills address private payer reimbursement, while 39 target Medicaid coverage and one addresses Medicare reimbursement. Other bills address issues including cross-state licensing, pilot projects, online prescribing, defining the provider-patient relationships and broadband coverage.