Starting in January 1, 2016 New York will be among the number of states providing healthcare reimbursement for telehealth services from both commercial health plans and Medicaid.  

By Vera Gruessner on October 22, 2015

Telehealth legislation continues to break new ground, as more states adopt telemedicine coverage and payment parity laws are put in place. When payment parity regulations are put into place, virtual doctor visits will receive the same reimbursement amounts as that of in-person care.

The latest changes for telehealth legislation stem from the state of New York where Governor Andrew Cuomo signed into law an amendment that alters New York’s telemedicine commercial coverage mandate, according to The National Law Review.

This amendment to New York’s telehealth legislation takes effect on January 1, 2016 and will impact the coverage of commercial plans as well as Medicaid insurance. With only a few months left before the telemedicine amendment takes hold, providers and insurers will need to be ready to assist patients interested in this coverage.

Developing business models and completing telemedicine implementations will be key to success with the amended telehealth legislation. The new amendment will allow for New York’s Medicaid recipients to receive telehealth services and ensure providers of telemedicine will be reimbursed under the Medicaid program.

There are important aspects of the altered telehealth legislation that healthcare providers will need to be aware of. For example, the type of providers eligible for telemedicine coverage under the new amendment include nurse practitioners, physicians, dentists, genetic specialists, physician assistants, nurses, social workers, and psychologists.

Additionally, the new regulations will have a very broad definition of telehealth, which includes using electronic data and communication tools for healthcare delivery. That varies from diagnosis, consultation, and treatment to care management or education.

The term telehealth under New York’s new telemedicine coverage amendment includes remote patient monitoring with regard to the type of technologies providers will receive reimbursement for.

The definition of telehealth under the new amendment is: “the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.”

The new amendment really expands the type of providers covered, the definition of telehealth, and remote patient monitoring coverage. Common telehealth site restrictions will also be changed in New York starting on January 1, 2016. Remote patient monitoring will be offered in the patient’s home and Medicaid insurance will cover the costs.

Also, virtual doctor visits covered by Medicaid will need to take place at qualifying originating sites, which include hospitals, mental health settings, hospices, school-based health centers, diagnostic and treatment facilities, and the typical physician office.

The new telehealth legislation prohibits insurers from declining to reimburse a provider for offering a service via telehealth means that would otherwise be proffered in-person. Additionally, insurers are not allowed to claim higher co-pays, premiums, or other patient requirements when it comes to telemedicine services.

In general, payment parity laws are spreading throughout the states to ensure better quality care and reduced hospital readmissions due to telemedicine services. spoke with Nathaniel Lacktman, attorney and expert in telemedicine law at Foley & Lardner, this past summer to hear more about telehealth payment parity legislation.

“From a statutory standpoint, the biggest coverage decision point is: coverage telehealth-based services to the same extent the service is covered when provided in-person; or cover additional telehealth-based services such as remote patient monitoring and mHealth apps. The latter are types of telehealth services that, by definition, do not really exist in the in-person setting,” Lacktman explained.

“For example, if a state legislature wants to cover the broader spectrum of telehealth services, but the proposed bill reads ‘health plans must cover services provided via telehealth to the same extent those services are covered if provided in-person,’ that bill would create an unintended gap and remote patient monitoring will be left out because many health plans do not have coverage of any in-person equivalent of remote patient monitoring. Some states have enacted follow-up legislation to expressly expand the scope of covered services even after enacting a first telehealth coverage statute.”

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