Forty-three states and the District of Columbia have laws addressing telemedicine reimbursement for private payers, with 21 mandating payment parity, and most insurers cover at least some form of virtual service.
When it comes to Medicaid fee-for-service, 50 states and D.C. offer some reimbursement for live video visits; 30 state Medicaid programs reimburse for remote patient monitoring. As part of a federal omnibus legislative package signed into law in March, the Centers for Medicare and Medicaid Services will continue its reimbursement flexibilities surrounding telehealth coverage for up to 151 days after the COVID-19 public health emergency ends.
The longer term is less certain. A return to pre-pandemic CMS policies would mean traditional Medicare would no longer cover most virtual services for the majority of beneficiaries. Many providers are advocating for CMS to permanently lift its restrictions on billing Medicare for telehealth care, said Dr. Robin Zon, chair of the American Society of Clinical Oncology’s Task Force on Clinical Pathways. If the agency opts to expand virtual care coverage, she said some commercial insurers are likely to follow suit.
There are also considerations surrounding reimbursement for the digital literacy education and technology—including broadband access—sometimes necessary to conduct telehealth visits, Zon said.
Licensing is another hurdle. Through the Interstate Medical Licensure Compact, a number of states are working to streamline the licensing process for qualified physicians who want to practice telehealth in multiple states, she said.
And as the pandemic progresses, Shah said some insurers and states are seeing potential risks in covering this type of care.
“This puts an immense burden on providers to figure out who has coverage for the services provided,” he said. “They’re going to provide care regardless and then on the back end probably won’t get paid for it.”
Ochsner Health’s Dr. Zoe Larned said the health system’s Chemotherapy Care Companion program is typically funded by grants and philanthropy, and offered to patients at no extra cost.
“We hope to show insurance companies the benefit of supporting programs like this, which allow significant monitoring from home in support of these patients,” she said.