- Pennsylvania has opened the door to becoming the next state to allow full telemedicine reimbursement parity for care services.
Senator Elder Vogel (R-Beaver) introduced Senate Bill 780 to define key components of telemedicine, set telemedicine licensing requirements and require that healthcare payers provide reimbursement for telemedicine services if they pay for the same service in person. Along with the Senate bill is a House companion making the rounds among state legislators.
The bill would also ensure reimbursement for telehealth services under "ancillary service plans." These are individual or group health insurance plans, subscriber contracts or certificates that provide exclusive coverage for dental services or vision services. Healthcare services purchased through ancillary plans cannot be excluded from coverage just because they were performed via telemedicine.
The state’s Department of Human Services will provide medical assistance for reimbursement on medical assistance, fee-for-service and managed care programs and general healthcare delivered via telemedicine under Medicaid.
Even though the bill opens up reimbursement options, providers are still required to follow strict guidelines under which they can receive payments for telemedicine.
To ensure reimbursement for services under the bill, providers are required to establish a provider-patient relationship through appropriate virtual exams and diagnostic tests to provide an accurate diagnosis. A provider can use interactive audio without video if, after reviewing a patient’s medical records, the provider determines they can provide equivalent healthcare to an in-person consult.
Providers also need to have an emergency action plan in place during their telemedicine consult. Parts of this emergency action plan include verifying a patient’s location, disclosing the provider’s identity, obtaining informed consent, establishing a diagnosis and treatment plan and creating an EHR record based on the visit.
The legislation is seen by Pennsylvania's healthcare experts as a way to enhance statewide care delivery through proper payments to providers. They include the Hospital and Healthsystem Association of Pennsylvania (HAP).
“HAP applauds Senator Vogel and Representative Quinn for their tireless work with hospitals and other stakeholders to ensure that Pennsylvania’s insurance system supports the use of the very best technology in the delivery of patient care,” Andy Carter, HAP's president and CEO, said in a statement. “SB 780, and its House companion, will make sure that technology provides even greater access to quality care no matter where a patient lives in the commonwealth.”
Carter said HAP supports the use of telemedicine in hospitals to improve healthcare delivery and suggests other hospitals should support the bill to make telemedicine a viable care solution.
By having telemedicine reimbursed, providers have the financial support to pursue telemedicine care as a way to deliver care to remote, underserved communities in their state.
Other states have already passed, or are on their way to passing, similar legislation to empower providers to use telemedicine.
In New Jersey, legislators recently approved a bill that provides telemedicine payment and parity, meaning that telemedicine visits can be treated as an in-person consultation. The bill is now on the desk of Governor Chris Christie and is expected to pass.
Vermont passed a bill that offers equivalent telemedicine reimbursement, and does not allow telemedicine to be reimbursed for more or less than in-person deductibles, copays or coinsurance.
Conversely, Texas endured heated debate on telemedicine policy before passing comprehensive telemedicine legislation this year. Among the arguments there was a debate on whether a telemedicine visit could be used to establish a relationship between a doctor and a new patient.
“Nowhere has telemedicine been more thoroughly examined and debated by all stakeholders than in Texas,” said Teladoc CEO Jason Gorevic, whose direct-to-consumer company had sued the state over what it felt was anti-competitive telemediicne regulsations.
“With the proven benefits that telemedicine has already demonstrated, and the rapidly expanding impact of virtual care, this telemedicine legislation should not only serve as the bellwether for all other states, but should be another indication for the federal government of the proven value of remote care models, benefiting patients across the country and the US healthcare system as a whole,” he said.