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Texas Mulls Telemedicine Coverage for Workers’ Compensation Cases

State officials have posted a proposed policy that would eliminate Medicare restrictions on reimbursement and originating sites for workers' compensation cases.

Source: ThinkStock

By Eric Wicklund

- Texas state officials are considering a new rule that would allow residents in workers’ compensation to use telemedicine – and allow healthcare providers to be reimbursed through Medicare.

The Texas Division of Workers’ Compensation recently posted an informal rule that eliminate Medicare-based restrictions on both reimbursement and originating sites for workers’ comp cases. The agency is calling for public comments on the proposed rule through October 23.

“Most states, including Texas, are limited in what they are doing with telemedicine,” Texas DWC Commissioner Ryan Brannan said in a news release. “We’re introducing this rule with the future growth of telemedicine in mind.”

He’s not the only one to notice the possibilities. A 2014 report by Towers Watson estimated that US businesses could save more than $6 billion a year by using telemedicine, while payers see the platform as an opportunity to cut down on manageable costs, like travel.

Even telehealth vendors like American Well have tailored their products to the workers’ comp industry. And this year’s National Workers Compensation Conference & Expo included at least one session on the topic.

The independent healthcare accrediting organization URAC reported this past May that telehealth has “the potential to transform the workers’ compensation industry, providing injured employees with a convenient, personal and effective alternative to on-site medical care while reducing utilization of unnecessary services.”

“This is not your grandpa’s Facetime,” the organization continued. “Telehealth programs that are customized for occupational health can reduce utilization, lower costs, improve the accuracy of claim compensability determinations and boost the injured worker’s care experience.”

In Texas, the DWC’s proposed one-page rule would eliminate Medicare restrictions that limit telemedicine reimbursement in workers’ comp cases to underserved areas, as well as the requirement that the patient be located in a doctor’s office, hospital or certain types of clinics.

Texas officials say they’re aiming to make telemedicine available to all residents in workers’ comp no matter where they live, and to make it easier for providers to be reimbursed. They also said the proposal is in line with new telehealth and telemedicine legislation passed by the state earlier this year, which the Texas Medical Board is now working to adopt to its protocols.

“We want to be proactive when we can to make the Texas workers’ compensation system more efficient, and this is one way to do that,” Brannan said in the release. “Telemedicine can be a huge benefit to employers and injured employees, saving them travel time and expenses, without sacrificing quality of care.”

Other states are considering similar measures.

In Washington, Senate Bill 5355, currently in committee, would have the Department of Labor & Industries – the state’s sole workers’ comp insurer – pay for telemedicine services under workers’ comp claims.

In New York, State Assembly bill 1419, also in committee, would make telehealth a covered service in workers’ comp cases. Meanwhile, the state Senate has approved S. 833, which would establish a task force to study how to integrate telehealth with the state’s workers’ comp system.

“The legislature recognizes due to geographic restrictions, provider shortages, inclement weather, restricted patient mobility and the lack of authorized workers' compensation medical providers that have familiarity with the language spoken by injured workers, patients face challenges in accessing healthcare providers and healthcare services,” the proposed bill states. “It is critically important that injured workers are provided with the ability to receive quality medical care in an efficient and expeditious manner. Telehealth is a valuable tool in improving the continuity, coordination, and efficiency of care for rural and underserved populations.”


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