8 Resources to Navigate Telehealth Laws

Telehealth continues to emerge as a cost-effective alternative to face-to-face visits. But do payers reimburse physicians for providing these services?

The answer is increasingly ‘yes,’ but with several caveats, says Barry Herrin, attorney at Herrin Health Law, P.C. in Atlanta, Georgia. The good news is that many states have enacted telehealth parity requiring certain payers to pay for telehealth consultations just as they would reimburse face-to-face visits, Herrin explains. Currently 35 states have private parity laws and 8 states have pending laws awaiting approval.

The bad news is that if you dig more deeply into these laws, you quickly realize that they vary significantly from state to state. “Every state has its own set of rules,” says Herrin. “There’s no national pre-emptive telehealth standard.”

Also, just because a parity law is in place doesn’t mean that telehealth is covered all the time, every time, says Herrin. “Parity doesn’t always mean parity. It may be limited to a particular geography, kind of activity, type of originating site, and more,” he adds.

According to the American Telehealth Association (ATA), thirty-five states have legislated parity for private coverage, and eight states have proposed such laws. Forty-eight states and the District of Columbia have laws requiring Medicaid coverage of telehealth through live video, according to the Center for Connected Health Policy (CCHPA). Twenty-two states reimburse for remote patient monitoring. Many states have also enacted parity laws for state employee health plans, and Nevada even requires parity for worker’s compensation plans, says Herrin.

It can be daunting to try and determine whether payers will cover telehealth services, and if so, whether any restrictions apply. Herrin says physicians inquiring about telehealth parity laws should consult these resources:

  1. ATA’s state legislation matrix  Use this matrix that was last updated July 24, 2017 as a starting point to delve into more specific research.
  2. CCHPA’s resource center on state laws and reimbursement policies  This website provides all current and pending laws and policies, including links to source documents.
  3. Centers for Medicare & Medicaid telehealth services guide  Published by the Medicare Learning Network, the guide helps physicians identify the correct CPT codes and other documentation requirements.
  4. Federation of State Medical Boards’ telehealth policies overview  This source provides important licensing-related information as well as details about state-by-state reimbursement parity.
  5. Medicare Telehealth Parity Act of 2015  If enacted, this law would greatly expand telehealth coverage for Medicare beneficiaries.
  6. National Conference of State Legislatures’ telehealth web resources  This source provides helpful information about telehealth policy trends and coverage.
  7. State Medicaid department  For example, Georgia provides a telehealth handbook. Colorado provides a similar telehealth handbook.
  8. State medical boards  Many boards issue guidance on the use of telehealth. Consider this example from the Alaska state medical board.

As physicians review their state parity laws, consider the following questions:

  • Does the law include telehealth licensure restrictions?
  • Does the law restrict where the telehealth must occur (i.e., where the patient and physician must each be located)?
  • Does the law include a formulary or list of telehealth services that are covered?
  • Do telehealth services require prior authorization?
  • What documentation pertaining to the telehealth visit is required for payment?

Keep in mind that legal developments occur frequently, and sources can become quickly outdated and inaccurate, says Herrin. “Everyone is trying to catch up with the technology, and [reimbursement] isn’t exactly crystal clear all of the time,” he adds. That’s why it’s always best to consult an attorney before your practice decides whether it’s feasible to move forward with offering telehealth options to patients, he says.

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About the Author

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a...

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