– Florida’s largest medical association is taking the state to task for not mandating telehealth payment parity during the Coronavirus pandemic.
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Several states have issued emergency declarations aimed at boosting coverage by Medicaid and private payers for telehealth services, and the Centers for Medicare & Medicaid Services (CMS) has loosened its coverage restrictions for Medicare.
“This action is needed in Florida given the uneven response of the health insurance companies doing business in this state,” Giffler wrote. “Florida Blue has indicated that for their commercial insurance plans, including Affordable Care Act plans, primary care providers, behavioral health providers and specialists can bill for virtual visits if they have telemedicine capabilities and want to consult with their patients virtually. United Healthcare, however, apparently is only removing the originating site requirement for telehealth services for members whose benefit plans cover telehealth services. We have yet to hear from any other insurers regarding their policies, or any changes thereto, regarding telehealth services for their insureds.”
Florida Gov. Ron DeSantis and other state officials have issued several emergency orders to help state healthcare workers and others deal with the emergency. Among other things, the state has:
- Relaxed licensure requirements so that Florida providers can treat patients in other states and out-of-state providers can treat Florida residents;
- Relaxed guidelines for prescribing controlled substances for chronic non-malignant pain through telehealth;
- Granted permission to qualified providers to use telehealth for certain medical marijuana treatments; and
- Allowed emergency medical personnel and nurses to obtain training via telemedicine.
Among the states moving to allow telehealth payment parity is Massachusetts, long one of the laggards in developing telehealth-friendly guidelines prior to the Coronavirus pandemic. In a March 15 order, Gov. Charlie Baker called on payers to “allow all in-network providers to deliver clinically appropriate, medically necessary covered services to members via telehealth.”
“The GIC (Group Insurance Commission) and all Carriers shall ensure that rates of payment to in-network providers for services delivered via telehealth are not lower than the rates of payment established by the Carrier for services delivered via traditional (i.e., in-person) methods,” Baker mandated.
In his letter, Giffler called on Florida officials to:
- “Allow all in-network providers to deliver clinically appropriate, medically necessary covered services to members via telehealth, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19;
- Allow the use of any non-public facing remote communication product that is available to communicate with patients;
- Ensure that rates of payment to in-network providers for services delivered via telehealth are not lower than the rates of payment established by the insurer for services delivered via in-person methods; and
- Notify providers of any instructions necessary to facilitate billing for such telehealth services.”
“Uniformity is desperately needed so that all health care providers can comfortably provide telehealth services during the existence of the state of emergency without patients having to worry about their insurer denying coverage for such care,” he concluded. “Governor DeSantis has made it clear that it is essential that the state do everything it can to limit face-to-face contact with others as much as possible. We ask that you require the health insurance companies doing business in this state to do their part to help contain the spread of this acute public health danger and issue an order to the effect requested above.”
Florida has long struggled with establishing telehealth guidelines, and previous efforts to create payment parity have been defeated by the powerful insurance lobby, which has argued that payers should have the freedom to arrange their own reimbursement rates with providers.