On Independence Day, Celebrate New Telehealth Freedoms

As the anniversary of our nation’s Declaration of Independence approaches, I’ve been thinking about a different kind of independence: The growing freedom from constraints on telehealth coverage.

Several recent and upcoming changes in telehealth policy are converging – nationally and here in Arizona – to reduce limitations on coverage.

Medicare chips away at restrictions

On the national front, Medicare coverage of telehealth has expanded in the past two years—a giant leap forward compared to the previous decades of inertia under the draconian restrictions imposed by Section 1834(m) of the Social Security Act. As you may know, these include strict limits on the patient’s geographic location, on the type of facility the patient can be in to receive the service, on providers who can bill, on allowable services, and on the type of interaction (live audio/video only).

Just this past year, the Centers for Medicare and Medicaid Services (CMS) used its own rule-making authority to skirt some of these “1834 restrictions” by covering certain services and not calling them “telehealth” services. These include new remote patient monitoring codes and three new “communication technology-based services” aimed at preventing unnecessary office visits. CMS also added two new codes to its list of allowable telehealth services.

Meanwhile, Congress has also started removing some of the “1834 restrictions.” Bills signed into law in the past year remove the geographic restrictions and allow the patient home as the originating site for diagnosed substance use disorder and co-occurring mental health disorders as of July 1, 2019; expand the list of originating sites and remove the geographic restrictions for acute stroke telehealth services and for home dialysis and end-stage renal disease services as of January 1, 2019; and expand telehealth options for Medicare Advantage plans and certain ACOs starting in 2020.

At the spring Center for Telehealth & eHealth Law policy summit just a few weeks ago, I was thrilled to hear that Congress doesn’t seem to be letting up—several staffers mentioned that their senators and representatives are continuing the momentum to remove Medicare telehealth restrictions.

In Arizona, SB 1089 cuts the red tape

Arizona has had telehealth coverage parity laws in place for private payers since 2013, but these have been “partial parity” laws.

At first, SB 1353 mandated private payer coverage for only seven clinical specialties: trauma, burn, cardiology, infectious disease, mental health, neurologic diseases (including stroke), and dermatology—and it required this coverage in rural areas only.

From there, Arizona moved forward in a “body part by body part” progression, as one healthcare executive put it. SB 1363 removed the rurality restriction and added pulmonology, and HB 2042 added substance abuse and pain medicine, and urology.

This year, Sen. Heather Carter introduced SB 1089, which was signed into law in April. The new law, effective December 31, 2020, extends private payer coverage to all healthcare services provided through telemedicine that would be covered if provided in person. Among the 39 states and DC that have private payer parity laws on the books, this leaves only two states (Utah and Alaska) limiting reimbursements to specific specialties. SB 1089 also expands the definition of telemedicine to include asynchronous store-and-forward technologies (transmitted clinical images, video, or data as opposed to a real-time patient interaction) and remote patient monitoring.

AHCCCS joins the party

Just last week, Dr. Sara Salek, CMO of AHCCCS (Arizona's Medicaid program), reported to the Northern Arizona Telehealth Alliance that AHCCCS is proposing an overhaul of its telehealth policies, including the following changes:

• Current AHCCCS policy limits real-time telemedicine coverage to 17 disciplines. The anticipated changes include removing these restrictions entirely and allowing the current standard of care to define what’s allowed.
• The current policy constrains asynchronous telemedicine coverage to very limited circumstances. The proposed changes will expand coverage to dermatology, radiology, ophthalmology, pathology, neurology, cardiology, and behavioral health (and possibly other areas if public comments demonstrate value).
• Currently, telemonitoring is limited to congestive heart failure. The proposed new policy will remove all restrictions on telemonitoring.
• The AHCCCS Telehealth Training Manual severely limits both originating (patient) and distant (provider) sites; these places of service will be broadened and will include the patient home. In fact, the training manual, along with its outdated list of telemedicine-allowable codes, will be retired and the coding information moved to a new web page.

The proposed changes seem poised to move Arizona back into the forefront of Medicaid telehealth coverage. The draft policy is expected to be posted for public comment on or around July 18. To offer your input, go to the AHCCCS Medical Policy Manual web page and click on “Tribal Consultation Notification/Public Comment.” You can also subscribe to email notifications of policy updates.

As the walls come down, access goes up

As government and private payers expand their telehealth coverage (and will likely save money by doing so), it’s the patients who will ultimately benefit. When healthcare providers know they will be paid for telehealth services, they will be empowered to offer them. And that means patients will have better access to care, won’t have to travel as far or as often to receive care, will have more healthcare choices, and will experience better outcomes.

Freedom from constraints leading to better health—now that’s something to celebrate!