State-regulated health plans in Texas will continue to reimburse for telehealth services at the same rate as in-person care through the end of the year, Gov. Greg Abbott announced last week — even as major insurers prepared to reduce their coverage nationwide.
Abbot and several other governors have joined the White House in announcing plans to extend, if not make permanent, telehealth access and coverage by state insurance and the federal Medicare program.
But others that rolled out the red carpet for virtual visits in the early days of COVID-19 — expanding Medicaid coverage, allowing out-of-state providers to practice online in their state and forcing insurers to pay up — may not be willing to leave that welcome mat out for good.
Private payers appear far less inclined than governments to continue footing the bill.
Starting Oct. 1, STAT reports, several health insurers will no longer fully cover virtual visits. Instead, they’ll begin passing costs back to consumers, including many seniors, who have been relying on virtual services to reduce potential exposure to the coronavirus.
UnitedHealthcare is ending a virtual visit benefit available to many members, who until this week could see in-network providers for free for non-Covid care. Anthem will also reinstate copays, coinsurance, and deductibles for non-COVID visits starting Oct. 1.
While the Centers for Medicare & Medicaid Services seems committed to more telehealth rather than less — announcing in August that it plans to add more telehealth services to its 2021 proposed Medicare fee schedule — states will have to decide whether they want to adopt similar changes on the Medicaid side.
Exactly what services are allowed, who can provide virtual care and which states or insurers will cover has already become so complicated that national consulting firm Manatt created a telehealth tracker to help its clients keep up with changes.
In Texas, Abbott’s announcement means state-regulated plans and the state Employee Retirement System and Teacher Retirement System will continue payment parity for telehealth through the rest of the year.
“Millions of Texans have chosen to use telemedicine over the past several months, and this new agreement with Texas network health insurers will help ensure that Texans can continue utilizing telehealth options,” Abbott said in a press release.
Lillian Phelps, senior director of product management at health information network Availity, says telehealth’s remote monitoring has been critical for home health care patients.
“The ability to review their blood pressure and blood sugar levels with their clinician has helped keep patients healthy while reducing unnecessary risk to COVID-19,” she tld McKnight’s. “To still talk to and visit their provider is critical to maintaining their health while avoiding unnecessary exposure to COVID-19.”
Telehealth advocates and technology providers want more states to continue emergency access to telehealth — and keep it affordable.
In a new white paper, Vivify Health argues for keeping gains made today “from a health and reimbursement standpoint” so the industry can continue forward.
Vice President Bill Paschall says more timely care such as that offered by telehealth providers has been shown to reduce emergency department visits, hospitalizations, and other high-cost care, while keeping patients satisfied.
But there’s no consensus on how to set fees.
“States can force insurers to pay the same rates as Medicare for telehealth and other services through Parity legislation,” Paschall told McKnight’s. “Some states make it mandatory, some make it voluntary, and some don’t have any Parity legislation to speak of yet.”
Private health plans oppose state-mandated parity, arguing they should get to establish reimbursement rates.
Telehealth parity supporters worry some patients may forgo appointments all together before they cough up co-pays. STAT found a telehealth appointment costs consumers between $100 and $400, depending on cost-sharing with their provider.
“Whenever a patient has to make a co-pay or other out-of-pocket expense, utilization of those services typically declines,” Paschall told McKnight’s. “Many of the telehealth expansions, and temporary ease or elimination of co-pays are Covid-related, and only during the Public Health Emergency. Some may see that coming to a close.”
This article originally appeared on McKnight's Senior Living