The Latest on Telehealth Coverage & Reimbursement (and It’s Good News)

1. The Latest on Telehealth Coverage & Reimbursement(and It’s Good News) Nancy S. Rowe Associate Director, Outreach & Public Policy Arizona Telemedicine Program

2. Arizona’s Telehealth Private Payer Coverage Law

3. Private Payer Coverage Parity Nationwide • Spring 2019: CCHP Report • 39 states + DC have some form of coverage parity From Center for Connected Health Policy (CCHP) Spring 2019 State Telehealth Laws and Reimbursement Policies Infographic

4. Small Steps: AZ Telehealth Parity Progression • Limited private payer coverage parity • SB 1353: Signed into law 2013; effective 1/1/15 • 7 specialties only (trauma, burn, cardiology, ID, mental health, neurologic diseases, dermatology) • Rural AZ only

5. Small Steps: AZ Telehealth Parity Progression • “Body part by body part” … • SB 1363, signed 2016: Removes rurality & adds pulmonology effective 1/1/18 • HB 2042, signed 2018: Adds substance abuse & pain medicine effective 1/1/19; adds urology effective 1/1/20

6. Giant Leap Forward: SB 1089 Signed into Law! • Extends mandated private payer coverage to all services that would be covered in person • Adds asynchronous & RPM • Signed April 2019 • Effective 12/31/2020 Bill sponsor Sen. Heather Carter

7. Payment Parity: Arizona’s Next Frontier? • Only 10 states have some form of payment parity • Lack of payment parity = disincentive for providers

8. Prelim AZ Telemedicine Uses & Barriers Survey • Sent to 20 NAZ sites; 15 responses, 11 users, 9 providers 44% 22%

9. Medicare’s ExpandingCoverage

10. Medicare Telehealth Restrictions • On pt. geographic location • On pt. facility type • On provider type • On covered services • On type of interaction • On FQHCs

11. Medicare Telehealth Good News • Payment parity • Facility fee • 2 new codes added • Restrictions lifted for certainservices…

12. CMS: Expanding Medicare Coverage • Not “telehealth”: • Always: Traditional S&F • New: RPM codes • New: 3 “Communication technology-based services”

13. CONGRESS: Expanding Medicare Coverage • Removed geographic restriction & allowed pt. home for SUD starting 7/1/19 • Removed geographic restriction & expanded allowed facilities for telestroke & ESRD starting 1/1/19 • MA Plans can offer expanded coverage not subject to geographic restriction starting 2020

14. CONGRESS: New Telehealth Bills, May 2019 • HR 2508: pilot program to include respiratory therapists as telehealth practitioners under Medicare for COPD • S 1618: grants & TA to support ECHO models, distance ed.

15. Medicaid Updates

16. Medicaid Overview • 50 states + DC reimburse for live video telemedicine • 11 states reimburse for S&F services • 21 states reimburse for RPM • 34 states pay a transmission or facility fee • 14 states explicitly allow the pt. home to be an eligible originating site under certain circumstances Stats from CCHP 50 State Telehealth Laws & Reimbursement Policies Report Spring 2019 Edition, S&F map from CCHP Key Findings Infographic Spring 2019

17. AHCCCS ? • Limited services covered • Limited S&F, limited RPM • Limited provider types • Consent required • Telehealth policies not consistent • Being updated!!

18. Thank you!Questions?Arizona Telemedicine Program: https://telemedicine.Arizona.edunrowe@telemedicine.arizona.edu