Measure Requires Insurers to Pay Providers Equally for Telehealth, In-Person Visits

A measure in one state that would require health insurers to pay providers equally for telehealth and in-person visits is reportedly a step closer to becoming a reality. If signed into law, the measure could be a boon for telehealth vendors and the home health agencies leveraging their services.

The measure is California Assembly Bill 744, first introduced in February by Assembly Member Cecilia Anguiar-Curry, a democrat.

Under AB 744, all contracts issued, amended or renewed on or after Jan. 1, 2021, between a health plan and a provider caring for its members would need to reimburse at “the same basis and to the same extent” for telehealth and in-person services. After receiving unanimous support in the California State Senate, the measure is supposedly headed to Gov. Gavin Newsom’s desk, POLITICO reported Monday.

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“Working people who must take several jobs to care for their families, people in small towns and rural communities many miles from their doctors and hospitals, and victims of disasters should be able to access medical services without the need to visit in person or travel long distances,” Aguiar-Curry told POLITICO. “All I am asking is for the state’s health insurance plans to cover the same services they do now, whether provided in person or through telehealth.”

While it’s not uncommon for home health providers to offer telehealth services, widespread adoption has been relatively slow due to reimbursement challenges.

The Centers for Medicare & Medicaid Services (CMS) has repeatedly tried addressing the issue on a federal level over the past couple of years.

In April, for example, CMS announced it was expanding the use of telehealth benefits under the Medicare Advantage (MA) program, specifically giving MA plans more flexibility for covering services in the home setting.

“Anytime CMS approves and reimburses for additional services that will enable the patient to get better comprehensive care and engages them in their own outcomes is a step in the right direction,” Florida-based Trilogy Home Healthcare CEO Dale Clift previously told Home Health Care News. “Right now, telehealth is an incurred cost and an investment by the agency. I think with the current landscape, one needs to be a ‘big picture’ and forward-thinking type of agency in order to validate the return on investment.”

In addition to CMS, Reps. Richard Neal (D-Mass.) and Kevin Brady (R-Texas) are also leading efforts to encourage telehealth adoption.

In June, the U.S. representatives introduced the BETTER Act, a bill that would loosen Medicare restrictions on mental health services delivered in beneficiaries’ homes through telehealth tools. The bill also seeks to eliminate originating-site facility fees.

The California Department of Finance opposed a previous version of AB 744, according to POLITICO.

While promising, the measure doesn’t go far enough, Barbara Gay, vice president of public policy communications for Washington, D.C.-based advocacy organization LeadingAge told HHCN. As written, AB 744 appears to mostly only apply to Medicaid and private insurance policies covering working-age people, she said.

“We want to see similar changes in Medicare payment policy to facilitate timely and effective care for older people,” Gay said.

But the California measure isn’t the only telehealth-related news from this week.

On Tuesday, Louisville, Kentucky-based Humana Inc. (NYSE: HUM) announced it is working with technology company Seniorlink Inc. on a new virtual care pilot aimed at digitally connecting Humana At Home care management teams to the insurer’s MA members and their families. The goal of the pilot is to help support members looking to maintain their independence at home.

The six-month pilot will include up to 250 Humana MA members and family caregivers in 34 states across the country, according to Humana and SeniorLink.

Additionally, on Monday, home health care technology company Axxess announced it is partnering with Connected Home Living Inc. to provide telehealth and remote care monitoring solutions to its clients. The partnership is part of Axxess’s efforts to help clients transition to the Patient-Driven Groupings Model (PDGM).

“Experts across the industry recognize that remote care monitoring is one of the solutions that will be most important under the new PDGM payment model,” Axxess CEO John Olajide said in a statement. “By offering remote care monitoring that can be used on any device through Connected Home Living, Axxess clients nationwide will have the opportunity to seek physician and nursing services using sophisticated technology in the comfort of their own homes.”

More than 90% of Connected Home Living patients using its telehealth offerings are able to stay at home without hospital or emergency room visits following an in-patient stay, according to the company.

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