Originally published on the Texas Medical Association website.
As you’re no doubt aware, telemedicine has made it possible for many physicians to continue seeing patients while reducing the risk of spread during the COVID-19 pandemic.
Temporary changes to state and federal rules, particularly regarding payment for services, have helped push up the new demand for and use of telemedicine.
Prior to the pandemic, health plans did not have to pay physicians the same rate for telemedicine visits as for in-person visits.
But what does each type of plan pay for visits?
The Texas Medical Association has compiled information for various types of plans. Remember that some plans’ policies are different for audio-only visits.
- State-regulated plans. The Texas Department of Insurance’s (TDI) emergency rules requiring state-regulated health insurers and HMOs to pay an in-network health professional at least the same rate for a telemedicine or telehealth service as they would for the same service or procedure in-person took effect March 17. Those rules remain in effect for up to 120 days (mid-July). They can be extended for an additional 60 days if needed. (For more details, see TDIs FAQs.)
- ERISA (self-funded) employer-sponsored plans. There is no requirement for these federally regulated plans to pay the in-person rate for telemedicine care. However, many ERISA employee health plans are administered by Texas insurers – as a Third-Party Administrator (TPA). Many of the plans’ administrators have encouraged these plans to pay for telemedicine services at the same level as TDI-regulated plans, and many have.
- The Centers for Medicare & Medicaid Services (CMS) has opened up a number of telemedicine payment policies for Medicare telemedicine services. The telehealth waiver remains effective until the Health and Human Services Department secretary declares the public health emergency has ended.
- In addition to audio and video services, CMS also allows for telephone-only encounters to be billed and paid at the in-person rate, retroactive to March 1. Refer to the Telemedicine Payer Policies matrix on the TMA Telemedicine Resource Center for payer policy updates.
- Texas Medicaid recently authorized telemedicine payment for well-child checks for children older than 24 months. The state also approved other telemedicine flexibilities, such as payment for audio-only telemedicine and telehealth visits. These waivers all expire May 31, but TMA anticipates the Texas Health and Human Services Commission (HHSC) will extend them at least for one more month. TMA and state societies representing primary care and obstetrical physicians have asked for a six-month extension, through November.
You can find more information on the Telemedicine section of TMA’s COVID-19 Resource Center, which is updated with the latest news, resources, and government guidance regularly.