As telehealth continues to evolve, understanding the complex landscape of laws and guidelines is crucial, particularly in regions like Central New York. Currently, telehealth accessibility is shaped by a mix of federal and state policies, with significant implications for patients and providers alike.
To help understand how federal and state legislation are contributing to telehealth accessibility locally, WAER’s Kat Kollins spoke with Mei Kwong, Executive Director for the Center for Connected Health Policy.
Role of the Center for Connected Health Policy
The Center for Connected Health Policy (CCHP) plays a pivotal role in navigating these complexities. As the National Telehealth Policy Resource Center, CCHP provides technical assistance and tracks telehealth policies at both state and federal levels. Their efforts help ensure that healthcare providers and patients stay informed about the latest developments in telehealth legislation. Kwong elaborates, "We track all of the state Medicaid policies, laws and regulations related to telehealth and we also do that for on the federal level as well too."
Federal Telehealth Policies During the COVID-19 Pandemic
At the federal level, telehealth policies have largely been influenced by temporary waivers introduced during the COVID-19 pandemic. These waivers allowed for an expanded use of telehealth under Medicare, and these provisions are set to remain in effect until the end of 2024. According to Kwong, "The expansions that they allowed for telehealth use in the Medicare program have remained. So, they are valid through the end of this year."
Kwong also mentions, "There is legislation moving through Congress to extend it an additional two years." However, without further legislative action, these temporary measures will expire, potentially impacting millions of Medicare beneficiaries who rely on telehealth services.
New York State's Telehealth Expansions
On the state level, New York has implemented several expansions in its Medicaid program to enhance telehealth access compared to pre-pandemic levels. This includes broader coverage policies, although specifics can vary, encompassing different areas such as prescribing, licensure, and privacy regulations. For instance, telehealth can be used for prescribing controlled substances under federal extensions until the end of 2024, while state-level regulations cover other prescriptions.
Kwong explains, “For example, if you're talking about a controlled substance, that’s on the federal level to handle. That's also been essentially extended until the end of 2024, like those COVID-19 extensions..."
Telehealth Reimbursement Rates in New York
New York has also addressed telehealth reimbursement rates. The state passed temporary legislation requiring commercial payers to maintain payment parity for telehealth services through April 1, 2026. However, complexities arise in defining what constitutes telehealth, which can impact billing and reimbursement practices. As Kwong notes, "Here's where the trickiness comes in is...what's their definition of telehealth? So, do they have a limited definition of telehealth? They say, oh - it's video or something like that? OK. Well, that eliminates if you did … the visit via audio only."
The Future of Telehealth: A Hybrid Model
Nevertheless, Kwong believes the future of telehealth appears promising, with a hybrid model likely to emerge as the norm. Telehealth will complement, rather than replace, in-person care, especially for follow-up visits and routine consultations. She highlights, "It's probably going to be more of a hybrid mix of in person and telehealth. The fact that we had so much expansion on some of the policies, especially the coverage and reimbursement policies during the pandemic and now post-pandemic, I think really speaks well to the use of telehealth."
Addressing Reimbursement Disparities
Reimbursement rates for telehealth versus in-person visits remain a contentious issue, particularly among specialty doctors. Public payers like Medicare and Medicaid typically maintain parity in payment rates. Kwong clarifies, "Right now, Medicare and Medicaid actually do pay parity, so they pay the same amount. It's not really different." However, discrepancies arise with commercial payers, often due to differing billing codes for telehealth services. The complexity of billing telehealth services, especially for specialty care, underscores the need for clarity and consistent guidelines. Kwong explains, "Now, there are some things where the rates may differ because and it gets complicated here because maybe the program doesn't consider it telehealth, though. It's using technology to provide those services. It's just in a different category and they do have different rates.” She summarizes telehealth’s layered medical billing as almost “medieval” to navigate.
Challenges for Healthcare Providers
Healthcare providers may face challenges due to rapidly evolving policies and potential misinformation regarding billing practices. Ensuring that providers have up-to-date information on telehealth billing codes and policies is essential to avoid discrepancies in reimbursement. This highlights the importance of ongoing training and clear communication from payers and regulatory bodies. Kwong points out, "It is possible they may have, you know, just been trying to figure it out themselves and are confused or, you know, gotten information from somebody saying like, this is what you're supposed to be billing. But then again, depending on where they got that information, it could be incorrect…"
Licensure and Prescribing Policies
Beyond coverage and reimbursement, other policies significantly impact telehealth use. For instance, state-by-state variations in licensure requirements can pose barriers to telehealth, particularly for patients seeking specialized care across state lines. A notable legal case in New Jersey is challenging the constitutionality of such licensure laws, potentially setting a precedent for nationwide implications.
Legal Challenges and Constitutional Issues
Kwong described a healthcare desert where two New Jersey residents sought care from specialty physicians in Boston and Pennsylvania. The patients and providers filed suit challenging the constitutionality of the medical board’s licensure laws around telehealth. Kwong, herself holding a JD from George Washington University Law School, and her staff are keeping a close eye on the case based on “the Commerce Clause, the Privileges and Immunities Clause, First Amendment Clause, and due process clause” alleging violations of the US Constitution.
Future Prospects for Telehealth
Despite litigation, pending legislation, and technological uncertainty, Kwong emphasizes the need for continuous monitoring and adaptation to change, ensuring that telehealth remains a viable and accessible option for patients across the United States. She shared her three-part outlook for telehealth, including a short-term holding pattern as temporary policies remain in place, a medium-term integration of telehealth into standard healthcare delivery, and a long-term potential for technological advancements to further revolutionize telehealth services. The rapid evolution of technology means that the healthcare landscape could shift significantly, making it challenging to predict long-term outcomes with certainty.
For More Information
For more information on telehealth policies and resources, visit the Center for Connected Health Policy's website (https://www.cchpca.org/).
