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REIMBURSEMENT
Telemedicine
Reimbursement Background Information
Reimbursement for
Telemedicine—Update on SB 24A
Department of Medical
Assistance Programs
Telemedicine
Reimbursement Background Information
The Telehealth
Alliance of Oregon (TAO) has been working diligently to negotiate contract
language with Oregon payers to secure reimbursement for telemedicine
services. We are pleased with the progress. In the 2003 legislative session,
HJR4 (.pdf),
which sets forth that it is Oregon's policy that payers should reimburse for
telemedicine, was passed and signed by the Governor. Several payers
currently are either reimbursing or have made commitments to reimburse in
the very near future.
Click HERE (.pdf) for a matrix that summarizes what each payer has agreed
to pay for.
Click
HERE for resources
addressing reimbursement topics.
TAO is in the process of
beginning the work to negotiate payment language with each of the Oregon
Medicaid managed care plans. We will be evaluating which plans currently
have the most covered lives, and will begin those negotiations first. We
hope to convince them to adopt the Oregon Medicaid fee for service language.
There are a few things to
note:
- Medicare states
that "Eligible geographic areas include rural health professional shortage
areas and counties not classified as a metropolitan statistical area
(MSA). Additionally, Federal telemedicine demonstration projects as of
December 31, 2000, may serve as the originating site regardless of
geographic location." [see
Medicare
Benefit Policy Manual, chapter 15, Section 270 - Telemedicine, August 12,
2005 (.pdf)]
- Medicare's
language is restrictive regarding the type of facility at which the
patient can be located (please see the MATRIX for more information on
which facilities are and are not covered).
- Medicare's
language does not include all of the health professional classifications
that we believe are appropriate for reimbursement (please see the MATRIX
for more information on which classification are and are not covered).
- All payers require
that the telemedicine session include both the physician (or other covered
health care provider) and the patient through an interactive video
session. None of the plans will reimburse for a visit if only "store and
forward" information is used for the consultation (digital images, etc).
- All payers will
only reimburse for the physician (or other covered health care provider at
the receiving site. If a physician participates with the patient at the
originating (remote) site, he or she will not be reimbursed for a visit.
- Physician to
physician consults are not covered at this time. Providence Health Plan
does include reimbursement for some physician to patient e-mail
consultation under very specific circumstances. None of the other plans
will pay for this kind of service.
- All payers have
agreed to pay a small transmission fee, but it is only paid to the
originating (remote) site.
Providence Health Plan and
Regence/Blue Cross have both adopted the Medicare language. There is a
national effort in process to change this language to be less restrictive.
We are encouraging anyone who is interested to contact his or her
congressmen to indicate support for this effort.
Please
CONTACT us if you have any questions regarding
this information. Some of you are already providing some level of
telemedicine services, and others are interested in exploring possibilities.
Let us know which other payers you would like us to begin working with. In
addition to Oregon Medicaid managed care plans, we are going to be
prioritizing other payers in the state for negotiation.
Reimbursement for Telemedicine—Update on SB 24A
SB 24A, the bill introduced in the 2009 Legislative Session requiring health
benefit plans to pay for services delivered telemedically is now law.
Governor Kulongoski signed the bill in June, and it will become effective on
January 1, 2010.
Summary of SB 24A
◊ Requires that all
health benefit plans in Oregon reimburse providers for appropriate
services that are provided through telemedicine.
Bill does not impact Medicare, Medicaid, or self-insured.
◊
Defines telemedicine as the use of real time two-way video communication in
which the practitioner can directly assess the patient.
◊ Requires health benefit plan to reimburse for medically necessary,
evidence-based telemedicine services if service is covered for in-person
service.
◊ Removes the distinction between services delivered to patients in rural
or urban areas.
◊ Allows provider fees for telemedicine services to be negotiated between
payer and provider at the time the contract is negotiated
Passage of the bill will impact the 42% of Oregonians who are covered by
some form of commercial insurance plan.
The
tendency by many is to think that once a bill is passed, the work is over.
This is not the case with SB 24A, and the workgroup has turned its efforts
to developing a plan to educate payers, clinicians, and provider billing
staff about SB 24A and how it applies to them. Work is being done in small
committees and a draft plan will be presented to the workgroup at its
meeting on October 8th. A timeline for implementing the plan will
then be developed and execution will begin.
If
you would like more information or would like to join the workgroup, please
contact Cathy Britain,
csbritain@gmail.com or 541-910-7366
Submitted
by Cathy Britain, Chair TAO Reimbursement Workgroup
Department of Medical
Assistance Programs
Notice of Rulemaking
Telemedicine
Statement of
Need and Fiscal Impact
Prioritized List
of Health Services
Rate Graph
Attachment B, C & D |
