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REIMBURSEMENT
Telemedicine
Reimbursement Background Information
Telemedicine Reimbursement
Workgroup
Meeting Schedule
Timelines for Development of Reimbursement Legislation for Oregon
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.
Telemedicine Reimbursement
Workgroup
One of the biggest barriers to the
full deployment of telemedicine services in Oregon is the lack of a single
state-wide policy governing reimbursement. Two bills have been introduced in
previous legislative sessions - SB 519 (2007 session) and SB 1100 (2008
session). Neither was passed by the Oregon Legislature. These bills were not
vetted fully with healthcare providers and payers and contained flaws that
would have led to several unintended consequences.
In order to create
a fully vetted reimbursement bill for the 2009 session that will have broad
support and prevent as many unintended consequences as possible, TAO is
working closely with Sen. Laurie Monnes Anderson, chair of the Senate
Committee for Health and Human Services, to convene a workgroup of
interested healthcare providers and payers to develop the bill and raise
awareness of its importance to healthcare in Oregon. Representatives from
the Dept. of Human Services and the Department of Consumer and Business
Services will also be invited to participate in the workgroup.
The workgroup will:
-
examine the telemedicine reimbursement laws of other states
-
review cost data if available from the above states
-
determine which components are needed/wanted in an Oregon bill, discuss
and work to resolve differences, and develop a draft bill
The
workgroup will then develop and deploy an education strategy regarding the
bill for legislators, the Governor's office, healthcare providers and payers
who have not been involved in the workgroup, and healthcare consumers.
If you are interested in joining the reimbursement workgroup or the
reimbursement listserv, please contact Cathy Britain at
csbritain@gmail.com.
Meeting Schedule
The meetings are held on the third Thursday of each month from 10 am – 12
noon at the Northwest Physicians Mutual Bldg. second floor conference room
located at 2965 Ryan Drive, S.E., Salem, Oregon. Here are the meeting
dates through September:
April 17th
May 15th
June 19th
July 17th
August 21st
September 18th
Please mark your calendars and plan to attend as many
meetings as you are able.
Timelines for Development Of Reimbursement Legislation For Oregon
At the first session of the workgroup developed timelines for completing the
tasks required to get a bill ready for the 2009 session. We built the
timeline based on Sen. Monnes Anderson's request that we have the final
draft of our legislative concept to Legislative Counsel by Sept. 15, 2008:
-
Complete research on legislation and rules from KY, TX, CA, OK, LA, CO, HI
- April 17, 2008
-
First draft of legislative concept paper - July 20, 2008
-
Final draft of legislative concept paper to Lege Counsel - September 15,
2008
-
Begin education program - providers, payers, State Gov. folks, legislators
- October 1, 2008
-
Legislative strategy ready - January 10, 2009
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 |
