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REIMBURSEMENT

Quality healthcare everywhere through telecommunications!

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.

  • Medicare, Providence Health Plan, and Lifewise are reimbursing for telemedicine services.
  • Oregon Medicaid fee for service has agreed to begin paying and currently has submitted an administrative rule that sets April 1, 2005 as the effective date.
  • Regence/Blue Cross has also agreed to adopt the Medicare payment language, and has given a target date of June of 2005 to begin payment.

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:

  1. 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)]
  2. 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).
  3. 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).
  4. 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).
  5. 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.
  6. 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.
  7. 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:

  1. examine the telemedicine reimbursement laws of other states

  2. review cost data if available from the above states

  3. 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:

  1. Complete research on legislation and rules from KY, TX, CA, OK, LA, CO, HI - April 17, 2008

  2. First draft of legislative concept paper  - July 20, 2008

  3. Final draft of legislative concept paper to Lege Counsel - September 15, 2008

  4. Begin education program - providers, payers, State Gov. folks, legislators - October 1, 2008

  5. 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

 

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Revised: June 18, 2008