State Insurance Regulators Extend Parity For Telehealth But Critics Say That's Not Enough
When the pandemic hit, health care providers pivoted from office visits to telehealth to protect patients, setting up secure phone systems, online chat rooms and video-conferencing.
Patients and providers adapted, and the use of telemedicine grew. Providers now want the system to stay but that depends on temporary regulations that call on insurers to pay the same amount for a virtual visit as one in person.
Without that guarantee, providers would have to pivot back to their traditional model, they say.
“We would basically be forced to transition back to primarily in-person care and we would not be able to offer the breadth of services that we’ve been able to offer in virtual services,” said Dr. Erik Vanderlip, chief medical officer of ZOOM+Care, a subsidiary of PeaceHealth, with clinics in Oregon and Washington.
Providers gained some reassurance on Tuesday: The Oregon Department of Consumer and Business Services announced it would keep the changes in place until Dec. 31.
Still, advocates and health care providers say that’s not long enough. A coalition of health care providers and advocates want lawmakers to extend the temporary regulations until July 31, 2021 when they meet during the special session on Wednesday. Besides payment parity, the change also eliminated restrictions forcing telehealth technology to comply with federal privacy regulations in HIPAA, the Health Insurance Portability and Accountability Act. That gives providers more flexibility to pick software and set up programs without the red tape of waiting for the federal government to sign off on the technology.
The coalition for extending the regulations beyond the end of the year includes ZOOM+Care, AARP Oregon, Planned Parenthood Advocates of Oregon, the Oregon Medical Association and other providers. That extension would add stability to a hastily-assembled system that morphed into a telehealth behemoth during the COVID-19 pandemic. It also would give lawmakers space to craft a permanent telehealth policy during the 2021 session.
“For the time being, especially in deference to COVID-19 being among us, we really need to keep the legislative gains we’ve had,” said Vanderlip of ZOOM+Care. “We’re just trying to say: ‘Can we please keep the current climate going?’”
It’s uncertain what will happen to payment parity after the end of this year. But for now, the Oregon Department of Consumer and Business Services agreement will cover many insurers. The list comprises Moda, BridgeSpan and Regence, PacificSource, Cigna, Providence, Health Net, Samaritan, Kaiser and United Healthcare.
In a statement, Gov. Kate Brown said she expects permanent telehealth policies to emerge in the 2021 session. Her statement didn’t address provider concerns about a gap in coverage.
“Throughout this pandemic, telehealth has provided Oregonians with essential access to health care services that otherwise might have been unavailable or required the risk of an in-person appointment,” Brown said.
The Oregon Health Plan, which provides Medicaid coverage, will also continue to provide pay parity and offer similar rates as in-person visits for physical health services, behavioral health services and dental and long-term care services. The new agreement does not cover self-insured plans that are common among companies, like Nike, Intel and many others.
About 2.3 million Oregonians have commercial health insurance. They include more than 900,000 who are in self-insured plans, according to state quarterly filings. This includes individual, large group, small group and student plans.
That doesn’t include Medicaid, which has nearly 1.2 million Oregonians enrolled.
Still, state officials heralded the decision as a major step.“This agreement is an important one for our state,” said Andrew Stolfi, insurance commissioner and acting director of DCBS in a statement. “It means Oregonians can get the critical health care services they need, and providers will continue to get paid for providing this important care, while we all work together to minimize the spread of the coronavirus.”
But advocates worry that the timeline poses problems for patients who need access. The extension’s expiration date comes before the 2021 session, potentially jeopardizing the fledgling system and leaving a gap in service for people who need telehealth service.
Rep. Rachel Prusak, D-Tualatin/West Linn and a nurse practitioner, said advocacy for the issue will continue even though it’s unlikely to come up during the special session.
“Myself and many other advocates were hoping it would extend until next year,” Prusak said, adding that a longer extension would preserve continuity of care.
Prusak, who works with patients in long-term care, said telehealth will grow in demand, even as the pandemic wanes. Patients like the convenience, and if they have an illness or compromised immune system, they avoid exposing themselves or others.
“It’s important that we allow access to telemedicine to not go back,” Prusak said. “I’m hopeful that payers really focus on access to health care during this challenging time.”
Providers communicate with patients in a variety of ways, including video conferencing and online chats. Sometimes, a simple phone call works just fine. That’s critical for rural areas with limited broadband access.
“We’ve had a lot of people who really would like to do phone visits and we didn’t really anticipate that,” Vanderlip said.
In the long-term, Oregon lawmakers also will face decisions about telehealth involving providers who work out of state. For example, Oregon’s telehealth law currently prevents a physician’s assistant licensed in Oregon to provide care to an Oregon resident if the physician’s assistant is working from out-of-state, Vanderlip said.
Oregon-licensed physicians, in contrast, can deliver care from out-of-state.
Jun 23 2020