August 21, 2018

August 21, 2018

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August 20, 2018

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New York Legislation to Require Payment Parity for Telehealth Services

New York introduced a new bill designed to ensure commercial health plans pay for telehealth services at the same rate the plans pay for in-person services. The legislation, SB 7953, comes on the heels of New York’s long-awaited telehealth coverage law and seeks to add payment parity language to the State’s existing telehealth coverage statute.

Effective January 1, 2016, the New York telehealth coverage law prohibited commercial insurers from “exclude[ing] from coverage a service that is otherwise covered under a policy that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth […].” While the intent and purpose of the telehealth coverage law was to ensure patients in New York could enjoy the choice to receive their covered services in-person or via telehealth technologies, the statute contains no payment parity language. In other words, unlike several states (e.g., Delaware, Minnesota), the New York law did not state that health plans must pay providers at the same or equivalent reimbursement rate for identical in-person and telehealth-based services.

Payment parity is an important issue when drafting and considering proposed telehealth coverage bills. Because of the lack of payment parity language in the New York Statute, some commercial insurers decided they would pay providers only a fraction (some plans only 50%) of the reimbursement rate the provider would receive for identical in-person services. This decision created an even greater disincentive for providers (particularly in-network providers) to offer patients telehealth services compared to if telehealth were simply a noncovered service the patient would pay for out-of-pocket.

XRay, Medicine, The disappointment among the provider community was palpable and they quickly mobilized to seek a remedy, which came in the form of the proposed legislation. SB 7953, introduced May 31, 2016, aims to resolve this issue and implement payment parity for telehealth services.  The bill seeks to amend the New York Insurance Code governing private health insurers to require insurers to “reimburse a telehealth provider for covered services delivered via telehealth on the same basis and at the same rate as established for the same service when not delivered via telehealth.” The bill also extends payment parity for telehealth services to New York Medicaid.

Payment parity is important for providers because it protects providers against arbitrary cuts in reimbursement for telehealth services as compared to services provided in-person. What occurred in New York should serve as lesson to providers in other states advocating for telehealth coverage legislation. While coverage parity is important, legislation that fails to address payment will open one door, only to leave another closed.

Currently, 29 states plus the District of Columbia have telehealth commercial insurance laws requiring commercial health insurance companies cover services provided via telehealth to the same extent those services are covered if provided in-person. Continued expansions in reimbursement mean providers can enhance telehealth offerings, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. Commercial insurance reimbursement is among the five telemedicine trends driving health care transformation in 2016 and beyond.

© 2018 Foley & Lardner LLP

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About this Author

Partner

Nathaniel (Nate) Lacktman is a partner and health care lawyer with Foley & Lardner LLP, and a Certified Compliance & Ethics Professional (CCEP). His practice focuses on health care compliance, counseling, enforcement and litigation, as well as telemedicine and telehealth. Mr. Lacktman is a member of the firm’s Health Care Industry Team which was named “Law Firm of the Year — Health Care Law” for three of the past four years on the U.S. News – Best Lawyers® “Best Law Firms” list. 

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Elizabeth Rosen, Health Care Attorney, Foley Lardner Law Firm
Associate

Elizabeth J. (Betsy) Rosen is an associate and health care lawyer with Foley & Lardner LLP. She focuses her practice in the health care field where she advises hospitals, hospital systems, physician organizations and other health care entities on regulatory, transactional and corporate matters. Ms. Rosen is a member of the firm's Health Care Industry Team. Ms. Rosen worked as a summer associate with Foley in 2012.

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