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Commercial Payer Policies

*Effective July 1, 2021* The omnibus bill HF33, which includes a revised Minnesota Telehealth Act (2021), enacted several changes for private and state health payers and providers. A document describing these changes alongside the text of the legislation can be downloaded HERE. Significant changes include:

  • Commercial payers
    • Requiring coverage (at the same rate) of audio-only telehealth services until July 1, 2023
    • Forbidding commercial payers from limiting coverage of telehealth visits on the basis of geography, special provider networks, or technology used
    • Requiring coverage of telemonitoring services
    • Allowing telehealth visits to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to FQHCs, RHCs, IHS, and CCBHCs if the service would have otherwise qualified for payment if performed in person.

*proposed update* Allow health carriers to pay a different rate for telehealth services (see also SF2383 & HF2176).

*proposed update* Health carriers can request waivers to address network inadequacy by providing patient access to certain specialist providers through telehealth.

TELEHEALTH DEFINITION: “The delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site… provided by means of real-time two-way, interactive audio and visual communications.”

SERVICE PARITY: “A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and a patient.”

PAYMENT PARITY: “A health carrier shall reimburse the distant site licensed health care provider for covered services delivered via telemedicine on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered in person by the distant site licensed health care provider… the deductible, co-payment, or coinsurance [must not be in] addition to, and [must] not exceed, the deductible, co-payment, or coinsurance applicable if the same services were provided through in-person contact”

EXPIRED: Temporary COVID-19 Policies (MN Commercial Payers)

EXPIRED FEBRUARY 1: A patient’s residence may constitute an originating site (expiration date 2/1/21)

  • The health carrier cannot exclude/reduce coverage for telemedicine visits where the originating site is the patient’s residence

EXPIRED JULY 1: Applicable during a peactetime emergency: An insurer cannot deny/limit reimbursement for telemedicine-delivered services

EXPIRED JULY 1: Applicable during a peactetime emergency: The definition of a “licensed health care provider” in Section 62A.671 (Minnesota Telemedicine Act) is expanded to include mental health practitioners & respiratory therapists

* While temporary guidances have expired, almost all of these new regulations were made permanent by Minnesota's omnibus bill, HF33 (above). HF33 expanded eligible providers to include mental health practitioners but NOT respiratory therapists *