Commercial Payer Policies
*proposed update* Minnesota has several pending pieces of legislation that address overlapping portions of telehealth regulations in statute. See HF2128, SF1160, SF2360, HF1412, SF2049, SF481 & HF1040. Proposed changes include:
- Amend the definition of telehealth to include audio-only patient-provider communication “if the communication is a scheduled appointment and the standard of care for the service can be met through the use of audio-only communication.” For mental health and substance use disorder services, non-scheduled audio-only appointments can be covered in emergency situations. (private payers only)
- Amend telehealth definition to include application of store-and-forward technology in addition to video/synchronous interactions. (private payers only)
- The definition of “face to face” is amended to be any real-time, two-way interactive communication between a client and a treatment service provider and includes services delivered in person or via telehealth (which includes audio-only, per language in the same bill—SF2360) (private payers only)
- COVERAGE PARITY: Health insurance carriers must cover telehealth services in the same manner as in-person services. Carriers cannot limit coverage of telehealth on the basis of location, create a separate provider network for telehealth services, or require enrollees to use specific providers to receive telehealth. Carriers cannot deny coverage for a service solely because it was provided via telehealth, cannot require a greater deductible/copay/coinsurance for telehealth services than for in-person services, and cannot make additional requirements for telehealth services if those requirements are not present for the in-person service. Carriers MAY establish criteria that providers must meet to demonstrate the safety/efficacy of a telehealth service if the carrier does not already reimburse providers for delivering that service in person. (private payers only)
- Carriers must cover tele-monitoring services if they are medically appropriate if the enrollee is able to operate the equipment and lives in a setting suitable for telemonitoring (i.e. without health care staff on site). (private payers only)
- PAYMENT PARITY: Health insurance carriers cannot limit reimbursement based on what type of telehealth equipment is used as long as it is HIPAA compliant and complies with industry standards.
- MENTAL HEALTH, SUBSTANCE USE DISORDERS:
- The exam required prior to prescribing for medication-assisted therapy or substance use disorders can be conducted via telehealth.
- If a client is receiving SUD treatment services via telehealth, verbal approval for treatment plan can be used in lieu of signature.
- Chemical dependency services can be provided via telehealth (including audio-only).
- A psychiatric care provider offering assertive community treatment (ACT) may offer services via telehealth.
- Intensive nonresidential rehabilitative mental health services delivered by a psychiatric provider can be provided via telehealth when necessary.
- MAT can be delivered via telehealth and into a patient’s residence.
*proposed update* Update the definition of telehealth to include audio-only services (applies to private payers).
*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”
Temporary COVID-19 Policies (MN Commercial Payers)
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
Applicable during a peactetime emergency: An insurer cannot deny/limit reimbursement for telemedicine-delivered services
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
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