Commercial Payer Policies
*proposed update* Audio-only telehealth may be used for e-visits (“A face-to-face digital communication initiated by a patient to a provider through the provider’s online patient portal”) and virtual check-ins (“A brief communication via telephone or other telecommunications device to decide whether an office visit or other telecommunications device to decide whether an office visit or other service is needed”) (private payer law).
TELEHEALTH DEFINITION: “the use of interactive audio, video, or other telecommunications technology… [and] the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real time or through the use of store-and-forward technology.” Telehealth does not include audio-only, email, or fax.
SERVICE PARITY: Insurers may not offer policies unless the policy “provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means."
PAYMENT PARITY: Payment/reimbursement for a telehealth service must be established “in the same way” as it would be for the same in-person, through negotiations with health care provider.
*proposed update* PAYMENT PARITY PILOT PROJECT: Reimbursement for telehealth cannot be less than in-person, deductibles/cost sharing/co-pays cannot be more than in-person, telehealth includes audio-only if no other means of communications technology is available to patients. The pilot project would end July 31, 2023.
Temporary COVID-19 Policies (ND Commercial Payers)
- “Secure connection” provision suspended
- “Audio-only” provision (barring use of audio-only telehealth) suspended
NEWLY ELIGIBLE SERVICES:
- Insurance carriers must cover virtual check-ins and e-visits for established patients “in accordance with guidance issued by CMS”
- Insurers must start or continue to provide covered services via telehealth for: office visits, PT/OT/ST plan evaluation, behavioral health/SUD treatment, diabetes education, nutritional counseling
- Expanded telehealth DOES NOT APPLY to deferrable elective care, chiropractic care, dental care, acupuncture
OTHER TEMPORARY ND COMMERCIAL PAYER POLICIES:
- Insurance carriers cannot subject telehealth coverage to cost-sharing
- Insurance carriers cannot impose specific requirements on technology used to deliver telehealth services
- Insurers must relax guidelines under HIPAA consistent with CMS guidance regarding telehealth modalities
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