While the law still isn’t on the books, Pennsylvania is much closer to introducing a telemedicine parity law that would ensure that payers cover telemedicine. A bill passed the state Senate on June 13, 2018, and it now travels to the State House for consideration. While the bill will go through several revisions before finding its way to the governor’s desk, this is a definite step in the right direction for service coverage in Pennsylvania.
Joining Many Other States
More than 30 states have telemedicine parity laws that require some sort of coverage for services provided via telemedicine. This makes Pennsylvania one of a handful of states left that haven’t passed a law encouraging technology as a means for expanding access to care for both rural and urban communities. Telemedicine services have been shown to reduce emergency room utilization, cut down on travel and expand treatment to frequently underserved areas, but the actual legislation to support it is often slow moving.
New Jersey passed a similar telemedicine law in 2017 that is still being regulated, even after it was signed by then-Governor Christie last year.
The Good News
Even though it’s not a fast track to success, the bill, introduced by State Senator Elder Vogel, Jr., unanimously passed the State Senate after going through committee last year. This is a drastic change from previous attempts in 2016 that were never up for a vote. The shift in readiness to review and pass these bills signifies a considerable change in attitude toward the realities of problems with access to care.
Considerable Support From Big Entities
Big organizations have put their weight behind the telemedicine bill, which encourages payers to cover these services. Pennsylvania medical society, hospital association and the AARP have thrown their weight behind the bill and eventual plans to introduce telemedicine as a covered benefit. These organizations focus on a variety of different perspective when tracking healthcare-related outcomes, and it’s a clear recommendation for telemedicine that they’re all behind the bill. AARP focuses on patient-centered outcomes that improve things for the lives of seniors. Hospital associations generally look the balance between quality of care and cost of care, and they also engage with solutions that increase patient satisfaction overall. Medical societies often consider a provider-centric perspective of utilizing technology to reduce burden on care delivery while still providing quality care with outcomes-driven goals.
What Will The Coverage Be Like?
It’s much too early to tell. The bill still has to pass the State House and be signed into law by the governor. There are two different kinds of parity that could be included in the finished law as well as a few pitfalls that can weaken laws once they’re on the books.
Coverage Parity Versus Payment Parity
Many telemedicine laws include provisions for coverage parity. This means that services that are medically necessary and appropriate for telemedicine must be covered if they would be covered as an in-person service. Laws that include coverage parity do not automatically include payment parity. Payment parity is the guarantee that services provided via telemedicine with be reimbursed at the same rate as in-person services. Without language that guarantees payment, providers can be reimbursed at a substantially lower rate for telemedicine services. In some cases, the rate (or a minimum rate) is specified in the law, while in others there is no language that addresses how much providers should be paid. Bills can change many times between being written and becoming law, so there is no way to know how broad Pennsylvania’s law will be–if it makes it to the governor’s desk.
Further, once the bill is law, there are simple language additions that can weaken it even when everything looks good. Additions of phrases like “subject to plan language” can mean that the service is covered if the plan itself covers the service, which isn’t much different than not having a law at all. For the most part, it will be a waiting game to determine what’s next.
What Do We Do Without A Law?
In the meantime, providers in Pennsylvania may be able to secure telemedicine reimbursement by approaching their individual payers to have the services added to their contracts. Providers across the country have success without a parity law. For more information on how Mend can help you see more patients and increase access to care, request a demo above!