Telehealth Regulations: State, Federal, and Private Payer

July 22, 2020

bench-accounting-C3V88BOoRoM-unsplash

While many of the adjustments required by COVID-19 have presented a challenge, the changes to the telehealth landscape have been highly positive. Within days, government regulations and private payer reimbursement policies that had stagnated for years were adjusted to make it easier for therapists to see their clients remotely. These changes to the regulatory guidelines and billing practices surrounding telehealth remain in flux, making it challenging for therapists to stay current. Our goal in this post is to get you up to speed with current telehealth regulations at the state and federal level, as well as private payer guidelines on providing and securing reimbursement for services delivered via telehealth.  

Federal Telehealth Guidelines: Medicaid and Medicare

Before the pandemic, under many circumstances, telehealth could not be conducted with a client at their home. In order to receive telehealth services, the client needed to drive to a separate location, usually a health clinic or medical office, to connect with a provider located elsewhere. All telehealth visits were required to be conducted over a HIPAA-compliant, secure connection. And telehealth services were limited to established patients only. New patients could not meet with a provider for the first time via telehealth — at least one face-to-face visit was required first to establish care.

The Centers for Medicare and Medicaid Services (CMS) made significant changes to existing telehealth policy under the combined powers granted by the federal emergency declaration and the CARES Act. As it stands today, telehealth services no longer require a client to leave their home to participate in sessions. All billable services can be delivered via telehealth to a client at home, without exception. In fact, current regulations now also allow a provider to bill for telehealth services while working from their own home, rather than in their office. 

The HIPAA-compliant telehealth connection requirements have also been waived at the federal level. If a provider is acting in good faith, they are permitted to use non-secure video messaging platforms like FaceTime or Skype to interact with clients. Just a word of caution here: state medical privacy laws may still apply. 

Additionally, new patients can now connect with a provider via telehealth for first-time visits. The established patient requirement has been waived.

Finally, reimbursement rates for all services now match those for in-person visits. Providers are allowed to use the same codes they would have used for in-person visits with the 95 modifier to designate that the service was provided via telehealth. For more in-depth coverage, see the Center for Connected Health Policy’s COVID-19 Telehealth Coverage Policies resource. 

The temporary changes announced by CMS amount to a massive expansion of telehealth services. Although temporary, the rapid adoption by healthcare consumers is likely to result in some of these changes becoming permanent once the pandemic subsides. For our take on what’s next for telehealth, check out our article on The Future of Telehealth After COVID-19.

State Telehealth Regulations: Medicaid and Medicare

Medicare and Medicaid are both federal programs, but they’re administered at the state level. Federal and state governments jointly cover expenses associated with these programs. As a result, individual states set their own guidelines for coverage through Medicare or Medicaid. While every state (and Washington, D.C.) all reimburse telehealth services to some degree, the telehealth-related legislation and reimbursement policies vary widely by state. 

The level of nuance and complexity of state-level telehealth-related legislation and reimbursement policies is truly staggering. For a concise, high-level view of state telehealth policy, we recommend reviewing the Spring 2020 State Telehealth Laws and Reimbursement Policies from the Center for Connected Health Policy. To locate applicable telehealth regulations in your state, check out CCHP’s Current State Laws and Reimbursement Policies state map.

Additionally, with the blurring of geographical boundaries created by telehealth, some state boards now issue licenses related to telehealth for out-of-state providers. These licenses allow providers with professional licenses in other states to provide reimbursable telehealth services within the licensing state. In the field of mental health providers, twelve states are currently participating in the Psychology Interjurisdictional Compact. This organization facilitates the provision of psychological services across state boundaries.

Private Payer State Telehealth Regulations

At the federal level, there are no regulations that require private payer insurance companies to provide reimbursement for services delivered via telehealth. On the state level, forty-two states and Washington, D.C. have laws that govern private payer reimbursement for telehealth. Most states simply require that private payers reimburse for telehealth delivered services. Only a handful of those states mandate that reimbursement rates for telehealth services match those for face-to-face visits.

In the wake of the pandemic, many of the major private payer insurance companies have voluntarily agreed to adjust their existing policies to equally reimburse for telehealth services in states without applicable telehealth laws. This temporary relaxing of private payer restrictions is a welcome broadening of access to telehealth-based therapy, and we predict that it’s likely to continue. 

What’s Next?

Although most of life has gotten far more complex since the onset of  theCOVID-19 pandemic, providing therapy via telehealth has become far simpler. With federal regulations relaxed, previous barriers to delivering mental healthcare remotely have been removed. Now that Medicare and Medicaid reimbursement rates are equal to those of in-person services, many of the largest private payer insurance companies have followed suit, allowing for reimbursement for services provided via telehealth. The end result is improved access to care, benefiting both clients and mental health providers.

For more tips and tricks on Telehealth for your practice, visit out The Definitive Guide to Telehealth Guide

See how Thera-LINK, a HIPAA-compliant telehealth platform, can help you connect effectively with your clients.

Get Started With thera-LINK

Recent Posts

skypebanner.png