CCHP has released a report based on research completed between June-August 2018 which examines compliance with one specific provision in Texas enacted legislation SB 1107 (2017), which requires health benefit plan issuers (referred to as “issuers”) to adopt and display in a conspicuous manner the issuer’s policies and payment practices for telemedicine medical services and telehealth services on their websites, effective Jan. 2018. This is the first law in the country to place such a requirement on issuers. The issuers included in the sampling were chosen from the Texas Department of Insurance (DOI)’s website, and narrowed to those that were shown to hold 1 percent or more of the market share. Because many of the issuers listed were subsidiaries of other companies in the sample group, the total issuers in the sample were further tapered to 18. Three CCHP researchers examined each issuers’ website and telehealth policy (if found), scoring issuer policies utilizing a Public Health Law Research model (see report and codebook for details). The questions addressed through the research and coding process included the following:
- Is the payer’s telemedicine reimbursement policy displayed on their website?
- Is the telemedicine reimbursement policy displayed conspicuously? (“Conspicuously displayed” was defined as to the number of “clicks” or other actions it would take to reach the policy from the company’s home page.)
- Are the eligible provider types listed?
- Are the reimbursable services or specialties listed?
- Is a transmission or facility fee mentioned?
- Are eligible modalities listed?
- Is contact information provided for further questions?
- Are eligible patient locations listed?
- Are billing codes for services delivered via telemedicine provided?
- Are telehealth modifiers provided for billing purposes?
Of the 18 issuers examined, nine received a score of zero as they did not display their telehealth services payment policy on their website. The remaining nine issuers received scores of three or higher out of 12 possible points. The most common details included in issuer telehealth payment policies were billing codes, telehealth modifiers to use when filing claims, and telehealth modalities eligible for payment. Incorporated least often into the issuer payment policies were contact information for further questions, types of providers eligible for reimbursement, and/or mention of reimbursement for any transmission or facility fees.
CCHP concluded from the results that with half of the issuers not publishing their telehealth policies at all (or in a conspicuous manner that CCHP could find), and many other issuers leaving out crucial details, that more specificity in the language contained in future similar laws may be needed. Inclusion of explicit guidelines and penalties for noncompliance may encourage more uniform adherence. If a provider is unsure about an issuer’s policy or the information is not clearly available on their website or elsewhere in their provider manuals, a provider may be given the impression that the issuer does not support telehealth and choose not to take advantage of its benefits. Policies that explain eligible services, locations, and healthcare professionals clarify for providers whether or not they can expect to be compensated for the healthcare services they render to patients via telehealth. The more difficult it is to find this information, the fewer the number of providers that will pursue this type of service delivery.
For more details on the study, read CCHP’s full report.