Funded by the Milbank Memorial Fund, CCHP is conducting a study to assess and describe telehealth private payer parity laws, assess the relative impact the laws have had on private and public payers, and develop recommendations for improving private payer parity laws.
The field of telehealth has grown at a rapid rate over the last ten years as a result of advances in the technology, and greater access to high-speed broadband and wireless communication. Also during this same period we’ve experienced a major transformation of health care delivery systems across the country as a result of the passage of the Affordable Care Act (ACA) and the movement toward value-based payments for care. Millions of Americans now have access to health coverage yet the availability and distribution of primary and specialty care physicians, dentists, mental health providers and others continues to be a serious problem that is only getting worse. Consequently, the field of telehealth is receiving unprecedented attention as payers, consumers and providers become more aware of its value and benefits.
While the federal government has been resistant to the expansion of Medicare coverage for telehealth beyond their strictly limited requirements, there has been a flurry of activities among states to address policy challenges to telehealth and in some cases, promote its use. One of the most common forms of telehealth-related state legislation has been “private payer parity” laws. Since 2010, 25 state private payer parity laws have been passed, yet prior to 2010, only eight had been in existence. These laws range in scope and features, adding further complexity to a state telehealth policy environment where no two states are alike. For example, some states only require parity of benefits, while others require parity of payment and many of these laws have qualifying clauses that make these requirements “subject to conditions and requirements of the insurer”.
While such legislation has gained momentum and popularity, there has not been any comprehensive analysis of the impact of these laws related to the expanded use and payment for telehealth services. Additionally, many of the private payer parity laws fail to address the impact on its Medicaid program, and whether these requirements extend to private payers that serve Medicaid patients.
Under this project, CCHP will conduct a detailed analysis of these laws, synthesizing the defining characteristics of the laws that have passed over the past two decades, while also examining the laws that failed to pass in order to identify the key components that make private payer parity legislation successful. CCHP will also select a small subset of states to critically assess the impact of their private payer law on implementation of telehealth within the state and identify any barriers or gaps that impede the expansion of telehealth. Additionally, CCHP will interview insurers and Medicaid directors in those states to determine the impact of the laws on cost, quality and access to care within the context of the insurance plans.
The main questions CCHP hopes to answer include:
- What has been the impact of the passage of the different forms of private parity laws on the expanded use of telehealth?
- What are the critical issues that have impeded the successful application of these laws?
- What has been the response of private insurers to the passage of telehealth private payer reimbursement legislation in their state?
- What, if any, influence have these private payer laws had on Medicaid?
- What are the critical issues that should be addressed by other states that can improve the impact of these laws, as well as contribute to improving existing laws?