Law passed during COVID special session expands telehealth coverage until April 2022.
During an August special session to address COVID-19, Tennessee legislators passed a law, HB 8002, requiring health insurers to cover virtual care the same way they would in-person care until April 2022.
Tennessee joined Alaska, Michigan, Utah, and several other states that passed telehealth legislation in the wake of the coronavirus pandemic.
Rural patients can face barriers to accessing in-person care under normal circumstances, let alone during a pandemic — telehealth can help fill the gaps. “Especially in rural Tennessee, you have people who now have access to healthcare who never had it before”, Dr. Justin Briggs told WSMV Nashville.
Coronavirus accelerates trend toward telehealth
As the coronavirus spread across the US in February 2020, the CDC recommended that “health care facilities and providers offer clinical services through virtual means.” Telehealth visits skyrocketed.
Blue Cross Blue Shield of Tennessee (BCBST) reported a dramatic increase in telehealth visits in its network: 18 times as many between March 16 and April 14 2020 as in the same period last year.
The spike led BCBST, which covers 70% of Tennesseans, to voluntarily expand telehealth coverage — first in March, as a stopgap measure, then permanently in May.
In Tennessee, there were reasons to support telehealth long before the pandemic. About 1 in 5 residents live in rural parts of the state, where medical specialists can be hard to come by. In recent years, telehealth initiatives have sprung up to fill the gaps. One program, STORC, brings virtual prenatal care to expectant mothers, helping address rural Tennessee’s high infant mortality rate.
But there are barriers to telemedicine adoption. One is technology. 18% of Tennessee households lack broadband internet access, making video visits difficult.
Additionally, healthcare regulations can keep providers from offering telehealth visits.
Regulatory Barriers to Telehealth Eased During the Public Health Emergency
“Under ordinary circumstances and with limited exceptions, Medicare telehealth services are limited to certain rural areas and can only be initiated in certain settings—not including the home, for most types of services”, explains Cal Marshall, healthcare law advisor at Chambliss Law. In the early days of the pandemic, the Centers for Medicare and Medicaid Services eased those restrictions.
Federal prescribing policy
“One of the significant remaining obstacles to telehealth practice in ordinary circumstances is the federal prohibition—to which there are very limited exceptions—on internet (including telehealth) prescribing of controlled substances when the prescribing practitioner has not conducted at least one in-person medical evaluation of the patient”, says Marshall. Because of the public health emergency, the Drug Enforcement Administration (DEA) eased restrictions on remote prescriptions of drugs like Adderall, Xanax, and Suboxone.
Private insurers don’t always cover patient costs or reimburse healthcare providers for telehealth equally to in-person visits. However, “many states, including Tennessee, have enacted various ‘telehealth parity’ measures designed to promote even-handed coverage (and sometimes payment for) telehealth by private insurers and in some cases also state Medicaid managed care plans”, says Marshall.
The new law
HB 8002 requires insurers to implement payment parity and reimbursement parity for telehealth services. In other words, patients must pay the same for a telehealth visit (payment parity) and healthcare providers must be paid the same (reimbursement parity) as they would for an in-person visit.
The new law builds on 2016 telehealth legislation that implemented payment parity in most situations, but not reimbursement parity. “Existing Tennessee law did not generally require that telehealth services be reimbursed in a manner consistent with the same in-person services”, says Marshall.
The new law also removes geographic requirements on original service location and expands the list of healthcare providers who are permitted to provide telehealth services — notably, to include drug addiction counselors.
The law passed with bipartisan support but was not without controversy.
State Rep. John Ray Clemmons (D) said he did not appreciate the way the law was handled. Clemmons suggested legislation could have been passed during the regular session in spring, and noted a still-valid executive order contained many of the same provisions as the telemedicine law. Still, Gov. Bill Lee called a special session to pass not only COVID-related legislation, but also a controversial anti-protest law.
Despite the disagreement, the State House passed the bill 91-0. The companion bill passed in the State Senate by 30-1.
State Law, National Trend
The Tennessee law echoes legislation passed across the nation in the wake of the coronavirus pandemic.
In March, the Centers for Medicare and Medicaid Services issued a waiver allowing reimbursement for video and telephone visits. Since then, 23 state legislatures passed bills aimed at removing barriers to telehealth adoption. In Congress, federal legislators have introduced dozens of bills with the same goal.
The increase in telehealth visits does not necessarily reflect an increase in healthcare access overall. G. Caleb Alexander, lead author of a telehealth study released in October, said “there has been a significant decline in primary care use, at least in the early phases of the pandemic.” He also noted “telemedicine is an imperfect substitute for many office-based consultations.” Blood pressure checks declined by half, putting patients at risk for undetected heart disease.
Not every part of the population is using telehealth equally, either. A November study found that Black and Brown patients, patients over 65, and patients who speak English as a second language are all less likely to opt for telehealth over in-person visits.
Still, many healthcare professionals and public health advocates hope Democratic and Republican legislators will extend telemedicine expansion laws past the pandemic. Despite partisan disagreements, “what [legislators] seem to be in agreement on is that telehealth is one of the ways that they want to make sure that Tennesseans have access to care”, said Dr. Briggs.
Problem Addressed: Access to Healthcare
Written by Ciara McLaren
Published on November 17, 2020
Feature image: Ridofranz
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Calvin Marshall, email interview with Ciara McLaren, Nov 11, 2020
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