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Legislation Introduced To Include Telemedicine Cost Coverage Under ERISA Plans

Bipartisan House members introduced a bill, known as the Health Care at Home Act (H.R. 6644), which would ensure all medically necessary benefits in Employee Retirement Income Security Act (ERISA) plans are covered via telehealth for the duration of the COVID-19 public health emergency.

The bill would equate traditional face-to-face physician visits with telemedicine visits, including audio-only visits. It would also bar restrictions on which conditions can be managed remotely, and require all cost sharing for COVID-19-related treatment can be waived.

The bill was introduced to address a potential gap in coverage benefits. Even though the Centers for Medicare & Medicaid Services has taken important steps to ease regulatory barriers to telehealth and also enforce pay parity for telehealth visits during the pandemic, private payers, including employer-provided ERISA health plans, have not necessarily followed suit. This legislation would change that, enabling greater access to telehealth for patients to get the care they need without needless exposure to potential infection.

The American Medical Association supports the proposed legislation, which is in line with the guidance that Medicare already has issued to providers. The AMA seeks to ensure that patients have access to diagnoses and treatments despite the challenges to office appointments at this time. By requiring plans to cover telehealth visits the same way they cover in-person visits, patients can still see their doctors without risking unnecessary exposure to COVID-19. There is no immediate expectation that the bill will proceed. "Bill requires ERISA plans to cover telehealth during COVID-19" www.ama-assn.org (Apr. 30, 2020).

 

Commentary

With the onset of the COVID-19 pandemic, digital checkups and physicals became the new normal. The CARES Act and other recent executive branch orders have changed a number of provisions related to telehealth. These include improving Medicare and Medicaid reimbursement rates for telemedicine visits, and now allowing physicians to prescribe controlled substances such as state-legal medical marijuana over telemedicine.

The Health Care at Home Act would establish several reforms to last as long as the official federal COVID-19 emergency declaration is in effect. This temporary but necessary solution would require health insurance plans to cover all “medically necessary” benefits via telemedicine, just as they currently do for in-person visits, and bans any restrictions on which ailments, conditions, or symptoms can be treated via telehealth.

One portion of the Act defines a qualifying telecommunication system as:

a telecommunications system that includes, at a minimum, audio capabilities permitting two-way, real-time interactive communication between the individual receiving an eligible service via such system and the health care provider furnishing such system, including a telephone, video conferencing system, internet communications system, streaming media communications system, and such other systems as specified by the Secretary of Health and Human Services.

Though deemed a temporary measure, it remains to be seen whether the clear advantages of telemedicine visits in terms of time, resources, safety, and money will lead to a permanent adoption.

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