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The Connecticut General Assembly’s Joint Committee on Insurance and Real Estate heard from medical practitioners and a representative of the private insurance industry concerned a proposed bill, to be considered this week during the legislative special session, to set a framework for telemedicine until next June.
The draft bill would address concerns voiced to lawmakers by healthcare providers as they have adapted to telehealth services to slow the spread of COVID-19.
The bill would authorize healthcare providers to meet with patients using any video or audio platform compliant with the federal Health Insurance Portability and Accountability Act passed by Congress in 1996 to regulate patient records and privacy.
The bill would also formalize “payment parity” as a matter of law, requiring insurers to reimburse providers for virtual visits at the same rate as in-person visits.
To date, private insurers have voluntarily agreed to reimburse providers until September at the same rate for virtual as for in-person visits, without committing to payment parity beyond that date.
Healthcare providers praised the bill during a listening session hosted by the joint committee on Tuesday. A representative of private insurers in Connecticut, on the other hand, reiterated the point that major changes to healthcare policy made in haste could have unintended consequences.
Payment parity
Susan Halpin, executive director of the Connecticut Association of Health Plans, said that she could not support a law requiring payment parity.
Halpin said that insurers see the value of telehealth, but that it is too early to fully evaluate its effect on cost and quality of care.
Changes not considered carefully could also jeopardize the programs of insurers that sell on the Affordable Care Act exchange if they are no longer compliant with federal standards, she warned. That could also jeopardize the federal subsidies for people who purchase plans on the exchange, she said.
“I’m not here to say that’s definite. It’s just, we need to be very careful that we don’t rush something that has unintended consequences,” Halpin said.
She pointed out that while the ability to access care remotely was needed during the pandemic, lower rates of vaccinations suggest other possible downsides of shifting away from in-person visits.
“We don’t want to incentivize folks to use virtual telehealth over in-person care,” said Halpin.
According to Dr. Madhuri Sharma, director of telemedicine at Fair Haven Community Health Center, the actual cost difference to a large clinic was marginal, and that they would still prioritize necessary care like vaccinations, eye exams or foot exams, requiring in-office visits.
“Especially during a pandemic, this is absolutely not what patients are thinking about,” Sharma said. “Sometimes telemedicine is the only way to prompt that.”
Sharma disagreed with idea, expressed by Halpin, that formalizing a reimbursement mechanism now would stymie innovation or remove incentives to make telehealth services more efficient and less expensive.
Sharma said that payment parity would encourage innovations by giving physicians space to think creatively instead of focusing on keeping their doors open.
Audio-only visits
Another common concern among medical providers is the ability to reach all patients with telemedicine, particularly patients who don’t have access to the technology or a reliable internet connection needed for video conferencing software.
Gov. Ned Lamont issued an executive order on March 19 that allowed providers to meet with patients by audio rather than by video, a change that has been essential for Community Health Center, Inc., a federally-qualified health center that mostly serves low-income patients.
Almost all of Community Health Center’s visits have been handled remotely since HUSKY Health started reimbursing providers for telehealth visits for the first time in March, President and CEO Mark Masselli told CT Examiner in a late June interview. Of those remote visits, 80 percent are being conducted over audio, Masselli told the committee on Tuesday.
Sharma told committee members that even patients who have smartphones may have a prepaid plan that doesn’t support a video visit. Allowing them and other patients without reliable access to video conferencing to speak with physicians over the phone has been critical, she said.
“In my experience without audio-only access to health care, these patients likely would not go in until it was too late, or seek ER-level services too early that were not warranted,” Sharma said.
State Rep. Cara Pavalock-D’Amato, R-Bristol, asked Masselli if the bill’s language was broad enough to include patients who would benefit from audio-only visits. The bill allows for audio-only visits when the provider is in the patients network, or both are enrolled in HUSKY Care.
“Shouldn’t it be based on whether the person has, let’s say, internet capability or whether they have or don’t have a smartphone?” Pavalock-D’Amato asked. “Because I’m sure there are plenty of people who may not fall into these categories, but don’t have internet access.”
Masselli said he agreed that the language should be broad in order to include more people.
“We should be right across the board, regardless of if someone is in-network or out of network, or where you live,” Masselli said.
September, December or June
For now, private insurers are voluntarily offering payment parity.
Halpin asked that lawmakers rewrite the bill to allow any requirement for in-person and remote parity to expire in December instead of next June.
Committee co-chair Sen. Matt Lesser, D-Middletown, questioned why insurers wouldn’t want certainty about regulations through June, rather than having to work through a series of executive orders.
Private insurers weren’t required to reimburse providers at the same rates for telehealth services by an executive order, Halpin said. They decided it was in the best interest of members and consumers, she said.
“I’m not saying that everyone is going to shut this down in December,” Halpin said. “If the public health needs are there, I would assume that the carriers would continue the policies beyond December, but we just don’t know where the needs are going to be.”
Halpin also expressed concern that the law would be extended indefinitely after it’s passed. Ending the mandate in December would give the legislature an opportunity to review the law during the regular session starting in January, she said.
“Having a fuller, more robust discussion about this issue in regular session, based upon information that we have available at that time, we think makes more sense,” Halpin said.