HARTFORD — Connecticut lawmakers are stepping back from passing a proposal to extend pandemic-era insurance reimbursements for telehealth and expand the pool of healthcare providers who can offer telehealth services across the state.
In 2021, the state legislature passed a law requiring that doctors, physical therapists, mental health providers, paramedics, athletic trainers, and other healthcare providers in Connecticut be reimbursed for telehealth visits at the same rate as seeing patients in person. The equal reimbursement provision for telehealth is set to expire on June 30, 2024.
A new proposal that was approved in the Health and Human Services Committee would extend that reimbursement requirement. The bill would also allow out-of-state medical professionals to see patients in the state remotely.
State Sen. Saud Anwar, D-South Windsor, the chair of the Public Health Committee, said that the original purpose of the bill was to address two issues: a shortage of healthcare professionals in Connecticut, and increasing access for patients.
But after hearing concerns about the legislation, Anwar said, the legislators planned to modify the bill before it gets voted on by the full legislature. The new bill, he said, will remove both the provisions allowing providers in other states to practice telehealth in Connecticut and the extension of equal reimbursement requirements for telehealth.
At least 24 states have approved laws permanently requiring insurers to pay equal amounts for at least some services rendered via telehealth and in-person visits. Other states, like New York and Vermont, have parity laws that are set to expire within the next few years. Massachusetts requires equal reimbursement for behavioral health telehealth sessions but not for physical health.
State Rep. Cristin McCarthy Vahey, D-Fairfield, co-chair of the Public Health Committee, said that the 2024 expiration gives the legislature a bit more time to consider how to address the continuation of telehealth services.
McCarthy Vahey said that she had heard arguments that there is a difference in cost for people who are offering telehealth only, versus those offering in-person services or hybrid services.
“Some are making the argument that there is cost savings to those who are only online. They don’t have the same overhead, for example,” she said. “On the flip side of that, we want to recognize that a provider offering those services is justly and fairly compensated for the work they’re doing.”
Doctors and hospitals objected to the inclusion of physicians, psychologists and other medical and behavioral health providers from outside Connecticut, saying that it could put patients at risk by allowing them to be seen by healthcare professionals who were not licensed in the state.
David Emmel, who serves as legislative committee chair for the Connecticut State Medical Society, said that allowing patients to see doctors that are not licensed in the state of Connecticut could cause what he called a “siloing of care,” where information is not transmitted back to a person’s primary care doctor. He said it might even encourage inappropriate prescribing of medications.
He also said that not requiring doctors to have a Connecticut license would mean a loss of accountability — physicians licensed in Connecticut can be brought before the Medical Examining Board and can be fined or have their license revoked for poorly practicing medicine. But physicians outside of the state are not subject to that regulation.
“There’s no way of holding them to account. There’s no way you can sanction them. No way you can punish them. So we’re encouraging, I think, in some ways, the potential for the very worst actors to engage in bad healthcare. That’s hard to do when you’re part of a community,” he said.
Emmel noted that Connecticut recently joined two interstate compacts – the Interstate Medical Licensure Compact as well as PSYPACT, which streamlines the licensure process for physicians and psychologists based in other states who want to practice in Connecticut.
Questions also arose in the legislature’s Human Services Committee about whether Medicaid would cover doctors located outside of the state.
Emmel said that the Connecticut State Medical Society did support payment parity for telehealth for Connecticut doctors that are seeing Connecticut patients, particularly if they had a prior doctor-patient relationship.
“I think that if it’s a kind of visit where you’re accomplishing exactly the same thing as you would with an in-office visit, there should be parity,” said Emmel. “When I use telemedicine, I absolutely know the patient I’m talking to and communicating with — whether it’s electronic, telephonic, or whatever. I’m familiar with their healthcare issues. Their chart is right in front of me.”
Susan Halpin, lobbyist for the Connecticut Association of Health Plans, the group representing the state’s health insurance companies, said the insurers were watching the proposal closely but were currently “neutral” on the idea.
“We are very much supportive of telehealth and believe it provides a critical access point but we need to assure that quality care is being delivered,” Halpin said.
Anwar said the public health committee would look at extending the telehealth reimbursement requirements next year. The current bill, he said, would be limited to a much narrower focus: expanding the definition of telehealth to include audio-only services as well as video.
Anwar said that expanding to audio would be an advantage for people who live in “internet access deserts” and in places with poor video or sound quality.
“Many of our seniors and individuals with some special needs feel restricted in ability to use the video option,” said Anwar.
According to Centers for Disease Control, 37 percent of US adults used telehealth in the year 2021. For people over age 65, that number increased to 43.3 percent.
Emmel said that physicians needed to be able to continue using telehealth in general.
“It has been a gigantic help during COVID-19. Physicians of all specialties made extraordinarily good use of it. And in the setting of an existing patient physician relationship, it’s a very powerful tool,” he said.
Anwar, also a medical doctor, echoed Emmel.
“COVID is still there. Thankfully not as ugly as it was before,” said Anwar. “So we are still using it every day, and [for] patients with behavioral health issues or restrictions in traveling for one reason or the other, it’s really helpful. It’s truly added an improved access of healthcare at this time.”