2018 Payer Coverage Priorities

Patient Location

Medicare Rurality Restrictions: Understanding there are many barriers to care in addition to a patient’s location, the SCTA urges Medicare to remove geographic restrictions based on rurality.

Originating Site Facility Fee: To prevent a financial disincentive for using telehealth within primary care settings, the SCTA urges government and private payers to provide a facility fee payment amount that is equivalent to the Medicare reimbursement of $25.76 in order to cover the cost of the visit for the primary care provider.

Homes as Originating Sites: The SCTA urges all payers to include the patient’s homes as a covered originating site for live video with providers. Connecting with patients via video, in the home has proven to be useful and beneficial for follow-up care for chronic conditions, such as COPD. In home video visits are also beneficial for urgent care needs.

Provider Type

Government and private payers are urged to expand their lists of covered providers who regularly provide care for patients, to include:

  • I. Physician assistants
  • II. Nurse practitioners
  • III. Nurse mid-wives
  • IV. Clinical psychologists
  • V. Master’s degree level mental health providers (example: LISW-CP)
  • VI. Registered dieticians
  • VII. Physical therapists, occupational therapists, and speech language pathologists
  • 1. AHA Telehealth Overview
  • 2. CMS Medicare Learning Network
  • 3. Blue Care Foundation and Center for Connected Health Policy Electric Consultation Roadmap

Service

Mobile Health: Government and private payers are urged to begin covering store and forward telehealth modality, specifically online visits (asynchronous), for urgent and on-demand care. There are several commercial companies that connect patients to national providers, but the SCTA supports the use of online visits with South Carolina providers to ensure coordinated care.

Remote Patient Monitoring: Private payers and Medicaid are urged to follow Medicare’s coverage of remote patient monitoring to better manage patients with chronic conditions.

e-Consults: The SCTA urges government and private payers to cover services rendered between primary care providers and specialists using e-consult platforms. e-Consults have the potential to provide relief for specialty shortages and can improve the current PCP specialist referral process.