2019 Payer Coverage Priorities

Service

Brief Communication Technology-Based Service: The SCTA urges Medicaid and private payers to adopt Medicare’s coverage for “virtual check-ins” which will allow providers (e.g. primary care, mental health) to efficiently use new technologies to deliver more cost-effective follow-up care for their patients. Medicare code: G2012

Remote Patient Monitoring ("RPM"): The SCTA urges Medicaid and private payers to adopt Medicare’s RPM coverage that will provide separate payment for time spent on collection and interpretation of health data (e.g. blood pressure, glucose) to support population health and care coordination services. Medicare codes: 99453, 99454, 99457

Interprofessional Internet Consultations: The SCTA urges Medicaid and private payers to adopt Medicare’s coverage of provider-to-provider consultations (“e-consults”) provided for the benefit of the patient. E-consults provide more efficient access to specialty care and have been shown to reduce unnecessary referrals by up to 40%. Medicare codes: 99446, 99447, 99448, 94449, 99451, 9945

Remote Evaluation of Pre-Recorded Patient Information: Remote Evaluation of Pre-Recorded Patient Information: The SCTA urges Medicaid and private payers to adopt Medicare’s coverage of remote evaluations of videos and/or images (“store and forward”) sent by the patient. Store and forward telehealth services (e.g. tele-dermatology) have demonstrated enhanced access and effective delivery of clinical care. Medicare code: G2010

Behavioral Health Integration (BHI): The SCTA urges Medicaid and private payers to adopt Medicare’s coverage of BHI for Project ECHO and similar models to be deemed billable collaborative time and allow for required availability of the behavioral manager to be enabled via telehealth. Medicare codes: 99484, 99492, 99493 and 99494

Provider Type

To improve cost-effective health care access, the SCTA urges government and private payers to expand their list of covered telehealth providers beyond physicians and advanced practice providers to also include:

  1. Clinical Psychologists
  2. Master’s degree level mental health providers (example: LISW-CP)
  3. Registered dieticians
  4. Respiratory therapists

Patient Location

Remove Originating Site Restrictions: The SCTA urges Medicaid and private payers to remove originating site restrictions to allow providers to reach patients using telehealth in more cost-effective care settings (e.g. home, schools, skilled nursing facilities).

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

Originating Site Facility Fee: To prevent a financial disincentive for using telehealth within primary care settings, the SCTA urges Medicaid and private payers to provide a facility fee payment amount that is comparable to the current Medicare rate.