Health and Human Services Task Force: Policy Prescriptions to Address Economic and Health Care Challenges in the Face of COVID-19
The Health and Human Services Task Force presents possible anecdotes to address the COVID-19 pandemic.
Address Restrictions on Medicaid Reimbursements for Telehealth
Each state has different laws about which telehealth services it will reimburse for and what restrictions surround those services. For instance, some states require an in-person relationship be established first, before telehealth services will be covered. Other states require different time or distance restrictions on telehealth services. In the ALEC telehealth guide, we recommend all these restrictions be removed and telehealth services are available for reimbursement at the broadest possible use.
We also recommend provisions for cross state licensing. Often those who are traveling will use telehealth services from their home provider or maybe have a primary provider in a different state. Reciprocity agreements (similar to what VA, MD and Washington, DC have), compacts, or origin of service provisions all allow providers to treat patients no matter which state the patient might be located in at that time. It’s best to have the broadest form of cross-state licensing your state licensing board will approve.
Another common restriction on telehealth services are those surrounding online prescribing. Obviously, patient safety comes first and foremost, and states should ensure they are not making the opioid crisis worse, but physicians across the country are using systems through companies to send prescriptions electronically and still avail themselves of Prescription Drug Monitoring Programs (PDMP) services. The physician is able to check the PDMP which monitors prescribing of controlled substances and then provides the pharmacy with the prescription. Many pharmacies will now deliver the prescription right to your door. The ALEC research recommends the removal of restrictions and regulations on online prescribing as long as the appropriate precautions are taken.
Finally, the ALEC guiding principles of free markets and limited government stand in opposition to government price setting of prescription drugs and health care services. By extension, state telehealth parity laws are also anti-free market. One of the key benefits of telehealth is that it is less expensive because it uses fewer resources than an in-person visit. As such, law that attempts to set the price of telehealth services on par with in-person services is not sound policy. The coverage of telehealth services is a positive development, but our research shows those prices should be negotiated by the payer and the provider and not dictated by the state.
As technology continues to advance, telehealth will continue to pay a much larger role in how Americans get their health care services. That is a positive advancement as we address health challenges in the future.
Certificate of Need (CON) laws require health care providers to obtain permission from a state board before opening a new health care facility and in some cases, before utilizing new technologies, purchasing new equipment or offering new services. The provider must prove to the board that the community “needs” the new service, facility, etc.
Many states have already eliminated their CON laws as a relic from the past that did not achieve the desired goal of improving access and lowering health care costs. However, some states are still requiring CON approval, including COVID-19 hot spot states like New York, Illinois and Washington.
Under CON, increasing the number of hospital beds is not a quick fix. Applicants have to jump through bureaucratic hoops that can take years and millions of dollars to manage. This simply is not feasible in many cases, especially when there is a good chance an existing provider will be successful in blocking applications.
Addressing bureaucratic CON laws would help prevent provider shortages in the future.
Policy prescriptions developed by our members can be found in ALEC Connect.