A coalition of healthcare advocates and providers are looking to put pressure on Illinois lawmakers to secure Medicaid payment parity for telehealth services.
This year’s unprecedented events saw the Illinois General Assembly temporarily increase flexibility which helped telehealth services in the wake of the pandemic. The letter sent by the coalition has urged lawmakers to make these changes permanent.
Original Order Which Helped Telehealth Services
The coalition’s letter praised the work done by Gov. Pritzker, who made decisions which seriously helped telehealth services. We covered the breaking news when the Governor made this move back in March, which has since helped thousands of people in the state.
The executive order applied to not only M.D.s, but to a wide variety of health care providers, including dentists, optometrists, physician assistants, and others; in addition, it prevented private insurers from charging extra deductibles for telehealth visits.
In their letter, the coalition specifically praised the Assembly for “temporarily lifted longstanding barriers to service access via telehealth for commercial health plans and Medicaid.”
As a result of the executive order, patients across the state were able to access medical and health care without sitting in crowded waiting rooms or endangering their lives with an in-person visit to a health care provider, cutting down on both risk and costs. The expansion of telehealth during the pandemic is why the coalition is now looking at making these moves permanent.
What Are The Coalition Asking For?
The letter, which was sent to every member of the Illinois House of Representatives, lays out a 10-part request to make permanent some of this year’s emergency provisions. The letter states:
“Absent action from the Illinois General Assembly, providers will not have the certainty they need to continue to invest in and utilize new care delivery tools, and Illinois residents will abruptly lose access to the telehealth services they have relied on during the pandemic,”
This is the largest concern we see in the letter, that all of the good work which has helped telehealth services during the pandemic will be undone if not continued. In-person care looks unlikely to return to anything like what we have seen in the past, hence the need to act fast.
“To ensure continued investment in the most effective and efficient technologies and, moreover, patient access to telehealth services, providers, professionals and patients need assurance that key flexibilities authorized during the pandemic will continue beyond its end.”
Requirement For The ‘Linchpin’ Of Payment Parity To Be Addressed
There are many in government, as well as those who pay out the most, who are opposed to payment parity–the same charges for telehealth consultations as for in-person visits–here. Their argument is that payers–large insurance companies–should be allowed to negotiate their own terms and rates with providers for telehealth services. The coalition letter, however, believes that parity is central to the future of telehealth:
“Payment parity is the linchpin to removing existing barriers to patient access and provider adoption, paving the way for the widespread implementation of telehealth”
The letter takes the argument of large payers and those in government head-on;
“By allowing insurers to negotiate separate in-person and telehealth payment rates, particularly as premiums continue to rise, insurers will profit at substantial expense to patients, providers, professionals, and employers”
Another state is also grappling with this issue between insurers and providers. Last month in Ohio, the Buckeye Institute formally issued their own report, putting pressure on lawmakers to remove payment parity from the negotiations, contrary to what’s been suggested in the Illinois coalition’s letter. How payment will play out in Illinois remains to be seen.
The Behaviors Of Other States Prior To The Pandemic
As the coalition noted in its letter, many states helped encourage telehealth services prior to the pandemic. In total, sixteen states mandated payment parity for those on commercial health plans. An additional twenty-eight states require parity when it comes to Medicaid plans.
Here in Illinois, Medicaid coverage for telehealth services is currently limited. There are no laws in the state which indicate that Medicaid should treat in-person services and telehealth as one and the same.
“Without telehealth coverage and payment parity for Medicaid and commercial insurance, Illinois health plans can reimburse providers at unsustainably low rates or choose not to cover services at all, stifling flexible access to services and investments in virtual technologies that have been rapidly adopted and accepted this year.”
A Heavily Backed Plan
This call from the coalition is a weighty one and the members of the coalition itself include all of the largest patient advocates and healthcare providers from the state. Given such overwhelming support, it is hard to see how the General Assembly will be able to ignore these calls.
It is fair to say, however, that the state government has been at the forefront in helping telehealth coverage. Back in June, we reported the further two million dollars in funding which the state had secured, specifically for telehealth services.
The most likely outcome which we will see at the moment is that the current temporary measures will remain in place for an extended period. A large issue with so many executive orders of this type is that nobody knows what the future holds with regards to the pandemic.
Should things go back to any kind of normal, it may well be that lawmakers prefer to keep things as they are. The reality, however, is that no matter what the future brings, the use of telehealth services is only going to grow.