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March 26, 2020

Governor Announces Telehealth Payment Parity in Response to Coronavirus Outbreak

Updated March 26, 2020: The WSMA thanks Washington state Gov. Jay Inslee, Health Care Authority Director Sue Birch, and Insurance Commissioner Mike Kreidler for their actions to ensure fair reimbursement for services that are delivered via telemedicine. Read our thank you letter, delivered March 26.

Late Wednesday night (March 25), Gov. Jay Inslee signed a proclamation providing payment parity for services delivered via telemedicine. Specifically, the governor made implementation of Senate Bill 5385 effective immediately, which requires state-regulated insurance carriers to reimburse telemedicine services on par with what they would reimburse for covered services delivered in person. The order specifically prohibits health carriers from:

  • Reimbursing in-network providers for telemedicine claims for medical necessary covered service at a rate lower than the contracted rate that would be paid if the services had been delivered through traditional (in-person) methods.
  • Denying a telemedicine claim from an in-network provider for a medically necessary covered service due to an existing provider contract term with that provider that denies reimbursement for services provided through telemedicine.
  • Establishing requirements for the payment of telemedicine services that are inconsistent with the emergency orders, rules, or technical advisories to carriers issued by the Office of Insurance Commissioner.

The OIC on Tuesday, March 24 issued an order that allows all in-network providers to use non-HIPAA compliant communication platforms to provide patient care under certain circumstances (read the OIC order). This aligns with a recent federal announcement around HIPAA enforcement discretion during the public health emergency. The order goes on to read that "All Regulated Entities shall treat the use of audio-only telephone as telemedicine, despite contrary language in RCW 48.43.735(8)(g)." The Washington State Health Care Authority took similar steps for our state's Medicaid and state employee plans on Monday, March 24 (read the HCA announcement).

At the national level, Medicare has also announced payment parity for most telemedicine services (read the CMS announcement). The WSMA is reaching out to our Congressional delegation urging them to require telehealth parity policies for ERISA plans that cannot be regulated by the state - including for telephone visits, which, as we've heard from a number of our members, are reimbursed poorly.

We expect to see more movement in the days ahead on this issue - we will keep you apprised as more parity policies are announced. The WSMA thanks Gov. Inslee, the OIC, HCA, CMS and insurance carriers such as Regence, United, and Molina, which had voluntarily adopted payment parity in advance of the orders, for taking these important steps during the COVID-19 crisis.

Be sure to visit our COVID-19 Telehealth and Reimbursement page for more resources and information, including other breaking updates.

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