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1. Do I Have To Pay A Copay For Telemedicine
2. Are Copays Waived For Telehealth
3. Aetna Copays For Telemedicine

The new adopted emergency regulation follows Governor Cuomo’s announcement on Saturday, March 14th, 2020 that DFS will require insurance companies to waive co-pays for telehealth visits, whether or not related to coronavirus (COVID-19). This new regulatory action helps to encourage New Yorkers to seek medical attention from their homes rather than visit a hospital or doctor's office for health care. Effective December 1, 2020, FQHCs may be reimbursed as telemedicine and telehealth distant site provider as permanent policy change. Rural Health Clinics. Rural Health Clinics (RHCs) may be reimbursed as telemedicine and telehealth distant site providers statewide for service dates from March 24, 2020 through April 30, 2021. During the COVID-19 public health emergency, the new waiver in Section 1135(b), opens in new window of the Social Security Act (found on the CMS Telemedicine Fact Sheet) authorizes use of telephones that have audio and video capabilities to provide Medicare telehealth services. Additionally, the Health & Human Services Office for Civil Rights (HHS OCR) will exercise enforcement discretion. Virtual Mental Health Care is eligible for sharing through a teletherapy provider approved by Impact. Members must pay 100% of the session consultation fee at time of service. Consult fees are published, shared, and reimbursed (minus a $75 specialist provider fee) after the member has met their PRA.

On March 24, 2020, the US Department of Health and Humans Services Office of Inspector General (OIG) issued guidance regarding OIG’s March 17, 2020, policy statement on reductions or waivers of cost-sharing obligations owed by federal healthcare program beneficiaries for telehealth services. While the original policy statement set conditions which, if met by physicians or practitioners, would allow them to avoid administrative sanctions for granting such reductions or waivers, the March 24 guidance clarifies OIG’s position on the scope of telehealth services covered.

On March 24, 2020, the US Department of Health and Human Services Office of Inspector General (OIG) issued guidance (Guidance) regarding the policy statement permitting routine waiver of copays for telehealth services (Policy Statement) issued on March 17, 2020. The Guidance clarifies the scope of “telehealth services” that may be the subject of the copayment waivers and clarifies the type of providers to which the Policy Statement applies.

Through the Policy Statement, OIG notified physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations that federal healthcare program beneficiaries may owe for telehealth services for arrangements that satisfy both of the following conditions:

1. A physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules.
2. The telehealth services are furnished during the time period subject to the COVID-19 national emergency declaration.

OIG will not view the provision of free telehealth services alone as an inducement or as likely to influence future referrals (i.e., OIG will not view the furnishing of subsequent services occurring as a result of the free telehealth services, without more, as evidence of an inducement) for any free telehealth services furnished during the pendency of the emergency declaration. The Policy Statement, however, did not define the scope of the “telehealth services” subject to the waiver.

The Guidance clarifies OIG’s position on the scope of “telehealth services,” stating that such services are not limited to the narrow set of services referred to by the Centers for Medicare and Medicaid Services (CMS) as “telehealth visits” under the Medicare Part B program. Rather, OIG reported that it intends for the Policy Statement to apply more broadly to “non-face-to-face services furnished through various modalities, including telehealth visits, virtual check-in services, e-visits, monthly remote care management, and monthly remote patient monitoring.”

In addition, OIG clarified that the availability of the waivers is not limited to physicians and other practitioners who bill for their services; the availability of waivers also extends to hospitals or other eligible individuals or entities that bill on behalf of the physician or practitioner pursuant to a reassignment of his or her right to receive payments to such individual or entity.

This clarification should be welcome to physicians, hospitals and health systems that are seeking alternatives to in-person patient visits and ways to alleviate the financial burden of such services for certain patient populations during the COVID-19 national emergency. However, as noted in our discussion regarding COVID-19 beneficiary inducement questions, certain other considerations might be at play when evaluating copay waivers that would apply to the still fairly narrow contours of OIG’s telehealth

Covered Services

Do I Have To Pay A Copay For Telemedicine

TRICARE covers the use of secure video conferencing to provide medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. services. You connect securely with a provider using a computer or smartphone. This includes for certain:

• Office visits
• Preventive health screenings
• Telemental health services (individual psychotherapy, psychiatric diagnostic interviews and exams, and medication management)
• Services for End Stage Renal Disease

Using Telemedicine Services

Depending on your TRICARE plan, you may first need an authorization or referral. Contact your regional contractor. Active duty service members need a referral for telemental health care.

TRICARE recently revised its policy on telemedicine services. These changes are temporary during the national health emergency due to the pandemic. TRICARE will now:

Are Copays Waived For Telehealth

• Cover audio-only telemedicine visits.
• Waive cost-shares and copayments for all covered telemedicine services. These services must be from a military provider or TRICARE network provider.
• Allow more providers to offer telemedicine services. Some providers may not offer this service, so be sure to ask.
  • If you're overseas, the country where you live must allow telemedicine. The provider also must be licensed to practice where you live. Contact your TOP Regional Call Center for more information, including provider eligibility.

If you use TRICARE For Life, Medicare should cover telemedicine visits when the service and provider are payable by Medicare. This temporarily includes audio-only telemedicine visits. If they aren't payable by Medicare, TRICARE For Life will process as first payer. Deductibles and cost-shares will then apply. Learn more about Medicare coverage.

As of Mar. 31, 2020, TRICARE covers telehealth care for applied behavior analysis (ABA) parent or caregiver guidance services under the Autism Care Demonstration. This is an ongoing temporary change during the national health emergency due to the pandemic

This list of covered services is not all inclusive. TRICARE covers services that are medically necessary and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 8/24/2020

Aetna Copays For Telemedicine

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