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Telemedicine Payment Parity Fails in Pennsylvania

Pennsylvania remains one of the few states that still lacks a dedicated Telemedicine Act. In an attempt to address both telemedicine payment parity and professional regulation in one Act, Pennsylvania Senate Bill 780—including its clause on coverage and reimbursement for its use—was unanimously approved last June by two Pennsylvania Senate committees, the full Senate, and the House Professional Licensure Committee. However, it failed to pass in the House of Representatives in October.

If it had passed, the Act would have required insurers to pay for telemedicine services a la carte if they pay for the same service in person, thus providing payment parity. In other words, the Act would require the same health care for everyone regardless of of whether they are paying insurance or paying for the telemedicine service directly.

According to Matthew Glans, a senior policy analyst for The Heartland Institute, this regulation had the potential to improve access to health care in areas that are hard to reach over land. Other experts foresaw less traveling for patients, better management of chronic conditions, and less hospitalizations. The bill garnered strong support from the Pennsylvania Medical Society, Hospital and Healthsystem Association of Pennsylvania (HAP), AARP, and other organizations; HAP even accused insurers of hindering the growth of connected care programs through confusing reimbursement guidelines.

On the other hand, payers—the insurers—fought the legislation. Although the payer industry generally supports mHealth and telemedicine, it argued that telemedicine should not be held to the same value as in-person care since some telemedicine programs remain unproven. In addition, the Insurance Federation of Pennsylvania declared that the proposed bill introduced opportunities for fraud and lower quality of care.

Since the bill was stymied in the House, sponsor Senator Elder Vogel (R-Beaver) is considering introducing a new bill in 2019, the start of the new legislative session. As he noted in June, when the bill gained Senate approval, telemedicine has been shown to save time, money, and lives. Due to the rising costs of healthcare and the complete lack of healthcare in some areas, he says, the need for telemedicine will only grow larger; the technology offers options and strengthens the bond between a patient and his/her physician. Ultimately, he hopes to offer telemedicine as an option to all Pennsylvanians.

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