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Additional Federal Guidance Regarding COVID-19 and Telehealth Coverage: Some Employer Take-Aways

The U.S. Departments of Labor, Treasury, and Health and Human Services (the ?Ç£Departments?Ç¥) recently issued FAQs regarding the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), and COVID-19. A number of these FAQs address a group health plan?ÇÖs required coverage of COVID-19 tests, including which tests must be covered, related facility fees, reimbursement rates, and balance billing to patients. Employers should ensure that the third party administrators of their group health plans have incorporated this guidance for plan administration purposes. In addition, some of the other FAQs may be of interest to employers. For example, the FAQs provide that, if a group health plan reverses the increased coverage of COVID-19 or telehealth after the COVID-19 public health emergency period is over, the Departments will consider the plan to have satisfied the requirement to provide advance notice of changes to the Summary of Benefits… Continue Reading

SBC Relief for COVID-19 Coverage or Telehealth Changes to Group Health Plans

Generally, if an employer-sponsored group health plan makes a material modification to coverage midyear that would affect the content of the plan?ÇÖs Summary of Benefits and Coverage (?Ç£SBC?Ç¥), the plan administrator must provide participants with 60 days?ÇÖ prior notice of the modification. The U.S. Departments of Labor, Treasury, and Health and Human Services have issued a FAQ stating that they will not take any enforcement action against any plan for not providing such notice when the modification is to provide greater coverage related to the diagnosis and/or treatment of COVID-19 or to add benefits or reduce or eliminate cost sharing for telehealth and other remote care services. However, the plan administrator must still provide notice of the changes to participants as soon as reasonably practicable. This non-enforcement policy only applies while there is a public health emergency declaration or national emergency declaration related to COVID-19 in effect. The FAQs are… Continue Reading

Telemedicine Parity for Texas

Texas Senate Bill 1107 was signed into law on May 27, 2017, bringing welcome change to the rules governing telemedicine benefits in Texas that are comparable to those in other states. Some significant changes include: (i) a physician-patient relationship can be established without in-person contact or the presence of another healthcare provider with the patient during the telemedicine visit through the use of live or delayed audio/video, and (ii) a telemedicine provider may write prescriptions for the patient as a result of the telemedicine visit. The use of delayed audio/video (e.g., a recorded video sent via email) is permitted when the telemedicine provider reviews the patient?ÇÖs medical records or other relevant material. The appropriate standard of care for a telemedicine benefit is the same as for inpatient physician visits, and telemedicine providers must inform patients about appropriate follow-up care. Senate Bill 1107 directs certain state agencies to jointly issue rules… Continue Reading

October 2021