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Based on current COVID-19 recovery trends, the Department of Health and Human Services announced that the US federal Public Health Emergency (PHE) waivers will end on May 11, 2023. Emergency declarations, Congressional legislative actions, and state regulations implemented unprecedented changes to many healthcare delivery aspects. Private payers, Medicaid, and Medicare initiated widespread telehealth reimbursement approvals. Some of these changes will expire in the next few weeks, but many will continue while further legislative action develops. The article below clarifies and summarizes the end-of-pandemic reimbursement decisions made by private payers, Medicare, and Medicaid. Resources for other end-of-pandemic decisions are also provided.

Access to Telehealth Services

Private Health Insurance 

Coverage for telehealth and other remote care services will vary by state and private insurance plans. Some states have mandated the continued reimbursement of all healthcare services through telehealth, while others have not. 

Also known as commercial insurers, these payers also have rules within their state-based plans that differ from one state to another. More specifically, company “A” in one state can have different benefit offerings from company “A” in a neighboring state. These issues are particularly important for providers to realize and correct as the end of the pandemic draws near, lest they be vulnerable to charges of insurance fraud for practicing over state lines without a license and billing insurance for those services.

The client’s location at the time of the contact can be a serious point of contention by private carriers if providers have been lax with their billing practices when delivering telehealth services to a client who relocated to a different state. Using the example above, if a client moves from state “A” to state…

From Telebehavioral Health Institute – Read More

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