Florida denies payment parity but leaves the door open for negotiation
Once signed by Governor DeSantis, Florida HB 23 will go into effect July 1st of this year. The bill sets guidelines for telehealth and telemedicine in Florida. It moves payment parity out of the picture, for now. It requires the healthcare provider to initiate discussion about different rates for virtual care and in-person care. Payment parity requires payors to reimburse providers the same rates independent of whether the encounter or service provided occurred in person or through virtual care. Payment parity is very rare and only 10 states currently have it. Coverage parity, on the other hand, requires payors to provide the same level of insurance coverage for patient encounters and services provided through virtual care. There are some coverage parity laws that prohibit health plans from charging different deductibles if the patient was seen through a telehealth platform. However, the bill provides the means for payers and providers to negotiate their own rates for telehealth services.
HB 23 Lines 242-251
“A contract between a health maintenance organization issuing major medical individual or group coverage and a telehealth provider, as defined in s. 456.47, must be voluntary
between the health maintenance organization and the provider must establish mutually acceptable payment rates or payment methodologies for services provided through telehealth. Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same services provided without the use of telehealth must be initialed by the [provider offering telehealth].”
Is this going to kill telemedicine in Florida?
Not at all. Telemedicine is thriving in Florida. This bill may seem like a victory for payer organizations that have lobbied to control reimbursement. But, in reality, it opens the door to allow representatives ranging from large healthcare organizations to small private practices to initiate negotiations regarding virtual care reimbursement rates.
HB 23 also allows for providers who live in another state to treat Florida residents, but the healthcare provider must register with the state of Florida prior to doing so. This provision opens the door to Florida patients to see specialists that they may not normally have convenient access to, or any access at all.
Is Florida behind the curve?
No, it’s on par with the way the country is moving in regards to telemedicine reimbursement. About ten states currently require payment parity for virtual care and 36 states require coverage parity. Massachusetts and Pennsylvania have been unsuccessful in their recent attempts to require a virtual care visit to be reimbursed at the same rate as an in-person one. Bottom line, it is not the norm, and Florida is not behind the curve. Actually, this legislation is a good step in the right direction.
What can healthcare organizations and providers do?
There are many scenarios that support the integration of virtual care without payment parity and a positive ROI. It’s not a black and white issue.
- Urgent care: Open to a fee for service pricing structure
- ED triage: Alleviates strain on time and resources in the ED
- Behavioral health: Provides access to psychiatric care when shortage is present
- Employee health benefit: Tap into your own employee population by offering virtual care
Also, with a platform like eVisit, the provider has the option not to charge a patient (eg. if it is a follow-up visit that needs to be bundled into a previous in-office visit).