October 11, 2023

Business Group on Health Policy Position Statements

Business Group on Health’s position statements on health policy issues impacting employer-sponsored health coverage.

Full Series

Issue

Federal and state laws and regulations affect the availability of telehealth and virtual care (telehealth) services, who can provide them, the conditions under which providers can offer them, and the cost of provision of these services. Provider licensure laws, facility requirements, the scope of services approved for telehealth, and payment regulations impact the availability and cost of care provided virtually. Similarly, the approach that federal programs like Medicare, Medicaid, and the Veteran’s Health Administration (VA) take toward telehealth influences the private market for telehealth services. Unnecessarily restrictive state laws and regulations, and variations among states, make it more difficult and costly for employers to offer telehealth services to employees and their families. Of particular concern are cross-state licensing limitations and state payment parity mandates, which require that patients and plans pay amounts equivalent to in-person visits for care provided virtually.

Though telehealth services had been widely offered prior to COVID-19, its adoption and utilization were accelerated because of the pandemic. Federal regulations loosened restrictions on telehealth coverage under Medicare during the declared public health emergency (PHE), as well as permitted employers to offer stand-alone telehealth benefits to employees that are ineligible for other employer-sponsored group health plan for the duration of the PHE. These temporary changes encouraged people to get needed care safely and conveniently during the pandemic.

While telehealth has gained greater acceptance among employers, patients and providers, there is now a heighted focus on quality of care received virtually, effective integration and extracting measurable value from the various modalities available to patients. Among large employers responding to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey, 70% are concerned about the siloed care experience due to the lack of coordination between virtual and community-based health care providers. As it relates to quality of care, 80% of employers indicated that the integration of virtual care delivery and in-person care would have a meaningful impact.

Position

Federal and state policies should foster growth of telehealth services that promise to improve the value of health care delivery. Business Group on Health previously testified before Congress on policy recommendations that will move the health care system toward evidence-based, efficient, and equitable telehealth services. Specifically, we recommend that policymakers:

• Permanently change the rules for coverage of telehealth and other remote services prior to meeting the HSA deductible, giving plans the option to provide these services at low/no-cost without jeopardizing the tax-favored status of their HSA contributions.
• Expand and permanently allow employer plan sponsors the flexibility to offer stand-alone telehealth benefits to employees not eligible for the employer’s medical benefits. This policy, which allowed employer plan sponsors to temporarily treat telehealth as an excepted benefit, was available to employers during the COVID-19 public health emergency.
• Ensure that telehealth providers follow all applicable state and federal privacy and information security rules/laws.
• Oppose telehealth payment mandates including those that would require parity in payment for services provided via telehealth as those in person or those that would impede employers’ flexibility for innovative, value-based payments.
• Eliminate state barriers to flexibility for employers to offer telehealth services to their populations (including access across state lines, to increase rural access, etc.) – without adding additional administrative burden on plans and employer plan sponsors (e.g., dealing with different residency, provider licensure, patient-provider relationship, technology, scope of services, and other requirements).
• Ensure that policies reducing or eliminating barriers to flexibility do not disrupt ERISA preemption, allowing self-insured ERISA plan sponsors the discretion to design programs and coverage for their employee populations.
• Cover a wide array of modalities (video conferencing, telephone and telephone-only, store and forward technologies, remote patient monitoring and mobile health technologies), where appropriate, to deliver telehealth services, including for mental health, chronic care management, primary and acute care, rehabilitation and other services.
• Recognize appropriate limits and conditions on the use of telehealth for prescribing and monitoring of the use of controlled substances and other medications where appropriate physicians’ supervision is desirable (e.g., narcotics or some mental health medications).
• Conduct large-scale independent study and analysis of health outcomes and costs associated with telehealth services, as compared to in-person services.

WHY IT MATTERS

• According to our 2024 Large Employer Health Care Strategy Survey, nearly all employers who responded will offer telehealth for some services, with 97% offering virtual care options for acute care. Telehealth, telemental health, and mental well-being (e.g., resiliency, mindfulness) will be offered by nearly all employers by 2026. Although many established virtual care solutions are anticipated to remain flat due to already being highly prevalent, certain virtual care solutions associated with emerging concerns (e.g., medication-assisted weight management, digestive health) are expected to expand.
• Among employers surveyed by the Business Group, slightly more than 70% viewed eliminating barriers for telehealth and maintaining telehealth flexibility enacted during the COVID-19 pandemic (e.g., pre-deductible coverage, out-of-state licensing, payment flexibility) as either very important or important policy and legislative priorities.
• With its adoption and utilization accelerated by COVID-19, telehealth is poised to become an integral and critical component of health care. However, there is now a heightened focus on quality of care received virtually, effective integration and extracting measurable value from the various modalities available to patients. It is imperative to evaluate the appropriateness of telehealth for various conditions and types of care (e.g., acute care, chronic care management, remote monitoring, mental health services, evaluation and management), and its impact on clinical quality and safety, access (including for services or geographies with provider shortages, rural areas, and for people with transportation and other challenges related to social determinants of health), convenience, and costs.

More Topics

Policy & Advocacy Telehealth