Update to 2021 Telehealth Services

February 19, 2021

In support of our members and employer groups during the ongoing national public health emergency (PHE) and in line with the new Administration’s information to expect the PHE to continue for the duration of 2021, we are expanding the telehealth services that we will cover through the end of 2021. This means we are no longer limiting coverage of telehealth services to the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) permanent lists.

Instead, during 2021, providers are able to deliver expanded telehealth services beyond the CMS and AMA telehealth lists, including, but not limited to:

• Applied behavior analysis (ABA) services
• Partial hospitalization programs (PHP)
• Physical therapy (PT)
• Occupational therapy (OT)
• Speech therapy (ST)

We have not changed our clinical viewpoint that the AMA and CMS provide an industry standard for determining the appropriateness of telehealth services and that many services can only be effectively delivered in-person. But we realize that flexibility is important to help our members continue to access services in various ways during this unusual time.

• The change will be retroactive to Jan. 1, 2021.
  
• It applies to our fully insured members and ASO customers. 
• Member cost share will still apply, except in Illinois where cost-share continues to be waived pursuant to the Executive Order.
• Medicare members’ telehealth benefits are determined by CMS.
• Medicaid members’ telehealth benefits are defined by state Medicaid requirements.

What this means to ASO customers:

You have the option to opt out of the expanded telehealth services. If you opt out, you will only have access to the telehealth services listed on the CMS and AMA permanent telehealth lists, plus intensive outpatient program (IOP) services. Your employees will not have the expanded telehealth services.

Please note, the decision to opt out is not applicable to Illinois ASO customers or to New Mexico ASO customers due to state requirements.

Here's how the process will work:

• If you would like to opt out of the expanded telehealth services, you must contact your account executive to let them know by Monday, March 1.
• If a decision is not communicated by March 1, your group will default to covering the expanded telehealth services.