Gavin Clingham, JD, Director of Public Policy, and the AfPA Governmental Affairs Team, Alliance for Patient Access (AfPA)

COVID-19 has made accessing in-person care more difficult, some areas have restricted travel, some sites of care have been limited, and some patients fear risks of exposure when seeking routine and even emergency care. But health care professionals know that a missed diagnosis or delayed or skipped treatments can be just as harmful to patients’ health. 

As a result, healthcare insurers, led by Medicare and private insurers, rapidly expanded access to telemedicine temporarily to meet this need. Can telemedicine work for pediatric patients as well? 

Appropriate Telemedicine Services for Pediatric Patients 

Telemedicine can cover any number of services and types of visits regardless of a patient’s age. Many insurers already cover telemedicine for behavioral health needs among the pediatric population. Telemedicine might also be appropriate for common medical conditions that are already diagnosed based on an image or phone call from the patients. Services delivered in this manner can, for example, be used for assessment, diagnosis, intervention, consultation, and supervision across any distance. 

Examples of services where a video visit can provide you with enough information to diagnose are common rashes or prescribing antibiotics for conjunctivitis. Telehealth can also be useful for follow-up visits after a recent in-person appointment or prescribing prescription refills. 

Telemedicine will not be able to meet all healthcare needs but is an exciting option that healthcare providers and patients should explore. 

Coverage and Reimbursement Policies 

Providers must remain aware that telemedicine coverage policies vary widely. In addition to private health insurers’ policies, the Centers for Medicare and Medicaid Services (CMS) has been encouraging states to expand coverage through both Medicaid and the Children’s Health Insurance Program (CHIP). To help answer questions, CMS released a State Medicaid & CHIP Telehealth Toolkit to urge States to implement the flexibilities that they have and to make it easier for them to apply for waivers if necessary. 

CMS makes clear that States have a great deal of flexibility with respect to covering Medicaid and CHIP services provided via telehealth. States have the option to determine whether (or not) to utilize telehealth; what types of services to cover; where in the state it can be utilized; how it is implemented; what types of practitioners or providers may deliver services via telehealth, as long as such practitioners or providers are “recognized” and qualified according to Medicaid federal and state statute and regulation; and reimbursement rates. 

Importantly, CMS makes clear that States are not required to submit a state plan amendment (SPA) to pay for services delivered via telehealth if payments for services furnished via telehealth are made in the same manner as when the service is furnished in a face-to-face setting.

Healthcare providers need to understand the differing rules for their state and private insurance programs so that they can take full advantage of new flexibilities. 

Privacy Concerns 

All telemedicine comes with new privacy concerns based on the technology used. Providers are encouraged to use HIPPA compliant technology as it will be the standard of care going forward. Treating pediatric patients means compliance with other legal requirements, including the Children’s Online Privacy Protection Act (COPPA). This law helps ensure any personal information gathered from children under 13 online is adequately protected and subject to parental consent. 

Conclusion 

COVID-19 has caused ripple effects throughout the healthcare system. Increased access to reimbursement for telemedicine visits is one development that has many excited. While much of the flexibility is limited to the duration of the declared Public Health Emergency, efforts are underway to continue coverage past that date. 

Telemedicine for pediatrics has different benefits and challenges than telemedicine for other populations. Experience from healthcare providers and their patients about what did and did not work in pediatrics will be important in informing the telemedicine policies that continue forward. 

Referrences: 

1. https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf