How Do I Implement Telehealth in My Plan? – Telehealth Crash Course Webinar Series

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Telehealth Crash Course:How Do I Implement Telehealth

in My Plan?

September 22, 2015

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How Will My Organization Absorb the Influx of New Patients?

Tuesday, September 29 – 2:00 – 2:15 p.m. ET

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Presented by

Adam C. Solander

Member of the Firm

[email protected]

202-861-1884

4


Overview

Telehealth in Employer Market

Options for Incorporating

• Benefit Under The Plan

• EAP, Wellness, On-site

Privacy and Security

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Move Toward Telehealth

Beginning in 2018, employer-sponsored plans will be subject to a 40 percentnon-deductible excise tax on the dollar amount of coverage that exceedscertain specified thresholds• 2018 threshold for individual coverage is $10,200 and the threshold for family

coverage is $27,500• Thresholds are indexed to CPI-U not medical inflation• Medical inflation far outpaces CPI-U.

oEvery year employers will get closer to the tax.

Employers are looking for innovation to lower the cost of the care theyprovide

• For smaller employers many of the same benefits of an on-site clinic

In the employer sponsored world we are seeing two different types oftelehealth providers:• Sick care• Disease specific cost drivers

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Implementation of Telehealth

There are a number of ways that telehealth can be incorporated byemployers

• Inclusion in Group Health Plan

• Offered as an EAP, Wellness, or On-site Clinic

Advantages and disadvantages to both

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Benefit under the Plan

Telehealth platform is included in benefit structure

• Enrollee uses a telehealth provider in the same way they use other providersunder the plan and the applicable cost sharing provisions of the plan areapplicable

Requires coordination with TPA

• The TPA will be responsible for administering the benefit

• Not all telehealth providers are set up with all TPAs

• Telehealth is new for employers and negotiations can be complicated

In this context, telehealth is only available to enrollees in group health plan

Plan compliance must incorporate telehealth services

• Mental health parity

• HDHP and discounts

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Telehealth as a Wellness Program or EAP

Employers are realizing the benefit in providing telehealth services toemployees outside the group health plan context

Can reach all employees

• Productivity, Absenteeism, Presenteeism

Under ERISA, any employee benefit that offers “medical care” is subject toACA, unless it qualifies as an Excepted Benefit.

• Should an EAP offer medical care it would be considered a group health plan andsubject to the ACA market reform and employer mandate provisions

• It is unlikely that a telehealth program would satisfy the market reform provisionsof the ACA. Thus, employer could be subject to a penalty of $2,000 x # of full-timeemployees if offered outside the group health plan context

• Additionally, because individual subsidies dependent upon an individual not beingeligible for employer provided coverage, provision of telehealth could complicateindividuals going to exchange

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Telehealth as a Wellness Program or EAP

How can an EAP qualify as an excepted benefit?• The program cannot provide “significant” benefits in the nature of medical care• Benefits cannot be coordinated with benefits under another group health plan• No employee premiums or contributions are required to participate in the EAP• No cost sharing under the EAP

Guidance states that an EAP that only provides referrals to outsideorganizations could constitute an excepted benefit• Conceivable that a telehealth program may be structured in a way where EAP

provides referrals to telehealth providersoHealth fair ok

Clear that disease specific programs can be offered in excepted benefitmanner

Even if EAP only provides excepted benefits, it still may qualify as a plan andmust maintain plan compliance• 5500, SPD, Claims procedure etc.

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Privacy and Security

If telehealth provided through the group health plan, the telehealth provideris likely a Covered Entity under HIPAA

• Employers do not have the ability to control the medical information given toproviders

• Employers who receive only aggregate information do not want specific treatmentinformation

If telehealth provided outside of the group health plan context thendepending upon scope of services may not be subject to HIPAA

• Only CE if a provider who is performing standard transactions

• Only BA if performing service on behalf of CE, employers not CEs

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Questions?

Adam C. Solander

Member of the Firm

[email protected]

202-861-1884

12


How Will My Organization Absorb the Influx of New Patients?

Tuesday, September 29 – 2:00 – 2:15 p.m. ET

To register for upcoming webinars, please visit www.ebglaw.com/events.

Upcoming WebinarsTelehealth Crash Course

13

http://www.ebglaw.com/events

How Do I Implement Telehealth in My Plan? – Telehealth Crash Course Webinar Series

Healthcare

Transcript of How Do I Implement Telehealth in My Plan? – Telehealth Crash Course Webinar Series