S.6733/A.7316 – FQHC Payment Parity

This legislation, S.6733/A.7316, would require telehealth payment parity for Federally Qualified Health Centers (FQHCs) for care delivered where neither the provider nor the patient were located in a clinic.  The New York Health Plan Association (HPA) recognizes the essential role FQHCs play in providing care to the most vulnerable members of their communities, and that these providers are struggling from the impact of the recent loss of 340B revenue as a result of the Medicaid pharmacy carve-out from managed care.  However, HPA has concerns generally regarding telehealth payment parity for any provider, and opposes the bill for the following reasons.

Telehealth has been a critical tool to help maintain – and even expand – access to health and behavioral health services during the pandemic, and plans believe telehealth will continue to be an important component of improving access to the delivery system now that the public health emergency has expired.  However, it is important that State policy balance the importance of creating access to services via telehealth with assurances that patients are able to receive in-person care when it is in their best interest.  We are concerned that payment parity mandates create incentives for providers to prioritize telehealth instead of in-person care.  When the statute was amended to grant payment parity to behavioral health providers as part of the FY23 budget, HPA expressed opposition, recommending instead that additional information be collected regarding the quality of outcomes for care delivered via telehealth as opposed to in-person, and that the State work to incorporate telehealth into value based payment arrangements that appropriately balance in-person and virtual care.

In addition, prior to the pandemic, telehealth was viewed as a way to help reduce health care costs, and we believe that the language in the existing statute strikes the correct balance for telehealth reimbursement, by not requiring payment for costs not incurred:

 “health care services delivered by means of telehealth shall not require reimbursement to a  telehealth  provider for  certain  costs, including but not limited to facility fees or costs reimbursed through ambulatory patient groups or other clinic  reimbursement  methodologies  set  forth in section twenty-eight hundred seven of this chapter, if such costs were not incurred in the provision of  telehealth services due to neither the originating site nor the distant site occurring within a facility of other clinic setting”

 Any other approach results in unnecessary costs being incurred and another missed opportunity to generate savings for consumers, employers and taxpayers.

For these reasons, HPA opposes S.6733/A.7316.