The telehealth revolution, accelerated by the pandemic, has transformed health care delivery. A critical deadline looms on September 30th, threatening to roll back key access points for millions of Medicare beneficiaries. The potential expiration of pandemic-era telehealth waivers creates a significant challenge for health insurance executives to ensure provider networks remain compliant while maintaining the continuity of virtual care that members have come to rely on. For leaders of health insurance provider networks, this isn’t a political issue; it’s a strategic and operational one.
The Business Impact of Expiring Waivers
Recent coverage in Becker’s Hospital Review reports that, for the past several years, these waivers have been instrumental in expanding virtual care by allowing a broader range of providers to deliver services and by permitting members to receive care from the comfort of their own homes. This flexibility has been especially vital for those in rural and underserved areas, where access to in-person specialists is often limited.
The potential expiration of these waivers, which the American Hospital Association (AHA) has called a “telehealth cliff,” brings with it a host of challenges that could impact a health plan’s bottom line and compliance standing. Without an extension from Congress, a sudden return to pre-pandemic telehealth rules could lead to disruptions in care access, a potential increase in out-of-network claims, and a complex web of billing and compliance issues.
The American Medical Association (AMA) has been a vocal advocate for a permanent extension, highlighting that telehealth has become a “routine part of care” that should be protected. The administrative burden on your network of providers could increase, leading to potential claims denials and a breakdown in the streamlined processes that have been built over the past few years. This uncertainty also jeopardizes the continuity of care for members, particularly for those managing chronic conditions through virtual consultations.
A Proactive Approach to Network Compliance
As a health insurance executive, a proactive strategy is essential to navigate this transition and ensure your network is prepared, regardless of the outcome in Washington.
Here are a few key actions to consider:
- Communicate with Your Network: Your first step should be to establish clear and consistent communication with your provider network. The Centers for Medicare & Medicaid Services (CMS) has detailed fact sheets on which waivers are set to expire and which have been made permanent, which can be an invaluable resource to share with your providers to help them prepare.
- Update Your Network Agreements: Review and, if necessary, update your contracts and agreements to reflect the evolving regulatory landscape. It’s crucial to have a clear understanding of what services will and will not be covered virtually post-September 30th so you can manage expectations and compliance proactively.
- Leverage Expert Resources: Navigating complex regulatory changes and ensuring your network is optimized for compliance is a significant undertaking. Resources like TOG Network Solutions, which specializes in managing and building compliant health care networks, can provide the expertise and support needed to assess your current network and implement a strategy that safeguards your operations and ensures continued access to care for your members.
By addressing the potential expiration of these waivers with a strategic, business-focused mindset, you can protect your network’s compliance and operational integrity. Taking action now to prepare for all possible outcomes will ensure your health plan continues to provide seamless, high-quality care, reinforcing your commitment to both your members and your network of providers.