Delivery of Care/Opinion

The view from OHIC

Marie Ganim, the R.I. Health Insurance Commissioner, shares her beliefs why telemedicine services are critical for maintaining health care accessibility in Rhode Island

Photo courtesy of OHIC

Marie Ganim, the R.I. Health Insurance Commissioner

By Marie Ganim
Posted 8/2/20
R.I. Health Insurance Commissioner Marie Ganim frames the conversation around the proposed telemedicine budget article now before the R.I. General Assembly, answering critics who have claimed that OHIC is exceeding its authority.
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Waiting in the wings of the coronavirus pandemic, which has killed more than 150,000 Americans in the last five months and infected more than 4.5 million across the nation, not to mention the still unknown consequences of continuing health problems as a result of contracting the virus, is the looming threat of climate change dangers that await us in the next few years.
The racial inequities in America have become more “visible” with the pandemic, and those disparities will continue to play out with climate change.
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PROVIDENCE – As the COVID-19 pandemic continues – and the opioid overdose and suicide epidemics persist – the provision of safe and accessible health care services has been increasingly challenging in Rhode Island.

Although in-person health care visits are occurring with protective safety measures in place, getting to those visits remains very difficult for many people. This is especially true for those with chronic health conditions, in need of transportation, and/or lacking adequate childcare assistance.

Rhode Island’s health insurers and health care providers must be congratulated and thanked for their rapid adaptation of policies and procedures to expedite the use of telemedicine services.

Throughout the nation, telemedicine – whether through traditional secure platforms that providers’ offices have put into place, through more commonly used audio-visual tools [such as Facetime or Skype], or through audio-only telephone calls – has become a critically important tool in the effort to slow the spread of COVID-19 and to increase access to needed health care services.

An effective tool

The Governor’s Telemedicine Executive Order has been in place since March to permit the current COVID-19 emergency requirements, which otherwise would not be possible under the Office of the Health Insurance Commissioner’s [OHIC] authority.

These actions taken during the COVID-19 pandemic have ensured that all health care services typically covered under an enrollee’s plan that are deemed clinically appropriate to be provided remotely are covered.

Telemedicine has served as an effective tool in both reducing infection risk at health care facilities, and in enabling health care providers to care for their patients during this unprecedented time.

What the data shows us
Data has shown that certain populations and neighborhoods have been hit particularly hard by COVID-19. Addressing health inequity is critical, and recent Medicare data shows equal access to care being delivered via telemedicine. There are also compelling reports that individuals facing behavioral health concerns – as well as children who lost in-person special services as a result of the pandemic – are dependent on this expanded telemedicine as a life-line to the assistance they need to be well and to progress, in the safety of their homes.

Rhode Island has made significant advances in containing the spread of COVID-19 through collaboration that will need to continue if we are to maintain the policies that have helped keep Rhode Islanders safe.

Encouraging innovative health care policy is at the core of OHIC’s work, and the Office will continue to work within its legal authority toward policies that protect Rhode Islanders and improve our health care system. It is in the interest of the state that we maintain telemedicine coverage requirements that ensure patients’ access to health care services while helping to prevent the spread of COVID-19.

Legislative action

Legislative action will be required to extend the current level of telemedicine access for a longer period of time than is covered by the Governor’s Executive Orders and to allow patients and providers to schedule and best accommodate telemedicine visits through the middle of next year. Governor Raimondo recently submitted proposed changes to the state’s Telemedicine Act to the R.I. General Assembly for their consideration as an addition to the FY 2021 state budget.

Current state law limits the use of telemedicine in our state, primarily by excluding telephone-only care, limiting the sites of care where telemedicine can be conducted, and by not addressing the important issue of reimbursement for health care providers. Fifteen other states have already enacted laws that require telemedicine reimbursement to providers be at the same rate as if the visit had occurred in-person.

The Governor’s “New Telemedicine Budget Article” proposes to make changes to our [existing] state law to allow many of the current COVID-19-related policies to stay in place until June 30, 2021. The proposed Article also calls for a comprehensive review of telemedicine data and best practices to be reported with recommendations to the Legislature by December 31, 2020. Only the R.I. General Assembly can change existing or enact new state law.

OHIC’s role

The Office’s role in informing the Legislature about this important budget article and in participating in the proposed comprehensive review of data and best practices to be reported back to the Legislature with recommendations, is clearly within OHIC’s legal authority. OHIC’s role reflects an obligation to provide legislators with the information they seek to make policy decisions based on facts and consumer needs surrounding telemedicine, during and after this pandemic.

Marie Ganim is the R.I. Health Insurance Commissioner.

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