The Division of Insurance has received numerous calls and emails regarding telehealth services during the public health disaster emergency declaration related to COVID-19. The following information is intended to address these questions.

HB29 – AS 21.42.422 Telehealth Insurance Mandate

HB29 became effective March 17, 2020. This legislation permanently expands the telehealth insurance mandate (previously limited to mental health services) to include medical services. The law was not intended to include every medical procedure as some covered health care services cannot be provided remotely. For example, it may not be clinically appropriate for chiropractic manipulations to be provided over audio-visual technology.

The statute is applicable in-network and out-of-network. No in-person visit is required prior to using telehealth services and so new patients are eligible for telehealth services. The Division also notified insurers in Bulletin 20-07 that the statutes does not require health care providers to use a particular technology platform in order to have telehealth services covered.

Health care providers are encouraged to contact insurers or other payers to verify telehealth coverage for services. The insurers maintain clinical guidelines under which a service would be covered (e.g. Medicare, Medicaid, etc.). For physical therapy, occupational therapy and other therapies, the provider should confirm coverage for services as some insurers may cover evaluations, but not treatments offered via telehealth. For mental health services, the statute change did not affect the offering and coverage of telehealth services.

Health care providers should be aware that the law does not provide for parity of payment between in-person and telehealth services. It should also be noted that Title 21 of the Alaska Statutes only apply to insured plans which account for about 15% of the health care market. Many patients may be covered by health plans that are not required to comply with AS 21.42.422. For example, large employers may be self-funded and exempt from the telehealth mandate.

COVID-19 Expanded Services

During the COVID-19 pandemic, insurers are following the lead of the Federal Centers for Medicare and Medicaid Services in providing unprecedented flexibility for telehealth services. We are seeing such flexibilities as telehealth services via audio only, expanded lists of covered codes for telehealth services, and increased reimbursement levels.

Some insurers recognize that some visits normally would only be provided in-person and are paying telehealth services at the same rates as in-person visits. Health care providers and their billing staff should carefully review communications from insurers related to billing for such services. Some insurers request that providers bill using the relevant telehealth code. Other insurers are requesting that in-person codes be used even if the service is provided via telehealth.

Health care providers may have additional flexibility during the COVID-19 pandemic to provide services through alternative communication means through the suspension of penalties under HIPAA issued by the Office of Civil Rights. However, providers should confirm coverage with a payer.

Insurers have been called upon to provide greater flexibility and coverage during the COVID-19 pandemic. Services that can appropriately be offered through telehealth in order to avoid unnecessary exposure to the virus and prevent regression of symptoms are expected to be covered by insurers. Insurers should be communicating these expanded coverages to providers and consumers as soon as possible.

Additional Resources

The Division encourages health care professionals to review the COVID-19 resources on the ASHNHA website including the Alaska Quick Start Guide to Telehealth.

If health care providers receive insurance denials for reasonable telehealth services, they are encouraged to contact the Division of Insurance to complete a provider complaint. Consumer services can be reached at 907-269-7900.

You may benefit from The American Rescue Plan of 2021 if you are seeking to enroll in health insurance, change your health insurance selections, are interested in applying for greater tax credit, or if you would like assistance with COBRA premiums. The American Rescue Plan of 2021 expands open enrollment April 1st through August 15, 2021

DOI Press release - Individual Market Open Enrollment Extended to August 15

HHS press release - Reduced Costs & Expanded Access Available for Marketplace Health Coverage

Federal Marketplace Information on Special Enrollment

• Consumers may choose a new plan during the Special Enrollment Period. If consumers choose a plan with a new insurer, they will need to meet a new deductible and pay other cost sharing. If consumers switch plans with their existing insurer through the same marketing method, they will not start over on a new deductible. For example, if the consumer has a plan purchased directly from an insurer and they switch to a plan from that same insurer on the marketplace through healthcare.gov, the consumer will start a new deductible. If they have a plan from healthcare.gov and switch to a plan with the same insurer on healthcare.gov, they do not have to start a new deductible.

Special Enrollment information from CMS

Where to get more information about this Special Enrollment Period

• Visit HealthCare.gov to learn more and start an application or update an existing one
• Call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325

PREMIUM TAX CREDITS

Those newly enrolling Federal Marketplace (healthcare.gov) may see greater tax credits under the American Rescue Plan of 2021. Those who are already enrolled may find increased tax credits by reviewing their account through healthcare.gov

• Consumers with incomes 100 – 150% of FPL will have $0 premiums (except for plans with benefits in excess of the benchmark plan, e.g., dental or abortion coverage).
• Consumers over 400% FPL who previously were not eligible for a premium tax credit are now eligible. Consumers in this category may want to reevaluate their coverage for 2021. Additional information can be found at healthcare.gov
• Most consumers will be eligible for a new tax credit amount. Consumers may log-in to their healthcare.gov account to update their application to see their new tax credit amount.
• Consumers who do not update their applications will be able to get the additional credit amount when they file taxes next year. Healthcare.gov’s system is not retroactive; consumers may want to make the update to their application ASAP.
• Anyone with a week or more of unemployment income in 2021 will be considered to have an income of 133% FPL.

For more information, please see the following links:

• Healthcare.gov: More Savings

COBRA PREMIUM ASSISTANCE

Premium Assistance for COBRA Continuation Coverage For Individuals And Their Families under the American Rescue Plan Act of 2021

The American Rescue Plan includes a program to fully subsidize COBRA premiums for consumers starting April 1, 2021, and continuing until September 30, 2021.

The ability to enroll in COBRA coverage has been expanded also. If you previously declined coverage or if you enrolled and subsequently disenrolled, under the American Rescue Plan, you may be able to enroll/reenroll for COBRA benefits. Plan administrators or insurance companies will be notifying individuals who qualify for this COBRA expanded enrollment opportunity.

More detailed information can be found on the DOL website at: www.dol.gov/cobra-subsidy

Click here for more information about The American Rescue Plan of 2021.

For more information about health insurance, visit Insurance.Alaska.Gov/Consumers/Health.aspx

• We’re here to help with resources for Members, Employers, and Providers
• Frequently-updated COVID-19 Resource Center

Moda has received questions and concerns about the novel coronavirus (respiratory illness), COVID-19 and would like to keep you informed with the most-up-to-date information as it relates to your health and benefits.

Visit our website at: www.modahealth.com/community/covid-19

Learn more about Premera's response to the COVID-19 outbreak for our customers.

Premera wants to help you get the care you need for the coronavirus that causes COVID-19.

Information for Employers: www.premera.com/ak/employer/coronavirus-19-faq

Getting Care for COVID-19 www.premera.com/ak/visitor/outbreaks

We are expanding your access to care, support, and resources to help you navigate through this unprecedented time. We are committed to helping protect your health by enabling you to get access to the right care including from the comfort of your home.

To learn more about resources available to you, visit our website at www.uhc.com/health-and-wellness/health-topics/covid-19

In response to business closures across the state of Alaska due to COVID-19, the Division of Insurance is reminding workers who lost their jobs that they are eligible to enroll in health insurance to cover themselves and their dependents.

COBRA: For businesses with more than 20 employees, employees and their dependents are typically eligible for COBRA continuation coverage under federal law. If eligible, your employer should provide information for how to continue coverage.

Employees who lose job related health coverage also will qualify for Special Enrollment Period. Consumers can contact insurers directly or shop on the marketplace at Healthcare.Gov. Some workers might be eligible for premium tax credits available through Healthcare.Gov.

For more information, visit Insurance.Alaska.Gov/Consumers/Health.aspx