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Update to 2021 Telemedicine Services

February 17, 2021

In support of our members and employer groups during the ongoing national public health emergency (PHE) and in line with the new Administration’s information to expect the PHE to continue for the duration of 2021, we are expanding the telemedicine services that we will cover through the end of 2021. This means we are not limiting coverage to the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) permanent lists.

Instead, during 2021, providers are able to deliver expanded telemedicine services beyond the CMS and AMA telemedicine lists, including, but not limited to:

  • Applied behavior analysis (ABA) services
  • Partial hospitalization programs (PHP)
  • Physical therapy (PT)
  • Occupational therapy (OT)
  • Speech therapy (ST)

We have not changed our clinical viewpoint that the AMA and CMS provide an industry standard for determining the appropriateness of telemedicine services and that many services can only be effectively delivered in person. But we realize that flexibility is important to help our members continue to access services in various ways during this unusual time.

  • The change will be retroactive to Jan. 1, 2021.
  • It applies to our fully insured members and ASO customers.
  • Member cost share will still apply, except in Illinois where cost-share continues to be waived pursuant to the Executive Order.
  • Medicare members’ telemedicine benefits are determined by CMS.
  • Medicaid members’ telemedicine benefits are defined by state Medicaid requirements.

What this means to you:

ASO customers have the option to opt out of the expanded telemedicine services. The groups that opt out will only have access to the telemedicine services listed on the CMS and AMA permanent telemedicine lists, plus intensive outpatient program (IPO) services. They will not have access to the expanded telemedicine services.

Please note, the decision to opt out is not applicable to Illinois ASO customers or to New Mexico ASO customers due to state requirements.

Here's how the process will work:

  • If ASO customers would like to opt out of the expanded telemedicine services, they must contact their account executive to let them know.
  • The account executive must confirm with their client service specialist or group benefit specialist by Monday, March 1 that their ASO group wants to opt out of the expanded telemedicine services. If a decision is not communicated by March 1, ASO clients will default to covering the expanded telemedicine services.