Future of telehealth coverage uncertain

Rules differ state to state

Telehealth became the new normal for both mental health patients and providers during the pandemic. But as public health emergency regulations sunset, uncertainty looms across New England regarding what insurance will cover.

Federally, many Medicare telehealth benefits were extended through December 2024. In May, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) extended the telemedicine flexibilities adopted during the pandemic through November 11 of this year, with an additional extension through November 11, 2024 for patients with preexisting conditions.

State to state, the rules differ, particularly when it comes to private payer insurance, said Mei Wa Kwong, executive director of the Center for Connected Health Policy. While Vermont, Massachusetts, Rhode Island, and Connecticut have current regulations in place regarding payment parity for in-person and telehealth, Maine and New Hampshire do not.

Lynda L. Marshall, executive director of the Vermont Psychological Association, noted that the state passed legislation in 2017 requiring parity for in-person and telehealth reimbursement. Vermont also recently enacted a statute to add “audio only” to its definition of telehealth to study its effectiveness. This (addition), she noted, will make telehealth more accessible to underserved populations who may not have a reliable internet connection.

The Connecticut Legislature passed a law extending most pandemic telehealth policies — including those for telehealth insurance reimbursement parity with in-person services — through June 2024. Beyond that, it is unclear how requirements regarding telehealth insurers will change.

“It’s a real changing landscape right now in Connecticut,” said Marcy Russo, Ph.D., legislative committee chair of the Connecticut Psychological Association. “There’s a lot of anxiety amongst both mental providers and patients who have really benefitted from telehealth.”

For example, Russo said, after June 2024, insurers may require patients seen via telehealth to have an in-person visit every six months. This presents a dilemma for mental health providers who gave up their office space during the pandemic when all appointments were virtual.

“They now have to consider whether they need or want to go back to renting a physical space,” she said.

Potential inconsistencies in what services are covered for telehealth versus in-person are also worrisome, Russo said. For example, while telehealth medication management sessions and services seem safe, she has seen some indication that Medicare may not reimburse out-patient telehealth group therapy going forward.

“We know in behavioral health that [medication] is only a part of someone’s recovery,” she said. “Individual and group psychotherapy is just as important, and there are concerns about how to continue to provide those services for fragile patients in our community.”

Private payer insurers have generally offered comparable coverage for telehealth and in-person services, like Medicare and Medicaid. But over the last few months, some commercial providers have started to offer lower reimbursement rates for telehealth. “That flies in the face of parity,” said Russo, who wonders what will happen with providers’ contracts with insurers when the emergency order in Connecticut completely expires.

“Will we see a slow decline in the rate of what we will be reimbursed for telehealth versus in-person?” she said. “There’s a lot that remains to be seen.”

Like Rhode Island, New Hampshire, and Maine, Connecticut is one of the 40 states that participates in the Psychology Interjurisdictional Compact (PSYPACT), which facilitates the practice of telepsychology across state boundaries.

“Psychologists who are registered with PSYPACT can offer telehealth services to other states that are part of the compact,” Russo said. “But as states start to have variations on what is and what is not covered for telehealth, it may unfortunately disrupt access to services.”