Reimbursement for telehealth still an issue

By Catherine Robertson Souter
March 1st, 2017

In Massachusetts, Blue Cross and Blue Shield announced that it would add coverage for telehealth services early last year. While the coverage was expanded, however, BCBS limited its reimbursement rates, falling short of parity with face-to-face services.

That announcement triggered questions for many psychologists in the Commonwealth. What other insurance companies provide coverage and at what rates?

When videoconferencing technology first became widely available in the late 1990s, professionals in the mental health field started to ask how they could use this new technology. If you can see someone, gauge their reactions, read body language and provide nearly the same services as in a face-to-face session, would therapy across a video platform be valid?

In the ensuing years, there have been numerous studies done looking at the efficacy of what has become known as telehealth. The practice of diagnosing and treating patients in far-off locals was first embraced by the Department of Veterans Affairs. But, although studies have shown that teleconferencing, if done properly, can offer similar results as face-to-face treatment, there is still a question of insurance reimbursement.

Over the years, coverage for telehealth services have grown, explained Deborah Baker, JD, director for prescriptive authority and regulatory affairs within the American Psychological Association’s Office of Legal & Regulatory Affairs. Close to 30 states and D.C. currently require it.

“It’s a snowball effect,” she said. “Every year, more states pursue this type of coverage mandate.”

Nationally, Medicare reimburses for telehealth but only if the patient visits an approved clinical location for his or her end of the treatment session and if the patient’s location is considered a Health Professional Shortage Area.

“There are strict requirements in terms of who qualifies for coverage under Medicare,” said Jennifer Warkentin, Ph.D., director of professional affairs for the Massachusetts Psychological Association. “The problem with requiring them to go to a clinical setting is when there are mobility issues. It is pretty complicated to get into Medicare.”

There are mandates throughout New England for telehealth coverage although they differ from state to state and none require reimbursement parity, according to Baker.

Maine and Vermont are pretty comprehensive in their coverage, requiring both private insurers and Medicaid to reimburse for telehealth. Rhode Island and Connecticut require coverage for private health insurance but not for Medicaid. New Hampshire and Massachusetts include private insurers and Medicaid but only for the managed care program and not the fee-for-service program.

According to Warkentin, most of the private mental health providers in Massachusetts do offer coverage for telehealth although they differ in either the amounts or what exactly is covered. For instance, BCBS covers diagnostic interviews and individual therapy but does not cover family therapy and pays less for telehealth services than for the same service done in person.

UBH Optum reimburses for telehealth services at the same rate as face-to-face but no longer covers family therapy.

“Previously, they covered all the codes used for therapy but that changed,” said Warkentin.

Beacon offers coverage for a smaller number of members.

“I am not sure when they may expand coverage,” Warkentin said. “Their polices are not clear cut and it often depends on the individual plan.”

Psychologists are encouraged to contact Beacon and all private insurers to check on coverage for each individual patient.

For each plan, there are also restrictions on what type of technology will be accepted. The conversation must be done in real time over a platform that is HIPAA-compliant.

“The provider also needs to take their copay at the time of service,” said Warkentin, “so electronic payment must be set up prior to treatment.”

The costly investment in equipment and the time lost treating on-site clientele can offer a roadblock to telehealth services becoming more widespread, especially where services are reimbursed at a lower rate. The MPA has been working with the state legislature to enact a bill that would require equal reimbursements.

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