In July of 2020, New Hampshire Governor Chris Sununu signed a bill into law that required insurance companies to cover telemedicine at equal rates to in-person treatment.
The move was lauded by both health care and mental health care professionals as a positive step toward expanding services, especially in remote areas where access may be more limited.
This year, one of that bill’s original sponsors, Jess Edwards (R-Rockingham 4), joined forces with two other Republican representatives to sponsor a bill that will remove the parity and audio-only pieces of the 2020 law.
“This past summer, the Senate inserted a provision into an omnibus bill that mandated that private payers must pay a reimbursement for telemedicine equal to an in-person clinic,” Edwards said.
“This provision did not get a public hearing in the House. As a consequence, a couple of significant principles were violated. One, state government failed to act in a transparent way and as a result, denied the public an opportunity to comment. Secondly, the state government interfered with the private relationships between health insurers and providers to negotiate with one another.”
The goal in removing the ability for insurance to cover audio-only services, he explained, is to take the state “out of the business of choosing the appropriate technology to support remote clinical interaction.
A telephone call may work great for a psychiatrist doing medication management. A telephone call is probably not the right way to deal with trauma. I think clinicians from academia and practice need to work through all the nuances between clinical practice and selecting the appropriate technology, “he said.
Still, the 2020 law brought the state “into a much better place,” he said. “Medicaid had previously not been allowed to reimburse for telemedicine. Commercial insurance had been paying for telemedicine, albeit at a rate typically lower than in-person care.”
In written testimony on the topic, Edwards argued for the need to leave it to a free market to decide on the path technology will take and to avoid directing it with too much governmental oversight and regulation.
“The reality is that we live in a nation of mixed economy with resources controlled by both private and public sectors,” he said in a Facebook post. “One of our key roles as legislators is to consider when government should lead and when private choice and investment can yield a superior result.”
Opponents to the new bill include both medical and mental health care providers. In a letter to the editor in the Valley News, administrators at West Valley Behavioral Health, a non-profit community mental health care provider in Lebanon, NH, said that by removing the audio-only option, those without ability to access the Internet or have the equipment or technological ability to use audio/video options are being left behind.
“And who are the people among us who do not have Internet access or the technology or technical knowledge to do video appointments?” the letter reads. “This bill is clearly biased against our most elderly, most poor, most limited and most rural citizens.”
As to the argument that the market should have the freedom to decide reimbursement rates, the option for negotiating rates is limited for smaller practices. According to Julie Wolter, Psy.D, chair of the New Hampshire Psychological Association advocacy committee, a 2020 workforce survey showed that 61 percent of respondents work in small to medium-sized practices.
“There are antitrust laws that don’t allow small to medium practices to come together to negotiate contracts,” she explained. “So, there are hindrances to access the free market for those businesses. You are just given a contract with very little room to negotiate.”
By reducing the requirement for parity in paying for in-person and remote services, the decision would be left in the hands of the insurance industry, which historically has resisted paying for telemedicine, said Roger W. Osmun, Ph.D., president and CEO of West Central Behavioral Health.
“That was the same argument used in behavioral health 10-15 years ago, let insurance companies determine the value of behavioral health,” he said. “The free market will say we are going to value mental health substantially less. The free market sometimes needs a little nudge.”
Creating greater access and supporting newer technologies financially may be key to a healthy economy for everyone, Wolter said.
“As scientists we applaud innovation,” she said. “Imagine the impressive innovations we could have with a healthy workforce? Mental health treatment, which is grounded in the therapeutic relationship for success, is about the here and now for future innovation and improved productivity.”