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Reimbursement Barriers Still Plague Telemental Health Expansion

An updated survey of state telehealth laws by Epstein, Becker & Green finds that telemental health is growing to meet the needs of students, seniors and veterans, but payers still aren't supporting connected health services.

Source: ThinkStock

By Eric Wicklund

- Federal and state efforts to boost telemental health may be blossoming – in particular for students, seniors and veterans – but “a lack of meaningful coverage and reimbursement rules” means the telemedicine specialty is still struggling for sustainability.

That’s the opinion of national law firm Epstein Becker & Green in their 2018 Telemental Health Laws survey, an update of the firm’s landmark 2016 report on state telehealth laws, regulations, and policies for mental and behavioral health.

“Telehealth is a proactive solution for patients who need quality care from health care providers who may not be located close by or require real-time or after-hours care,” Amy Lerman, a member of the law firm’s Health Care and Life Sciences practice, said in a press release accompanying the survey. “As access to this method of care expands, it also opens the door for various subsets of medicine, including behavioral and telemental health. We are excited to find that it is still evolving, growing, and improving Americans’ quality of life, and we will continue to keep a pulse on the industry to ensure that we capitalize on telehealth opportunities while maintaining compliance with applicable laws.”

And while the law firm’s cadre of telehealth experts finds a lot to like in new connected health programs and policies, they still see significant barriers in how these programs are supported.

“Despite Medicaid’s fewer restrictions on telehealth coverage as compared to its Medicare counterpart, there is limited federal guidance or information regarding the implementation of telehealth services in state Medicaid programs or coverage parameters for states choosing to offer such services,” the attorneys noted in the press rlease. “Healthcare practitioners who treat Medicaid populations are at risk for steep penalties for noncompliance, including fines and the potential loss of their professional licenses.”

Likewise, the attorneys noted that third-party payers are across the board on what they cover, leaving healthcare providers struggling to figure out what they can provide. They cite a recent report from the Medicare Payment Advisory Commission (MedPAC), which indicates “most commercial health plans have had little incentive to offer telehealth services because there has been scant evidence of reduced costs or improved outcomes associated with telehealth services.”

Putting the gloominess aside, Lerman and fellow EB&G attorneys Daniel KimFrancesca Ozinal and James Tam say the future remains bright for telemental health, in particular because so many people need it.

“(P)ublic recognition of the benefits of utilizing telehealth technology to provide greater access to healthcare services has significantly increased,” they pointed out in an overview of the report. “While the shortage of behavioral health providers has long been acknowledged, the growing use of telehealth technologies as a strategy to increase access to psychiatrists, psychologists, counselors, therapists and other behavioral health professionals continues to gain attention and validation as an alternative model of care delivery.”

Over the past year, the report identified three drivers for increased access to telehealth and telemedicine services: the Bipartisan Budget Act of 2018, which expanded Medicare coverage for certain telehealth services to beneficiaries who are being treated by practitioners participating in accountable care organizations; the Centers for Medicare & Medicaid Services, which has begun encouraging states to integrate telemental health into their Medicaid plans; and the ongoing opioid abuse epidemic, which is spurring legislators and healthcare providers to be creative in adapting connected care platforms to support substance abuse treatment.

Beyond those drivers, Lerman and her colleagues identified three areas in which telehealth and telemedicine are expanding to meet increased: pediatric and school-based healthcare, the aging-in-place population, and the Department of Veterans Affairs, which over the past year has launched an ‘Anywhere to Anywhere VA Health Care” program that includes online scheduling, mHealth-based services and a new framework that allows VA-sanctioned healthcare providers to treat veterans via telehealth no matter where either are located.

“Overall, interest in, and acceptance of, telehealth services continues to increase,” the report concludes. “Current events and issues, such as the opioid epidemic, have put more pressure than ever before on federal and state legislators to pass laws that promote access to telehealth services. Providers should continue to monitor developments in federal and state laws, regulations, and policies in order to capitalize on telehealth opportunities while maintaining compliance with applicable laws.”

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