- Utah lawmakers are grappling with proposed legislation that would require insurers to cover telemental health consults.
HB 139, sponsored by Rep. Steve Eliason (R.-Sandy), would mandate that the state’s Medicaid program and private insurers reimburse providers for “telepsychiatric consultations” with a board-certified psychiatrist, either via video-conference or a store-and-forward platform.
"It actually increases our capacity because someone who does in-patient counseling for a living … can easily fit (the consultation) in," Sandy told the House Health and Human Services Committee this past week, according to the Deseret News. He noted the state ranks 42nd in psychiatrists per capita, with residents struggling to find a mental health professional and those in the profession struggling to balance workflows and business needs.
“The crux of the matter is, do we as a society believe this is worth paying for?” he asked.
The bill faces some opposition from insurers, who – in a familiar refrain heard in other states – question whether mandating reimbursement parity would increase costs, boost premiums and negatively affect the entire state.
“Anytime there’s a mandate … there’s a potential those costs are going to be borne … by the citizens of the state of Utah,” Kelly Atkinson, executive director of the Utah Health Insurance Association, told the committee.
Mark Hiatt, executive medical director for Regence BlueCross BlueShield of Utah, also raised concerns, saying the bill might flood the market with out-of-network telepsychiatry services.
The back-and-forth between payers and healthcare providers over telemedicine reimbursement isn’t new. According to the American Telemedicine Association, at least 33 states and the District of Columbia have some sort of payment parity law on the books, requiring that telehealth visits be reimbursed at the same rate as in-person visits.
In states like Massachusetts, health plans have successfully fought against such legislation.
"It's mostly a vehicle for making sure that people who want to do telemedicine on whatever terms they make up and charge what they want will get away with it," Jim Kessler, general counsel for Springfield, Mass.-based Health New England said in 2016, when efforts to legislate payment parity failed to pass. "If you mandate certain services and reimbursements, you're taking away the whole negotiating ability of health insurers to benefit consumers."
That hasn’t stopped healthcare providers or telehealth advocates from trying. At an August 2017 roundtable, several Bay State providers – including those in the behavioral health field – once again urged legislators to support parity.
"On the one hand, we have the technology, but we don't have the payment and regulatory support to do that," Karin Jeffers, who heads the six-clinic Clinical & Support Options in western Massachusetts and serves on the board of the Association for Behavioral Health, told the gathering, as reported by the Worcester Business Journal.
Last October, payers in Kansas also fought back against proposed parity legislation.
“Telemedicine services are not equivalent to in-person services and, therefore, should not receive parity to in-person services in reimbursements,” Coni Fries, of Blue Cross Blue Shield of Kansas City, said during a Kansas Legislature committee meeting in October. “Primary care physicians are paid at a higher rate because we expect them to manage our members’ care throughout the year. On the contrary, telemedicine appointments might be one-time engagements.”
Last year, a Center for Connected Health Policy study found that only three states – Minnesota, Delaware and Hawaii – have an explicit mandate for payment parity.
“Therefore, in 28 states and the District of Columbia, commercial health plans are only required to cover a telehealth-delivered service if the service is covered if delivered in person, but are not legally required to reimburse at the same rate as is paid for in-person delivered services,” the report found. “This gives private payers the flexibility to set lower or higher rates of reimbursement for telehealth-delivered services.”
“This study makes clear there is broad misconception that because private payer laws are in place in many states around the country, telehealth is achieving its promise of parity of benefits and payment with in-person care,” the report concluded. “The reality is that lack of clarity and clauses that impede the expansion of telehealth-delivered services weaken many of these laws.”
The challenge lies in creating legislation that will prompt payers to support telemedicine and telehealth without forcing them to. In Utah, supporters of HB 139 – including the Utah Medical Association, Utah Academy of Family Physicians and YWCA Utah – say the lack of access to on-demand mental health resources puts residents’ health at risk.
“(T)here’s a mental health (services) shortage in Utah,” Michelle McOmber, the UMA’s CEO, said during the committee meeting. “We don’t have enough providers in the state of Utah. That’s part of the problem. We need to get as much access as we can.”
Per Eliason’s request, the committee delayed a vote on HB 139 so that he could make a few changes. Whether they’ll gain the support of the payer community remains to be seen.