Psychiatrists Advocate for Expanded State Telehealth Laws
Abstract
APA and its district branches across the country have been advocating to ensure broadened telehealth laws and reimbursement parity at the state level.
Soon after the start of the COVID-19 pandemic, many governors issued executive orders that relaxed telehealth regulations and improved insurance coverage. Yet many of these orders were only temporary, and now APA and its members are working vigorously to encourage states to make the changes permanent and ensure patients continue to have access to care.
In late June, APA and 11 partner organizations issued letters to governors and insurance commissioners, urging them to support legislation and regulations that would “require the broad coverage and payment of telemedicine even after the pandemic ends.”
The letter continues, “While telemedicine cannot replace all patient care, the extension of telemedicine benefits in recent months has rapidly changed the way we see patients and has provided a push for innovation that has allowed us to safely increase access to high-quality care. Even after COVID-19 is no longer considered a health concern when traveling to a doctor’s office, many patients will still want to use telemedicine.”
Similarly, district branches in numerous states have been hard at work to share their experiences of telemedicine with policymakers and encourage them to make the broadened telehealth access permanent. Already some states, including Colorado and Michigan, have passed legislation that ensures psychiatrists are reimbursed at the same rate for virtual and in-person visits. Other states have extended their temporary expansions until the end of the year.
“Continuing to provide access to mental health care beyond the original limited time imposed at the beginning of the pandemic is going to be immensely beneficial to patients,” says Patricia Westmoreland, M.D.
“Unfortunately, I don’t believe we’re anywhere near seeing the end of the suffering that people are experiencing due to the pandemic,” said Patricia Westmoreland, M.D., immediate past president of the Colorado Psychiatric Society (CPS).
In Oregon, the Department of Business and Consumer Services (DBCS) announced in March that insurance plans would provide more services to patients through telehealth and expand access for the duration of the pandemic, but the expansion did not apply to reimbursement parity for commercial payers, explained Katy King, government relations director for the Oregon Psychiatric Physicians Association (OPPA). The Oregon Health Authority directed the state’s Medicaid plans to reimburse physicians for telehealth services on par with in-person visits for their members.
OPPA sent a letter to DBCS urging it to extend telemedicine reimbursement parity, and in late June the governor’s office negotiated an agreement with several insurance companies to provide expanded telehealth options and provide parity until the end of 2020.
CPS also advocated for legislation to make expanded access to telepsychiatry permanent. SB20-212 was signed into law on July 6, and among its provisions, it prohibits insurers from requiring patients to have a relationship with a clinician before receiving telehealth services or from imposing additional requirements on clinicians as a condition for telehealth reimbursement.
Trump Orders Extension of Telehealth Flexibilities Beyond Pandemic
President Donald Trump has ordered the Department of Health and Human Services (HHS) to permanently extend some of the relaxed telehealth regulations implemented during the COVID-19 public health emergency.
In his August 3 executive order, Trump called on HHS to review parts of the temporary Medicare telehealth measures and, within 60 days, propose a rule to extend those measures beyond the pandemic.
According to an HHS press release, before the pandemic only 14,000 Medicare beneficiaries received virtual services each week. “By the last week of April, that number had jumped to almost 1.7 million,” the release stated.
By early September, HHS is also required to develop a new payment model for rural hospitals to give them greater flexibilities from existing Medicare rules and to work with the Federal Communications Commission and the Department of Agriculture to improve access to telehealth in rural areas.
“People are going to need expanded access to care because of the pandemic for the foreseeable future, and for many patients providing access to care is tantamount to keeping them out of the hospital,” Westmoreland said.
APA is developing state telehealth model legislation to increase access to care and ensure reimbursement parity with in-person visits, and it is already prepared to work with district branches and members interested in advocating in their own states, said Erin Berry Philp, APA’s director of state government relations.
The Massachusetts Psychiatric Society (MPS) conducted a survey on telehealth use from March through early June and found that, generally, its members have had a positive experience with telepsychiatry.
Of the 250 respondents, 87% reported that they were satisfied or somewhat satisfied with telehealth, and 80% said they were seeing patients for whom telehealth was the only treatment option during the pandemic.
Additionally, 85% of respondents indicated they would like to continue to use telehealth after the COVID-19 public health emergency ends but were concerned about future barriers; among them were lack of payment parity and the loss of flexibility regarding the platforms that can be used (such as limitations on audio-only care).
Psychiatrists should consider advocating for the continuation of expanded access to telehealth in their own states, Westmoreland said.
“Getting involved at the local level, where you’re actually physically present and know the legislators, makes a huge difference,” she said. “Very often, once you achieve something in one state, other states tend to follow because people can see the benefits, and eventually the federal government may follow as well.” ■
APA members interested in learning more about advocacy can contact Erin Berry Philp, director of state government relations in APA’s Department of Government Relations, at [email protected] and visit APA’s Advocacy Center here.
