The COVID19 pandemic has forced the federal government and states to lift barriers to telehealth so patients can get care leaving home. Insurance carriers have also expanded coverage for care delivered by phone or virtually to reduce the potential risk of community exposure to the coronavirus.
“It’s like a totally different landscape and we’re still getting updates from the health plans so things are still changing on a day to day basis,” said Jennifer Warkentin, Ph.D., director of professional affairs for the Massachusetts Psychological Association (MPA).
Many insurers, including all 36 independently-operated Blue Cross and Blue Shield (BCBS) companies, Aetna, Cigna, and Tufts Health Plan, have waived cost sharing for telehealth services for their members.
Warkentin said she was getting 200 emails a day from MPA members in the days after the pandemic and ensuing state of emergency declarations were declared in mid-March. Many members had operational questions about getting set up with technology and addressing privacy concerns. The number of emails had decreased to between 50 and 75 per day by the first week in April, with most inquiries about insurance and licensure issues.
Telehealth Visits Will Be Paid at Same Rate
On March 6, President Donald Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, which temporarily removes a restriction that previously only paid for telehealth for Medicare beneficiaries living in rural communities or when they left their homes to go to a clinic or hospital. Telehealth visits now will be paid at the same rate as regular, in-person visits.
However, Medicare will only cover telehealth services that have a video component. Telephone only sessions are not yet covered.
The Centers for Medicare and Medicaid Services (CMS) has temporarily waived potential penalties for Health Insurance Portability and Accountability Act (HIPAA) violations for providers who use telehealth to treat patients during this crisis. Skype, FaceTime and other previously noncompliant telehealth platforms are now considered acceptable options to provide care for Medicare patients.
Temporary Mechanisms Created
CMS also waived reimbursement restrictions on practicing across state lines, although state licensure requirements still apply. Many states created temporary mechanisms for out-of-state health care professionals, including psychologists, to practice through the duration of the crisis. Among New England states:
● Vermont permits out-of-state providers to care for people in Vermont during the state of emergency without having to obtain a license in the state.
● New Hampshire allow out-of-state providers to apply for a temporary license that will remain in effect for the duration of the state of emergency.
● Rhode Island is granting temporary 90-day licenses to out-of-state licensed providers who can renew one time at no cost.
● Maine will issue a temporary license for psychologists to provide care up until 60 days after the state of emergency ends
● Connecticut allows out-of-state psychologists to practice without obtaining a Connecticut license for up to 60 days.
● Massachusetts allows out-of-state mental health practitioners, including psychologists, to apply for a temporary license to practice in Massachusetts during the state of emergency.
Gov. Charlie Baker had first issued a March 17 executive order allowing Massachusetts psychologists, social workers, medical doctors and nurses to provide telehealth services to students attending Massachusetts colleges or universities who returned home out of state.
“The licensure laws were designed to be a patchwork,” Warkentin said. “Each state gets to make its own determination for what you have to do to get licensed and what people outside the state are allowed to do.”
States Rise to Challenge
The rise of telehealth has shown how complicated that patchwork system can be. But states have risen to the challenge with rapid regulatory changes needed to ensure people can get the care they need during a pandemic.
Peter Oppenheimer, Ph.D., chair of the Rhode Island Psychological Association’s Legislative Committee, praised Gov. Gina Raimondo for being among the early state leaders updating telehealth policies to include telephone-only services. Prior to the pandemic, all insurers required telehealth to be conducted by video conference despite the fact that some people don’t have internet access or the technology or expertise to use it.
“Being able to connect to people by phone has reduced the barriers and helped us to engage more people quickly,” Oppenheimer wrote in an email. “This is a real health disparity issue.”
For years, federal regulators and lawmakers have resisted pressure to expand coverage for telehealth services, citing concerns about costs and the quality of care delivered. That’s even though research has shown that telehealth can be just as effective as in-person treatment when done appropriately.
But the silver lining of a pandemic that has mandated social distancing and made office risks too risky may be that regulators have seen the light when it comes to telehealth.
“I do think that telehealth is going to be expanded after this is all over,” Warkentin said. “It’s kind of like once the genie is out of the bottle it’s hard it put it back in.”