TOPEKA — Members of a panel focused on telemedicine in the mental health arena are considering a study to outline costs to provide remote care to clarify and promote payment parity.
During the COVID-19 pandemic, the need for remote care became clear to many health care providers. This led to many temporary, pandemic-contingent actions to expand services. Efforts to have many of these enacted in permanent legislation fell short this past legislative session.
Now, members of a subcommittee of the 2021 Special Committee on Mental Health Modernization and Reform are focusing on several incomplete recommendations a similar committee proposed last year. A pivotal area of focus for mental health advocates is ensuring rate parity between in-person and remote services.
While no formal bill was filed to ensure payment parity, the issue was discussed. The issue did not go further amid disputes between providers and insurers, the latter of whom questioned the fiscal impact of such a move. Shawna Wright, associate director of the University of Kansas Center for Telemedicine & Telehealth, suggested a study of what expenses are involved in telehealth and what makes it more or less expensive.
“There are so many costs that I think that we need to research, and be fair with telehealth not to incentivize the use of telehealth and also not to de-incentivize the use of telehealth,” Wright said. “We haven’t really studied those cost elements to figure out how to make it a viable option here in Kansas without trying to tip the scales one way or the other.”
At the onset of this public health emergency, Gov. Laura Kelly issued an executive order significantly expanding access to telemedicine services, including expanded reimbursement and payment parity for some services through Medicaid. Private health insurers temporarily enacted improved payment parity for telehealth.
It is expected that after the pandemic, telehealth services will once again be reimbursed at lower rates than in-person services. Advocates hope the 2022 legislative session will bring meaningful action on the topic for the first time since 2018, when lawmakers passed the Kansas Telemedicine Act.
According to a poll conducted earlier this year by the United Methodist Health Ministry Fund and REACH Healthcare Foundation, about 86% of Kansans supported expanding or maintaining telehealth access post-pandemic. Nearly half said they had used telehealth, compared with just 11% of people nationwide who used these services before COVID-19.
Another survey through the fund and the University of Kansas Medical Center showed reimbursement before the pandemic did not cover costs for 60% of providers surveyed.
Members of the panel had different ideas for the study, including adding it to a list of recommendations for the Legislature or reviewing what other states have done. Rep. Brenda Landwehr questioned what sort of study the committee would be asking of the Legislature.
“If you just say study, what does that mean?” the Wichita Republican and chairwoman of the panel asked. “What are the details on that? What would we look for? Who would be the right people to do that?”
Efforts in past years at the Capitol have resulted in coverage parity — a requirement that the same services be covered via telehealth as would be covered if delivered in-person — but payment parity fizzled partly because health insurers opposed such measures. They said the effects of this sort of parity on the health insurance market would not be positive.
Instead, health insurance lobbyists argued rate negotiations should be left between insurer and provider.
Some panelists recommended a broader study showing the benefits that could be created through payment parity and emphasizing the social and emotional benefits.
“Some sort of comparison analysis that could be provided to psychology providers and help them determine in which cases would telehealth be preferable to that patient,” said Brittany Nichols, EMSC coordinator for KDHE. “Something looking at all aspects, not just the patient disposition but also the financial impact and maybe some community factors might make it really easy for providers and patients both to kind of understand what care to choose and why it’s being chosen.”
