Telehealth coverage expands in Massachusetts

Blue Cross Blue Shield of Massachusetts was expected to notify its provider network on May 15 of its plans to expand telehealth coverage starting this summer.

On Jan. 1, the largest private health plan in Massachusetts started covering diagnostic evaluations and psychotherapy for 30 minutes or less conducted by videoconferencing. But as of July 1, BCBSMA will expand from two Current Procedural Terminology codes to seven for covering diagnostic evaluations and 30, 45, and 60 minute sessions of psychotherapy with patients and/or family members and such psychotherapy sessions when performed with an evaluation and management service.

The telehealth coverage announcement followed advocacy efforts by the Massachusetts Psychological Association to improve telehealth services in hopes of achieving reimbursement parity with face-to-face services. However, BCBSMA’s expansion of coverage stops short of that goal and would reimburse psychotherapy codes by videoconferencing at a lower rate than in-person.

MPA, which represents about 1,600 psychologists in Massachusetts, informed its membership of BCBSMA’s pending telehealth expansion in a spring email announcement co-signed by Executive Director Brian Doherty and MPA Director of Professional Affairs Michael Goldberg, Ph.D. They called the expansion “a significant improvement” from the initial two codes covered.

“We are encouraged by this imminent change in policy,” they added.

Their statement continued: “While we are pleased to report this successful outcome as an incremental improvement on the current BCBSMA policy, the fact that the practice expense formulas have not yet been revised is a fundamental flaw in their rate-setting process for telehealth.”

In an emailed statement to New England Psychologist, BCBSMA corporate communications spokesperson responded:

“We continuously evaluate and evolve our practices, offerings and benefits based on many factors, including dialogue with providers and customers or feedback from members. Often feedback we receive from various channels weighs into our programmatic decisions. On a regular basis, we seek and consider input from provider networks, advocacy groups, professional societies and others. MPA is one of the many groups we are in regular communication with about our policies.”

Massachusetts does not mandate parity coverage for telehealth services despite a number of bills introduced in 2015 to achieve parity under private insurance, Medicaidand state employee plans. Several telehealth bills are pending at the Statehouse. They include SB 617, sponsored by Sen. Mark C. Montigny (D-New Bedford), and HB 267, sponsored by Rep. John W. Scibak, (D-South Hadley), which both seek to make telehealth coverage consistent with services provided in-person.

Goldberg testified in support of both bills on behalf of the MPA last October. BCBSMA opposes HB 267 but has taken no position on SB 617. The insurer’s spokesperson stated:

“Along with increased access, telemedicine has the potential to produce significant improvement in efficiency in the way services are delivered. That efficiency should translate into reduced unit cost for the consumer. As such, reimbursement rates should reflect both the services that are provided, and their underlying costs. However, HB 267 would require that telemedicine services be reimbursed at the same rate as in-person services provided in a doctor’s office, regardless of the difference in overhead or other efficiencies realized through the use of this exciting new technology.”

In a recent MPA member survey, 29 percent of respondents answered “very concerned” and 25 percent answered “concerned” when asked how they felt about telehealth services delivery in the next three to five years. While many psychologists do not currently provide telehealth services, the number is expected to increase dramatically by 2021, the association stated.

As of late 2015, 29 states plus the District of Columbia had enacted mandates prohibiting private health insurers from refusing to cover services delivered via telehealth solely on the basis that those services were not provided through an in-person consultation.

But there is variability across state mandates, according to Deborah Baker, JD, director for prescriptive authority and regulatory affairs within the American Psychological Association’s Office of Legal & Regulatory Affairs. Some states allow private insurers to limit coverage to services delivered by in-network providers. Louisiana appears to limit coverage to physician services only while Arizona’s statute limits coverage to rural areas.