CLAREMONT — A state legislative bill aimed to strip reimbursement guarantees to telehealth providers could have an adverse impact on mental health programs and patients, according to local health organizations.

For nearly a year, “telemedicine,” in which health services are administered over the telephone or video-conferencing in place of in-person visits, has been a critical tool for maintaining communication with patients or clients amid the ongoing novel coronavirus pandemic.

Many area mental health care providers, including West Central Behavioral Health, say the technology offers long-term benefits even beyond the ongoing novel coronavirus pandemic, particularly to reach clients in rural areas or are unable to travel.

“Telemedicine is not the panacea to cure mental illness but it is an important tool in our kit,” said Dave Celone, director of development & community relations at West Central Behavioral Health.

Currently state law, under an executive order by Gov. Chris Sununu, requires all insurance companies to reimburse for telehealth services at the same rate as for in-person care. That order was issued on March 18, 2020.

But a new bill, HB 602, looks to undo that rule by permitting insurance companies to choose different or lower reimbursement rates for telehealth services.

The bill’s lead sponsor, Rep. Jess Edwards, an Auburn Republican, says he wishes for “government to get out of the way” and allow the new technological innovation of telemedicine to demonstrate its value via the free market.

“Let’s not forget that both canals and railroads had their day and both were replaced with superior technology and new superior infrastructure,” Edwards wrote in a letter explaining his bill. “Telemedicine as we know it will be radically more vibrant if we let it free.”

In a letter published on Facebook, Edwards acknowledged the rationale to financially support telemedicine initially when the state sought to minimize in-person interaction. However, Edwards asserts that the government determined the reimbursable worth of telemedicine in an emergency rather than the financial analysis conducted by health care professionals.

“How much is that [service] worth?” Edwards writes. “What should the insurance company pay?

I think the honest answer is that we do not have a clue. What I think we know is that the shortest distance between us and that future is with the government out of the way.”

Celone said that the costs to provide counselling or other services via telehealth are nearly the same as in-person. Staffing is the primary cost to administer services. Telehealth still requires having a doctor or clinician present.

Medicaid reimbursements only cover 78% of West Central Behavioral Health’s cost of care, according to Celone, so any decrease to that reimbursement makes the providing of services more challenging.

While larger health care institutions like hospitals have the resources to negotiate reimbursement rates with the insurance companies, smaller companies like West Central Behavioral Health lack that similar leveraging ability, Celone said.

If this legislation succeeds, “the insurance industry is going to have the upper hand,” Celone said. “We will get hurt and our clients will get hurt.”

In a statement published this week, West Central Behavioral Health said that in-person appointments will always remain important but teletherapy will remain an important option for many clients in the future.

“The ability to reach some of our most vulnerable clients — those in rural areas, those without access to transportation, the elderly, disabled, and those without the latest technology — is a boon for improved mental health,” the letter states. “Less travel to appointments can also cut down on the use of fossil fuels and reduce greenhouse gasses, while also allowing our therapists the flexibility to reach communities they’ve had to drive to access.”

Teletherapy has also proven an effective tool to reach clients who are isolating, including who struggled with isolation prior to the pandemic, and as an alternative way to meet during winter storms, Celone added.

Currently, 38% of West Central Behavioral Health’s clients are using telehealth to access counseling and services, according to Celone. About half of those clients use telephone rather than video technology to meet.

Celone said that counselling via video technology works more effectively with adult clients than with children. When working with children, it is often important to observe a child’s body language during the process, which can be challenging over video. Additionally, parents or guardians are frequently involved in the counselling sessions, so having multiple windows on screen or multiple people sharing one camera is less than ideal.

HB 602 is currently under review in the Health, Human Services and Elderly Affairs Committee with a final hearing scheduled for March 8. The committee will determine whether to approve the bill for consideration by the full assembly or to let the bill die.

Initially the bill sought to eliminate reimbursement eligibility for telemedicine services administered by telephone but that language was amended following objections by many across the New Hampshire health care industry.

Edwards may be reached at (603) 370-7885 or by email at jess.edwards@leg.state.nh.us.

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