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Hawai'i Chapter

Urge the Veto of HB1980 CD1 - It Favors Insurers by RESTRICTING Telehealth & Access to Telephonic Mental Health Services

Please ask Gov. Ige to VETO HB1980 CD1

This is a MENTAL HEALTH ACCESS Issue.  

Rather than expanding access to much needed mental health services, as it 'purports' to do, HB1980 CD1 actually restricts access - especially to vulnerable residents (rural, low-income, Kupuna, limited English proficient, ethnic minorities) who have difficulty affording and using the high-tech audio-visual equipment and bandwidth required for "Telehealth."  

HB1980 CD1 puts hurdles in front of patients' access by imposing these new restrictions on insurance reimbursements that did not exist before, requiring that:  (1) telehealth technologies must be "unavailable" at the scheduled time; (2) treatment be a "covered" health care service; and (3) patients meet in-person with the mental health professional within a year before they can use the phone - significant barriers for disabled, elderly, rural, and neighbor-island patients.  

The requirement that the telephonic treatment be a “covered service” may delay all telephonic treatment  (not just behavioral health) until new insurance codes are issued - which may take at least 6 months, through which insurers will be authorized to reimburse at whatever rate they want.

To be clear, HB1980 CD1 does not give any authority to insurers to offer reimbursement for telephonic treatment that did not exist before. Rather, it creates a new authority with unreasonable and unnecessary conditions.  HB1980 puts all private health insurers on equal footing; with their feet on the necks of vulnerable patients.

Here at this link is Kaiser explaining at the first hearing on HB1980 how they have been providing insurance reimbursement for telephonic health care before, during, and in the waning days of the pandemic - without being bound to the restrictions outlined in HB1980.  Now, if HB1980 CD1 becomes law, all insurance companies will be required - BY LAW - to impose these restrictions on patients, where none existed before.  

Even Hawaii's Insurance Commissioner explained, on page 1 of his testimony on HB1980 HD1:  "[We] point out that our State insurance laws do not currently prohibit health plans from voluntarily providing coverage for health services delivered via standard telephone contacts."

Moreover, the Federal Department of Health and Human Services Office of Health Policy issued a clear, comprehensive policy brief, entitled "National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services"  analyzing the significant research and data collected during the pandemic, recognizing the "disparities in audio- only vs. video- enabled telehealth modalities by race/ethnicity, age, education, income, and health insurance coverage. . . [and] barriers for older adults, lower income households, and those with limited English proficiency.”  This research was influential in the Centers for Medicare and Medicaid Services decision to adopt language that included audio-only behavioral health care as a reimbursable "telehealth" expense if the "patient is not capable of, or does not consent to the technology" required for Audio-Visual Telehealth access.  (The Senate amended HB1980 to do the same as the feds; but the House presented their proposed CD1 during the conference committee period, which the Senate agreed to - taking the draft back to near original form.)

Accordingly, beneficiaries of our taxpayer-funded public health plans receive better mental health coverage than can ever be allowed under a private health plan provided by a Hawaii Insurance if HB1980 CD1 becomes law.

IF IT'S GOOD ENOUGH FOR MEDICARE - IT SHOULD BE GOOD ENOUGH FOR PRIVATE HEALTH INSURANCE

 

MORE CONSIDERATIONS:

If this CD1 becomes law:

  • The disabled and rural residents will face further barriers to achieving the 'in-person' meeting requirement.
  • If a patient has a smartphone or computer and broadband access, they MUST use Zoom-like software, even if they prefer not to.
  • If a patient had always connected via zoom - as many do (and necessarily have) through pandemic, and that zoom connection drops, then the law requires that you can’t use the phone because you never saw the provider "in-person" first.
  • Suicidal patients who need to talk to their provider - if not scheduled and not via zoom-like technology, this life-saving call is NOT covered.
  • Someone with a disability and depression and who can’t manually use technology (ie Parkinsons Disease) needs to physically travel to their provider’s office first. Even worse if they don’t have someone who can take them; even worse if they live in rural area.
  • There are no connection speed thresholds outlined in this bill.  So if your connection is really poor, spotty, and freezing (typical in rural areas) - patients are still responsible for paying for the full hour, though perhaps only a fraction of that time was spent on treatment.
  • Exclusively remote therapy practices, with well-established patients who live on other islands, will lose all their telephone patients because they won’t ever be likely to meet them “in person” - threatening to put many effective practices out of business - when demand is so great.

 

BACKGROUND:

To learn more about this issue, please view the press conference (below) held by several organizations when the CD1 was passed.

During the Pandemic and to comply with social distancing protocols, Governor Ige issued emergency orders to allow healthcare over the telephone to qualify as "Telehealth" - a bridge to so many patients cut off from services by the digital divide.   Those orders expired in August 2021, but it became clear just how effective telephonic health care can be - so several legislative proposals were introduced during the 2021 and 2022 legislative sessions to make Telephonic Telehealth permanent.

None of those proposals have survived.  However, two bills in 2022 showed promise in at least creating a carve-out for mental health treatment:  SB2645 SD2, retained the approach in Ige's Emergency Order to allow behavioral health services to qualify as "telehealth"; and HB1980, which emphasized that telephonic treatment was NOT telehealth, and imposed unnecessary burdens on patients.  

The Senate amended HB1980 in logical and effective ways to prioritize needs of patients, so it harmonized with the Centers for Medicare and Medicaid Services (CMS) reimbursement schedule that defined "interactive telecommunications system" as including landline telephone treatment for: "services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home . . .  if the distant site physician or practitioner is technically able to use an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology; and provided further that the term shall have the same meaning as the term is defined in title 42, Code of Federal Regulations section 410.78, as amended."

Several organizations issued this letter to legislators on April 29, 2022 - the day after the conference committee voted on a CD1 offered by the HHH chair - urging them to recommit the bill and pass out the SD2.  Unfortunately, the CD1 passed both houses, with legislators being unaware of the harmful changes made during conference; and is now enrolled with the Governor.  If signed, many people will be harmed.  Please urge Governor Ige to veto this bill.

Aloha~

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