Telemedicine now covered by N.H. Medicaid for primary care visits, substance use disorder

  • A telemedicine kiosk is outfitted with touchscreens, medical screening devices and videoconferencing capabilities in the lobby of Palm Beach County School District's administrative building in West Palm Beach, Fla. The private, 8-by-7 enclosure enables Nicklaus Children's Hospital medical providers in Miami to see and treat adults and children in West Palm Beach. (Phil Galewitz/KHN/TNS) Phil Galewitz

  • Gov. Chris Sununu signs a bill allowing for Medicaid coverage of telemedicine at the Health First Family Care Center in Franklin, Aug. 13, 2019. Ethan DeWitt—Courtesy

Monitor staff
Published: 8/13/2019 5:37:30 PM

The technology continues to improve. But for years, telemedicine has been out of reach for many – costly, sparse and often not covered by insurance.

That may change soon, with a new law to expand telemedicine for low-income Granite Staters. Following the signing of a bill this week by Gov. Chris Sununu, New Hampshire’s Medicaid program will soon cover the use of the technology for primary care visits, substance-use treatment and more.

Senate Bill 258 lifts a barrier that many say has limited the expansion of telemedicine, which involves using cameras, screens and other internet technology to diagnose, interact with or monitor a patient from afar.

The new law, which takes effect in October, will allow practices that provide telemedicine to get reimbursed for those services for Medicaid patients. And it will add telemedicine as a required benefit to private insurance plans, significantly expanding its reach.

“Today is yet another opportunity to expand access to care that targets those in our rural areas and those with mobility challenges,” Sununu said at a signing ceremony in Franklin.

The bill came out of a study commission last year that sought to address problems of a dwindling health care workforce and rising need for behavioral health, mental health, home and primary care – particularly for those in rural areas.

Providing a telemedicine link will allow counseling and therapy sessions to be done from afar, stakeholders say. It could help monitor those with home health needs, and allow for better-integrated health care for those far from hospitals and clinics.

For Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association, the new payment models opened by the law will help the state keep pace with the technology.

When telehealth technology came out, it was unclear how to reimburse, monitor, code for services, that sort of thing,” he said. “This kind of legislation I think sort of forces the issue more and hopefully will create a bigger avenue for uses of tech to help people access care.”

And for mental health professionals, Lamy continued, the bill would allow agility.

“Providers can still operate within the scope of their license, and get additional services reimbursed that maybe weren’t before.”

The technology could especially help with home health care, where low Medicaid provider rates has meant that salaries are often comparable to fast-food jobs, and workers are scarce.

Amid often long waitlists for in-home care, telemedicine could help certain patients with chronic diseases like congestive heart failure and chronic obstructive pulmonary disease, said Gina Balkus, CEO of the Home Care, Hospice and Palliative Care Alliance.

“It’s for patients who would mostly likely, if their condition is not well managed, would end up back in the ER, so this saves trips to the ER and helps manage people at home,” Balkus said Tuesday.

Previously, if that remote patient monitoring was being done, it wasn’t getting paid for. The new law would change that.

Lamy and others have pointed to telemedicine as the “way of the future” – for the state and the country. Combine an aging population with a falling health care workforce and a burgeoning technology sector, and the method appears obvious, they argue.

But prior to the new law, the use of the technology was relatively low. Even though New Hampshire allowed Medicaid billing for medical specialists, only 1% of Medicaid reimbursements comprised telemedicine services, according to Sen. Jay Kahn of Keene, the prime sponsor of the legislation.

Now, Kahn said he hopes the services can be used everywhere. Telemedicine is already used in some New Hampshire schools, allowing nursing staff to link in a student’s pediatrician and parents via the same system. Those services can be expanded and paid for with Medicaid coverage, Kahn said.

“We think of it as this is going to help rural health care,” he said. “But here are examples where it has uses well beyond (that).”

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