Telehealth guidance by state during COVID-19

State emergency orders relevant to licensed psychologists during the COVID-19 public health crisis.

Delaware

Status as of April 24, 2020

Existing state telehealth coverage mandate? 

YES for commercial health plans; requires reimbursement parity; and allows audio-only phone

Del. Code Title 18, Ch. 33

Emergency state action on telehealth reimbursement parity? 

CMS Section 1135 Medicaid Waiver approved 3/27/20 allows for reimbursement of payable claims by out of state licensed providers not enrolled in the state Medicaid program subject to certain conditions for the duration of the public health emergency.**

Emergency licensure waiver? 

A joint order issued 3/24/20 by the Department of Health and Human Services and Emergency Management Agency allows out-of-state mental health providers with an active license to provide in-person and telemedicine mental health services. Further, all mental health providers who held a Delaware license within the last 5 years which is now inactive, expired or lapsed may provide services.

Online registration form is available.

Supervised Trainee Telehealth Services – Telesupervision and Medicaid Reimbursement 

Trainees are not eligible to provide telehealth services as they are not licensed in Delaware (and those performing services from other jurisdictions are required to have an active license elsewhere). Postdoctoral students licensed as Psychology Assistants would be eligible to perform services.

For more information by state: https://www.apaservices.org/practice/clinic/covid-19-telehealth-state-summary

On March 6, President Trump signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (H.R. 6074, Public Law 116-123), which provides $8.3 billion in emergency funding, including a provision that allows the Secretary of Health and Human Services (HHS) to waive Medicare telehealth restrictions during the coronavirus outbreak so that patients can receive care no matter where they are located, including at home.

House sponsors of the CONNECT for Health Act, another bill that would waive telehealth reimbursement restrictions during national emergencies, sent a letter last week to HHS Secretary Alex Azar urging the expeditious waiver implementation and guidance, as did Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee.

On March 17, HHS waived key restrictions and issued public guidance on that waiver. Notably, the guidance allows Medicare patients to receive telehealth services in their homes and permits psychologists to provide services to both existing and new Medicare patients allowing for greater service delivery than what was enacted into law. Providers can use telephones for patient services as long as they are equipped with audio and video capabilities that enable two-way, real-time interactive communication. The Office of Civil Rights at HHS announced it would waive penalties for potential HIPAA violations during this public health emergency.

APA will be releasing more details on these waivers as soon as possible. In addition, APA will continue to advocate for increasing patient access to telehealth services at the federal and state level so that psychologists can provide essential mental health care.

APA applauds the House and Senate sponsors of the APA-supported CONNECT for Health Act—Sens. Brian Schatz (D-Hawaii), Roger Wicker (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), Mark Warner (D-Va.) and Cindy Hyde-Smith (R-Miss.) and Reps. Mike Thompson (D-Calif.), Peter Welch (D-Vt.), David Schweikert (R-Ariz.) and Bill Johnson (R-Ohio) for securing elements of their telehealth bill in the coronavirus response package.

For more information, contact Laurel Stine, JD, at lstine@apa.org and Deborah Baker, JD, at dbaker@apa.org.

http://d3dkdvqff0zqx.cloudfront.net/groups/apapractice/attachments/apa%20advocacy%20washington%20update%203_18.pdf

DPA members: 

Please consider attending one of the upcoming Town Hall meetings for the Lt. Governor's Behavioral Health Consortium. This is a great opportunity to learn about the accomplishments of this group and to be a voice at the conversations about ongoing initiatives and opportunities. I plan to attend the meeting for New Castle County and I look forward to seeing many of you there!

Please see below for more information about BHC and visit the website to review past meeting minutes: https://ltgov.delaware.gov/behavioral-health-consortium/

The Behavioral Health Consortium is an advisory body comprised of community advocates, law enforcement, healthcare professionals, and state leaders that will assess and outline an integrated plan for action to address prevention, treatment, and recovery for mental health, substance use, and co-occurring disorders. The consortium will develop short-term and long-term strategies and initiatives to address the major addiction and mental health challenges we face in Delaware.

Malina Spirito, Psy.D., M.Ed.

Licensed Psychologist

Delaware Psychological Association

Executive Council-President

BHC Sussex Forum.pdf

BHC NCC Forum.pdf

BHC Kent Forum.pdf

Beginning Jan. 1, 2020, psychologists will receive higher payments for providing treatment to Medicare patients who receive services for coping with or managing a physical health condition.

APA had been strongly advocating for changes to psychologists’ payments for these treatments—billed as Health Behavior Assessment and Intervention (HBAI) services—to more accurately represent current clinical practice. As part of its advocacy, APA urged psychologists to submit comments to the Centers for Medicare and Medicaid Services (CMS) in support of a new coding structure for HBAI services and proposed value increases (see chart below).

CMS listened. They accepted APA’s recommendations and issued their approval of the rate increases in the agency’s 2020 Medicare Physician Fee Schedule Final Rule, released Nov. 1. 

CMS noticed psychologists’ efforts, stating in the final rule that the “total number of comments for the HBAI CPT codes are from Psychologists who are uniformly pleased to see that CMS has accepted all of the AMA RUC’s recommended increases for the Health Behavior Assessment and Intervention (HBAI) services....” 

“The rate increases are strong evidence that CMS recognizes the importance of addressing the psychological factors that affect patients’ physical health problems. The new HBAI code set will make it financially more sustainable for psychologists to provide HBAI services and expand access to psychological care for patients with physical health conditions,” says APA Chief of Professional Practice Jared Skillings, PhD, ABPP. 

Although CMS accepted APA’s recommended values, Medicare will still not cover Health Behavior Family Intervention services offered without the patient being present. 

APA will continue to review and analyze the 2,500-page final rule and provide further details on payment policies and other issues that psychologists need to be aware of in the next issue of “PracticeUpdate.” 

Visit APA Services’ Reimbursement webpage for more information and updated resources related to HBAI and other coding and billing issues.

Article published Nov. 7, 2019

Finalized coding changes and work RVUs for HBAI services in 2020

CPT ® Code	Code Descriptor	2020 wRVU
Health Behavior Assessment Services
Assessment or Re-Assessment
96156	Health behavior assessment or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making)	2.10
Health Behavior Intervention Services
Individual Intervention
96158	Health behavior intervention, individual, face-to-face; initial 30 minutes	1.45
✚ 96159	Each additional 15 minutes (List separately in addition to code for primary procedure)	0.50
Group Intervention
96164	Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes	0.21
✚ 96165	Each additional 15 minutes (List separately in addition to code for primary procedure)	0.10
Family Intervention with Patient Present
96167	Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes	1.55
✚ 96168	Each additional 15 minutes (List separately in addition to code for primary procedure)	0.55
Family Intervention without Patient Present
96170*	Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes	1.50
✚96171*	Each additional 15 minutes (List separately in addition to code for primary procedure)	0.54

“ ✚ ” Indicates an Add-On Code to be reported with primary service/base code

Delaware Joins the Psychology Interjurisdicational Compact (PSYPACT).

On July 4, 2019, Governor Carney signed into law House Bill 172. This change in the law enters Delaware into PSYPACT, allowing Delaware licensed psychologists who wish to practice psychology in another compact state via telepsychology. For more information on PSYPACT, including which other states are members of PSYPACT, go to  www.psypact.org.

COMPACT COMMISSION PROPOSED RULES:

The Psychology Interjurisdictional Compact Commission has published Proposed Rules for consideration and comment. The Proposed Rules can be found HERE.

These Proposed Rules are open for a period of 60 days for public comment for those stakeholders interested in providing such comment. The deadline for submission of written comments is September 30, 2019.

Written comments should be submitted via the public comment form found on the PSYPACT website (www.psypact.org) and submitted to the PSYPACT Commission no later than 5:00 pm EST on September 30, 2019.

A public hearing will be conducted via Zoom on October 1, 2019 beginning at 3:00 pm EST. Interested parties may participate and notification will be posted to the PSYPACT website (www.psypact.org) 30 days prior to the meeting with call -in information provided.

PSYPACT's Executive Director, Janet Orwig, MBA, joined the DPA on May 31st from 12-1 PM in order to support our members' understanding of PSYPACT.  Please use the information below to view a recording of the webinar.

PSYPACT Webinar 

2019-05-31 12.07 PSYPACT Webinar.mp4

Check out these handouts for more information:

Why PSYPACT is Important.pdf

PSYPACT Fact Sheet.pdf

PSYPACT and Discipline.pdf

How PSYPACT Works.pdf

Thank you to everyone who made it to our evening with Dr. Arthur Evans on May 10th.  If you were not able to attend, but have interest in what was discussed, please check out this link for an audio recording of the night.  

2019-05-10 17.48 A NIGHT OUT WITH DR. ARTHUR EVANS_1.mp3

SURVEY: AMERICANS BECOMING MORE OPEN ABOUT MENTAL HEALTH American adults mostly harbor positive views about mental health, though some stigma remains WASHINGTON – Most Americans harbor positive views about mental health disorders and treatment, according to the results of a survey released today, in recognition of mental health month.  The survey was conducted by The Harris Poll on behalf of the American Psychological Association.    A total of 87% of American adults agreed that having a mental health disorder is nothing to be ashamed of, and 86% said they believe that people with mental health disorders can get better, according to the poll. "The results of this survey are encouraging, and a signal that APA's and others’ work over the years to promote mental health care is paying off," said APA CEO Arthur C. Evans Jr., PhD. "They indicate a willingness to be more open about mental illness, as well as a strong belief among older respondents that having a mental disorder is nothing to be ashamed of."  Despite this welcome news, some stigma still persists. A third of respondents (33%) agreed with the statement, "people with mental health disorders scare me," and 39% said they would view someone differently if they knew that person had a mental health disorder.  In the case of mental health disorders, familiarity seemed to breed comfort: 42% percent of people who had never had a mental health diagnosis or known someone who did said that people with mental health disorders scared them. Of people who had been diagnosed with a mental health disorder or knew someone who had, only 27% and 28%, respectively, said the same. Most respondents — 59% — know someone with a mental health disorder. This personal experience is a step toward destigmatizing mental illness, Evans said.  The survey found that 81% percent of people said they would be very or somewhat comfortable being friends with someone with a mental health disorder, and 79% would be very or somewhat comfortable interacting with a person with a mental health disorder. Those numbers dropped, though, for more intimate involvement: The proportion of people comfortable dating someone with a mental health disorder was 51%, and only 35% said they would be comfortable letting someone with a mental health disorder care for a child.  Notably, significant minorities of Americans do not consider the most common mental health disorders to be disorders. A third (33%) said they did not consider anxiety to be a mental illness, and 22% said the same about depression.  The survey also delved into attitudes about suicide. Large majorities of Americans agree that people who are suicidal can be treated and go on to live successful lives (91%) and that suicide can often be prevented (87%). Most also supported openness around suicide, with 87% agreeing that people should talk about suicide more openly, and 84% agreeing that people should not be ashamed to say a loved one died by suicide. Nearly 4 out of 5 (79%) agreed that less stigma and shame around mental health disorders would lower suicide rates.  However, 30% of people said that they would keep quiet about the cause of death if their own loved one died by suicide, and 63% agreed with the notion that suicide is a selfish act.  Young adults between 18 to 34 reported the poorest mental health of those surveyed, as well as the most shame around mental health disorders. Twenty-seven percent of this age group reported poor or fair mental health, compared with 20% of 35 to 64-year-olds and 4% of those 65 and older. While 92% of those 65 and older and 89% of those between 35 and 64 agreed that having a mental health disorder was not something to be ashamed of, only 78% of the youngest adults said the same. Young adults were also more likely than older age groups to believe that most mental health disorders do not require treatment (35% of 18 to 34-year-olds, 17% of 35 to 64-year-olds and 9% of those 65 and older), to say that they would keep quiet about the cause of death if a loved one died by suicide (40% of 18 to 34-year-olds, 30% 35 to 64-year-olds, 18% of those 65 and older), and to disagree that people with mental health disorders can live normal lives (23%, 14%, and 10%, respectively).  "More young adults reported feeling shame and stigma surrounding mental health issues than their older peers," Evans said. "This points to the need for psychology to continue to educate the public so that more people understand that there is no shame associated with being mentally ill."  The survey of 1,006 U.S. adults was conducted by The Harris Poll between Nov. 20-29, 2018. Respondents took a 15-minute online survey about their attitudes toward mental health disorders and mental health treatment. The results were weighted by education, age, gender, race, ethnicity, geography, household income, household size and marital status to represent the U.S. population.  The full report and additional graphics are available here.

We hope to have the finalized document to you very soon.

In conclusion, I am pleased to share a positive development regarding reimbursement.  Anthem BCBS of CT, the last major company we’re aware of with payment delays, appears to finally be reprocessing and paying claims. 

Please continue to keep us informed of any problems.  Thank you all again for working with us to solve these issues.  

Best Regards,

Jared L. Skillings, PhD, ABPP

Chief of Professional Practice, American Psychological Association

Board-certified in Clinical, Clinical Health, and Behavioral & Cognitive Psychology

Certified Black Belt, Six Sigma Process Improvement

202-336-5913 | JSkillings@apa.org | Twitter: @JLSkillings | Linkedin.com/in/jlskillings