Is Home-Based TeleHealth Reimbursement Here at Last?

Do we need to conduct in-person assessment before delivering telemental health or online therapy? Is reimbursement for home-based telehealth still prohibited from federal reimbursement? Answers depend on your state law.

For Californians, state law just changed, making home-based telehealth care of many types not only feasible, but reimbursable. The Telehealth Advancement Act of 2011 was passed in September of 2011. Repercussions are far-reaching, and open the door to home-based practice state-wide.

While the entire law can be seen here, I will re-post a few key sections for your convenience:

2290.5. (a) For purposes of this division, the following definitions shall apply:

(6) "Telehealth" means the mode of delivering health care services
and public health via information and communication technologies to
facilitate the diagnosis, consultation, treatment, education, care
management, and self-management of a patient's health care while the
patient is at the originating site and the health care provider is at
a distant site. Telehealth facilitates patient self-management and
caregiver support for patients and includes synchronous interactions
and asynchronous store and forward transfers.

1374.13.  (a) For the purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.
   (b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the health care provider.
   (c) No health care service plan shall require that in-person
contact occur between a health care provider and a patient before
payment is made for the covered services appropriately provided
through telehealth, subject to the terms and conditions of the
contract entered into between the enrollee or subscriber and the
health care service plan, and between the health care service plan
and its participating providers or provider groups.
   (d) No health care service plan shall limit the type of setting
where services are provided for the patient or by the health care
provider before payment is made for the covered services
appropriately provided through telehealth, subject to the terms and
conditions of the contract entered into between the enrollee or
subscriber and the health care service plan, and between the health
care service plan and its participating providers or provider groups.

Again, the link to the original document is here. 

This law will set the tone for telehealth practice across the country, forcing other state legislator to consider the many restrictions they are putting on their practitioners. For some of us, this has been a long time coming. For consumers who have been denied care despite their desperate need, this is a God-send.

California legislators are to be heartily congratulated for having the education, vision, and courage to enact a law that will reduce the suffering and thereby give hope to the people who now can access affordable healthcare.

That’s my opinion. What’s yours?

~

Marlene M. Maheu, Ph.D. is the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.