The COVID-19 pandemic created many challenges for people trying to access healthcare, especially those in need of mental or behavioral healthcare and patients with disabilities who often face physical challenges, such as finding transportation to a doctor’s office. The demand for mental or behavioral healthcare during the pandemic period grew substantially for all residents: We saw more children suffering from isolation during remote learning. Older Americans, especially those in continued care facilities and nursing homes, also suffered increased mental health issues due to separation from loved ones and friends. Sudden unemployment created high levels of anxiety and pushed many people into depression as they feared the possible loss of their homes and faced the anguish of worrying about how they would feed their families.
Looking back, we can see that this pandemic has been a case study of how effective telehealth and telemedicine can be for New Jerseyans in need of healthcare. The pandemic proved that mental and behavioral healthcare services can be delivered via telemedicine with no loss in quality. Often, they can be provided at lower cost and greater convenience for all parties involved through telehealth.
With this in mind, my colleagues in the 11th Legislative District, Assemblyman Eric Houghtaling and Senator Vin Gopal, and I recognized that we had to move past the outdated model of providing telemedicine that punishes innovation and technology and create a new paradigm that rewards efficiency and accessibility. Telemedicine is medicine, and for many New Jerseyans, it is the best option they have for accessing healthcare. For some, during the pandemic, telemedicine has been the only real option. That’s especially true in mental and behavioral healthcare.
“It will end the discrimination against virtual care and make sure that everyone can get coverage for the medical services they need.”
My legislation, A4179 (S2559 in the Senate), will expand coverage for healthcare services provided through telemedicine and telehealth by equalizing or increasing reimbursement for the services. The bill will end the discrimination against virtual care and make sure that everyone can get coverage for the medical services they need. Legislators throughout New Jersey agree on this. The Assembly and the Senate passed A4179/S2559 unanimously.
To ensure that everyone has access to telehealth, we have to ensure pay parity for healthcare providers. My legislation requires entities that offer a health benefit plan in New Jersey to provide coverage and payment for behavioral health services delivered through telemedicine or telehealth at the same payment rate as in-person services.
As amended, this bill would clarify that the pay parity provision does not apply if a telemedicine and telehealth organization does not provide a given service on an in-person basis. This provision also does not apply to a physical healthcare service provided through telemedicine or telehealth via audio only. Physical audio-only health services, although exempt from pay parity, would be required to be covered under the contract with a provider at a rate of at least 50 percent of the reimbursement for the equivalent in-person service.
In addition to ensuring pay parity, A4179/S2559 prohibits carriers, Medicaid and NJ FamilyCare, the School Employees’ Health Benefits Program (SEHBP) and the State Health Benefits Program (SHBP) from placing restrictions on the electronic or technological platform used to provide telemedicine and telehealth, as long as the services provided meet the in-person standard of care for that service. The bill requires the platform to comply with the requirements of the federal health privacy rule set forth in 45 CFR Parts 160 and 164.
The legislation also prohibits entities from imposing “place of service” requirements on services provided using telemedicine and telehealth. A4179 clarifies that regardless of their location, a provider can provide services through telemedicine to patients in New Jersey provided the provider is licensed by the state.
In addition, the bill prohibits health benefits plans, Medicaid and NJ FamilyCare, and the SHBP and the SEHBP from denying coverage or refusing to provide reimbursement for routine patient monitoring, and from limiting coverage to services provided by select third-party telemedicine or telehealth providers. The bill also prohibits health benefits plans from imposing more stringent utilization management requirements using telemedicine and telehealth than when those services are provided in person. Moreover, health benefits plans cannot impose more restrictive requirements than when the service is provided in person.
The Legislature recognizes that state expenditures for monthly capitation payments to state-contracted Medicaid managed care organizations (MCOs) for providing services to New Jersey FamilyCare beneficiaries will increase. However, the increased expenditures will be eligible for additional federal Medicaid matching funds that will increase state revenues, although the amount has not been determined. Thus, the legislation has appropriated $5 million from the State General Fund for the Department of Human Services to establish a program to reimburse healthcare providers for services to NJ FamilyCare enrollees. The reimbursement would cover the cost of providing temporary or ongoing access to the devices, technologies and programs to patients who do not have it.
Although the Office of Legislative Services cannot precisely estimate the fiscal impact of the bill’s requirements on the SEHBP and the SHBP, the Department of the Treasury projects that the bill will increase annual costs for these programs in a range between $5 million and $50 million. While we understand the State’s concerns that the bill will lead to greater utilization of telemedicine, we believe the recent amendments will prevent the costs from reaching those estimates. In-person services will remain a viable alternative even after the enactment of the bill.
Even if the cost of the bill meet the state’s estimates, in the long term, it is a small price to pay to ensure equity in healthcare.