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Insurers push back on bill requiring coverage of psychiatrists' telehealth consultations

SALT LAKE CITY — Following fervent debate Monday over a bill requiring insurers to provide coverage for mental health consultations between a patient's primary care physician and a psychiatrist, a vote on whether to recommend the measure was delayed by the request of its sponsor.

HB139 would oblige the Medicaid program and private insurers to provide reimbursement for the service, which bill sponsor Rep. Steve Eliason, R-Sandy, said is aimed at getting patients faster and more extensive access to mental health care by working with their own family doctor.

"It actually increases our capacity because someone who does in-patient counseling for a living … can easily fit (the consultation) in," he told the House Health and Human Services Committee.

Eliason made a motion that the committee delay a vote, saying he is hoping to make changes to the bill first. He told the Deseret News that the changes will be minor and will exempt a small handful of plans that cover "very few" Utahns and have been in place since before the enaction of the Affordable Care Act.

Eliason said there were some fears among insurers that imposing the measure on those plans, which until now have been exempted to some other parts of the sweeping federal health care law passed in 2010 due to being grandfathered in, could establish grounds for nullifying those exemptions the plans are being administered under.

Eliason said the bill would help doctors "refer a patient to a telepsychiatric (evaluation) instead of sending a patient out into the open market and saying 'good luck finding a psychiatrist who is taking patients.'"

The problem with the open market in Utah, he told the committee, is that it ranks 42nd for psychiatrists per capita and is also listed near the bottom in terms of how well people in that profession are compensated.

Eliason added he had an intern call 35 psychiatrists Monday morning, and that "28 were not taking new patients." He called the lack of availability for mental health appointments a "silent shortage" that compounds the "silent crisis" of mental health suffering.

Eliason said all those factors combined make it sensible to give patients a contact point they're well familiar with — their family doctor — as a potential portal into mental health care services.

"The crux of the matter is, do we as a society believe this is worth paying for?" he said.

Kelly Atkinson, executive director of the Utah Health Insurance Association, told the committee that health plan providers were not asked for their input on the bill.

"Until today, the people I represent had not been talked to," Atkinson said. "The bill hasn't been thoroughly vetted by the insurance industry."

Insurers have not yet had a chance to conclude whether there could be "any increase in insurance premiums as a direct result of this legislation," he said.

"Anytime there's a mandate … there's a potential those costs are going to be borne … by the citizens of the state of Utah," Atkinson said.

But Eliason said "my firm belief is this actually reduces costs" for insurers because it will lead to less need for urgent mental health-related care, most notably emergency room visits. Such emergency care actually represents "ambulances at the bottom of the cliff," he said.

"When we get upstream, the issue is access."

The consultation between a primary care provider and a psychiatrist, referred to in HB139 as telepsychiatry, would enable a quicker mental health diagnosis and recommended course of action for a patient suffering from suicidal ideation or another crisis, Eliason said.

The consultation between medical professionals would be based on a written questionnaire filled out by the patient, he said.

Atkinson said he's worried that such a consultation between doctors would be "taking the patient out of it," and patients who receive their portion of the bill for that consultation could be taken by surprise.

"We don't want a primary care physician going to talk to a psychiatrist about our client without our client knowing about it," he said. "Because our client is going to be billed for that."

Eliason disputed that the consultation between doctors amounted to removing the patient from the equation, since patients must consent to such a service before submitting the questionnaire.

"You can't make this patient take the questionnaire by surprise," he said.

Eliason added that it is not a requirement for a primary care physician to even offer those services to their patients in the first place, but only that insurers cover them if they are in fact provided.

Mark Hiatt, executive medical director of Regence BlueCross BlueShield of Utah, voiced similar concerns, adding that the bill may leave insurers unnecessarily vulnerable to a high rate of out-of-network psychiatrists used for consultations.

"I love the intent of this bill," Hiatt told the committee. "I have some concerns with how it is written."

Representatives from the Utah Medical Association, Utah Academy of Family Physicians and YWCA Utah were among several people — including some medical providers — who spoke at the committee hearing in favor of HB139, saying it would be a critical step forward in increasing Utahns' access to mental health services.

"As you know, there's a mental health (services) shortage in Utah," Michelle McOmber, CEO of the Utah Medical Association, told the committee. "We don't have enough providers in the state of Utah. That's part of the problem. We need to get as much access as we can."