Bill to expand mental health coverage to telemedicine

Alaska’s mental health services may soon be easier to access, even for patients in remote and rural areas.

A bill pre-filed for the January legislative session, sponsored by Rep. Liz Vazquez (R-Anchorage), would require insurance plans in the state to cover telemedicine mental health services — therapy or counseling delivered via electronic communications — the same as in-person services without requiring an in-person appointment first.

The law would only apply to the approximately 15 percent of Alaskans that have individual or group insurance through a private provider, said Lori Wing-Heier, the director of the Alaska Division of Insurance. Most Alaskans have Medicare, Medicaid or are insured through the federal government, she said. Medicaid already covers behavioral and mental health services provided by telemedicine.

If the bill does pass, there will be a lot of work to do to establish the infrastructure needed to get it going, Wing-Heier said.

“You’d have to have a good Internet connection, you’d have to have good privacy rules,” Wing-Heier said. “We have some homework to do to figure out how the mechanics would work. Not only on the provider end, but on the rural village end as well.”

In that way, the purpose of the bill is still unclear, said Kate Burkhart, executive director of the Statewide Suicide Prevention Council. The Alaska Department of Health and Social Services boards have not taken a formal position on the bill yet, but will be researching the bill further and speaking with Vazquez about it, she said.

“At this point, I don’t know whether this bill will expand access or not, given that the major insurers in the state already pay for the service,” Burkhart said. “We’ve reached out to private providers who are billing for telemedicine behavioral health and are getting reimbursed.”

It’s also unclear how the medical community and the American Medical Association will take it, Wing-Heier said. The American Medical Association has condoned the use of telemedicine as long as the same standards of care are applied, but the medical record privacy requirement is trickier over the Internet than in person, she said.

Burkhart said there is a broader conversation in the Legislature about what constitutes sufficient care in telemedicine. Some have suggested that a telephone conversation is enough to meet a standard of care, but the Alaska State Medical Board has taken issue with that, as have the Department of Health and Social Services boards, she said.

“Therapy is effective because of the relationship between the provider and the client, so we’re trying to understand what is the service that (the state) is anticipating if there’s no in-person encounter,” Burkhart said.

In Alaska, telemedicine is admissible when there is an established relationship between the health care provider and the patient and when there is a licensed provider physically with the patient on the receiving end. Physicians can only prescribe medications by telemedicine if they are not controlled substances and if they are physically located in Alaska.

Wing-Heier said the law makes sense and could be a good thing for many rural communities.

“I absolutely see where Representative Vazquez is coming from,” Wing-Heier said. “It’s so expensive to have a behavioral analyst visit rural communities.”

Telemedicine is being actively used and expanded in rural parts of Alaska, including the North Slope Borough and the Eastern Aleutian Tribes, which both received hundreds of thousands of dollars in grants from the U.S. Department of Agriculture to expand their telemedicine capabilities in November 2015.

Alaska has already authorized telemedicine for many other uses as an aid for the small communities where medical access is limited. Wing-Heier said it has gotten progressively easier to implement and has been useful, particularly on the North Slope where there are a lot of oil workers and few services. Behavioral and mental health services are delivered differently, though, she said.

“Nothing’s impossible, the kinks just have to be worked out,” Wing-Heier said. “We absolutely are looking into how to make this work if it does pass.”

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