How APA Services is working for you during the COVID-19 crisis

Most government agencies and payers have responded positively to the COVID-19 crisis by easing barriers to care via telehealth. APA Services, Inc., has been aggressively advocating to remove remaining impediments to service and to promote extensions of emergency orders and payer policies that expand the ability to provide services via telehealth.

The offices of Legal and Regulatory Affairs (LRA) and Health Care Finance (HCF) work shoulder-to-shoulder with partners inside and outside of APA Services to promote the expansion of telehealth, advocate for providers and patients, and guide members through the confusing array of fast-changing directives. During the COVID-19 pandemic, here’s how we are advocating for you.

APA Services collaborated with the Inter Organizational Practice Committee—IOPC—(a coalition of the major national neuropsychological organizations), to create a resource covering over 50 insurers’ COVID-19 telehealth policies. This resource will help inform our advocacy efforts with payers around telehealth and should help psychologists understand the different insurer policies.

The IOPC—which has worked with APA Services on an array of member guidance and advocacy initiatives—did a tremendous amount of research on these policies. We also relied heavily on our state psychological association (STPA) Directors of Professional Affairs (DPAs), who provided additional information and reviewed the resource for accuracy. The DPAs are one of our major sources for what is happening in the trenches, as well as key advocates and member resources at the state level on insurance, telehealth, and a variety of other issues.

When the resource becomes available, psychologists will be able to:

• Access basic information on the company, effective dates of its telehealth policies, and web links to those policies.
• View which of the common and less common behavioral health procedures/codes are covered by the company’s telehealth policies.
• Obtain information on billing, co-pays, out-of-network, etc.

The resource focuses on commercial insurance but includes some specific information on variations for other programs like Medicaid and Medicare Advantage.

These policies are constantly changing with some larger companies updating them very frequently. We will add additional insurers (particularly ones operating in only one state) as we finish analyzing their policies.

LRA compiled a summary of all state executive orders and emergency waivers that address the provision of telehealth during the crisis. These orders vary widely and cover important mandates such as allowing for audio-only services, requiring reimbursement at the same rate as in-person services, Medicaid waivers, and allowing for interjurisdictional practice in some cases. LRA continues to monitor these orders for changing expiration dates and is using this information to identify gaps in service delivery that may require our advocacy.

States have different expiration dates for their emergency orders, which is causing confusion and anxiety about the timeframe for returning to a greater frequency of in-person services. This is especially concerning for psychologists and patients in states without coverage or reimbursement mandates in statute.

To help ease the transition to in-person service delivery, APA Services worked with SPTAs to request that governors continue their expanded telehealth policies until 12 months after the federal health emergency orders expire. That extension would give APA Services time to work with payers and regulators on what expanded levels of telehealth make sense to keep in place permanently.

APA Services has also aligned with coalitions (including National Association of Social Workers, American Psychiatric Association, the National Alliance on Mental Illness, and Mental Health America) to advance the shared vision of expanding telehealth.

These letters follow two prior waves of letters at the start of the crisis by APA Services and SPTAs that urged governors and state insurance commissioners to order, and payers to adopt, expanded telehealth policies.

APA Services successfully advocated with the Centers for Medicare & Medicaid Services (CMS) and members of Congress to allow audio-only services to Medicare recipients. We continue to advocate for phone-only services beyond the expiration of the national emergency.

Medicare beneficiaries, who are already at risk for developing severe symptoms of COVID-19, are the least likely to own or operate the technology otherwise required for traditional telehealth services, which CMS defines as simultaneous audio/visual communication with the patients at an approved videoconferencing location instead of their home. Lifting these video requirements has allowed this vulnerable population to receive crucial care via phone and from the safety and comfort of their homes.

APA Services has been in fruitful discussions with major national commercial payers about expanding and continuing their telehealth policies, including allowing for phone-only services, expansion of eligible services, reimbursement parity, freedom to use different telehealth platforms, and pushing back the end dates of their COVID-19 telehealth policies.

While APA Services is making progress with insurers about their telehealth policies, these companies have limited influence over the policies of self-insured plans (known as ERISA plans). State insurance regulators and laws have no jurisdiction over ERISA plans. These plans, although administered by companies like Optum/UHC and Aetna, are run by employers and governed by the Department of Labor (DOL) under ERISA. (See the sixth question in this FAQ.)

APA Services has contacted the DOL urging them to require ERISA plans to cover telehealth. We have also supported bills to achieve the same end. We will continue to work on this advocacy as well.

Our efforts to protect psychologists’ ability to provide necessary services to the community is ongoing. We will keep you apprised of updates and results.

• FAQs addressing practitioners’ big questions during the crisis, e.g., what happens if you or a patient is infected; considerations for whether to switch to telehealth and how to prepare, billing and co-pays; HIPAA enforcement; video platforms; phone only and self-care.
• Guidance explaining the different telehealth advances we have secured from CMS.
• Guidance on returning to in-person services and an informed consent for patients.