Coalition criticizes Hawaii telehealth bill

A coalition of social workers, psychologists and other medical professionals is urging Gov. David Ige to veto a bill that could restrict telehealth appointments for mental health services, which soared during the pandemic.

House Bill 1980 on its surface seems to bolster telehealth, but critics say it actually allows for limits on telehealth services provided by phone, as opposed to online video conferencing.

Alex Lichton, chair of the Hawaii Psychological Association’s legislative action committee, said those restrictions would disproportionately affect the most vulnerable, including disabled, low-income and neighbor island residents who may not have easy access to high-speed internet or at-home video conferencing.

“There are poison pills in there,” Lichton said of the bill.

While telehealth typically encompasses health care services provided remotely via telecommunications technology, HB 1980 exempts telephone communications from this definition of telehealth, which by law insurers are required to cover, and appears to limit when phone appointments can be covered.

For example, insurers can deny coverage for a telephone appointment if a patient hasn’t been seen by that provider in person within the preceding 12 months. Critics say this could create added hurdles for those who live in more remote areas of the islands, such as on Molokai or Lanai, who may have to fly to Hono­lulu to see a specialist before they can consult with them by phone.

The measure also requires new insurance codes be created for phone appointments, which critics say could take months and lead to lower reimbursement rates for phone appointments. This, in turn, could make providers less apt to offer the service.

“To be clear, (the bill) does not give any authority to insurers to offer reimbursement for telephonic treatment that did not exist before. Rather, it creates a new authority with unreasonable and unnecessary conditions,” according to a petition by the Hawaii chapter of the National Association of Social Workers urging Ige to veto the measure. “HB 1980 puts all private health insurers on equal footing; with their feet on the necks of vulnerable patients.”

Other groups urging Ige to veto the bill include the Hawaii Association of Professional Nurses, the Hawaii chapter of the American Association of Retired Persons, Mental Health America of Hawaii, the Hawaii Psychological Association, the Hawaii Family Caregiver Coalition and the Hawaiian Islands Association for Marriage and Family Therapy.

Becky Gardner, a lobbyist for several of the advocacy groups, said HB 1980 is a “Trojan horse” with confusing language that obfuscates its true intent. She said that restricting telephone appointments for mental health services, in particular, doesn’t make sense given the services typically involve “talk therapy,” and phone consultations are routine for crisis hot lines.

State Rep. Ryan Yamane, who chairs the House Committee on Health, Human Services and Homelessness and introduced the bill, declined to comment and referred Honolulu Star- Advertiser questions to the Hawaii Medical Service Association and Kaiser Permanente, the state’s primary health insurers.

In testimony to the Legislature, HMSA, the state’s largest private insurer, supported carving out telephone appointments from the definition of telehealth.

HMSA, in a statement to the Star-Advertiser, said the bill “will modernize the current statute to allow for the delivery and reimbursement of both telephonic and telehealth services, while ensuring access to high quality care for people wherever and whenever they need it.”

“The bill does not force or prevent the clinically appropriate delivery of services in any way, but instead its language respects the differences,” said Jennifer Dies­man, HMSA’s senior vice president of government policy and advocacy.

Supporters of a veto say HB 1980 goes against best practices that have been supported at the federal level and note that telephone appointments are covered under Medicare.

A 2021 national survey conducted by the U.S. Department of Health and Human Services’ Office of Health Policy found that use of telehealth services surged during the COVID-19 pandemic. From April to October 2021, the study found that 23.1% of respondents reported use of telehealth services in the previous four weeks.

The study also found significant disparities between groups who were using video versus audio-only telehealth, with video telehealth rates much higher among white respondents and those earning at least $100,000 annually.