Tele health Services: Insurers Pushing Back on Certified Peer
and Family Advocates Reimbursement

March 25, 2021

As we stated last week, the Senate has passed the bill (discussed below) while the Assembly version awaits forward movement.   At this moment we fear for passage in both houses. We will be working today to ensure passage in both houses and the signature of the Governor.  Stand by for more.

A bill now advancing through the state Legislature would make telehealth services by certified peer recovery advocates and credentialed family peer advocates permanently eligible for reimbursement. Insurance industry representatives, however, say the state needs to set standards for virtual care before expanding its use.

The bill, which the Senate approved Tuesday, adds to a growing push by state lawmakers and health advocates to expand access to telehealth care, which has boomed in popularity during the pandemic. The bill is now with the Assembly’s ways and means committee.

Peer advocates have offered virtual support to New Yorkers dealing with substance abuse and parents or caregivers of children with disabilities during the pandemic, as behavioral and mental health concerns have increased. When conducted in-person, those services are a billable expense.

“This is somebody who has been where the patient is,” said Sen. Pete Harckam, the bill’s sponsor. “They have real life experience.”

In a memo of opposition, the New York Health Plan Association wrote that the state should first work with stakeholders to develop “meaningful standards for the appropriate use of this rapidly evolving technology.” The association represents 28 managed plans in the state that cover about 11 million people.

Leslie Moran, the association’s senior vice president, said there is little to no available information on how widely virtual peer support services are used and how much it would cost to make the services reimbursable. The Senate’s bill said the fiscal implications are to be determined.

“That would be valuable information to know,” Moran said.

Gov. Andrew Cuomo issued an executive order early in the pandemic last year to lower barriers to telemedicine, such as requirements that services be provided only from approved facilities. In January he announced a telehealth reform package that would adjust reimbursement incentives and authorize more behavioral-health providers to deliver virtual care.

The demand for telemedicine has surged during the pandemic. According to the nonprofit Fair Health’s latest monthly tracker, telehealth claims in the Northeast increased by more than 9,000% in December, compared to the same month in 2019. —Maya Kaufman