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Volume XI, Number 267

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The “State” of Telehealth: Utah

Utah Bill Uses Telehealth to Address Mental Health

On March 2, 2021, Utah Governor, Spencer Cox, signed Senate Bill 41 (“SB41”) into law. The bill, sponsored by State Senator Luz Escamilla, allows coverage for mental health services delivered by telehealth – often referred to as “telemental health” services.  While we have seen many states move to create greater access to telehealth services in efforts to address the current public health crisis (the “Pandemic”), Utah is one of the first states to expand telehealth coverage to address the mental well-being of its citizens.  In a statement to State of Reform, Sen. Escamilla noted that “mental health is becoming a big crisis and in our state we’re seeing an increase in needs, and access has become very limited.”

With the Pandemic intensifying already-high levels of stress, depression, anxiety and substance abuse, a number of states have sought to improve access to mental health services through the use of telemedicine. Utah’s bill will require that the state’s Medicaid program and commercial health plans reimburse providers “at a commercially reasonable rate” for “medically necessary” mental telehealth services, provided that these services are also provided in-person and that services meet the appropriate standard of care.

While some states, like Utah, are moving to make mental telehealth coverage permanent, the federal government, in its Consolidated Appropriations Act of 2020, already allows for Medicare coverage of mental health services, upon satisfaction of certain restrictions, such as, requiring that the provider and patient have met in person within the prior six months and continue to meet in person at regular intervals.

Other states have responded by mandating strict payment parity for telehealth services, requiring reimbursement for telehealth services at the same rate as in-person visits, see for example our March 5, 2021 blog post, The “State” of Telehealth: West Virginia, discussing payment parity in West Virginia. Utah, however, joins the few states that allow the provider and payer to set rates for telehealth care services, provided that such rates are “commercially reasonable”.

SB41 also prevents payers from imposing any originating site, geographic or distance-based restrictions on connected health reimbursement, providing wider access for Utah citizens seeking mental health services. “The state moved, since last session, to be more practical with telehealth — it’s working well. Now, we’re bringing this telehealth component to mental health,” stated Escamilla. SB41 aims to directly address the growing concern of the mental wellness amongst Utah citizens.

Supporters of SB41 are attracted to the “commercially reasonable rate” for telehealth services introduced in the bill. Many believe that payment parity laws should not prevent payors and providers from negotiating for different reimbursement rates for telehealth vs. in-person services, so long as such negotiations are truly voluntary by the provider and not forced upon them.

Utah joins the roster of states creating permanent legislation for telehealth services following the Pandemic. We will continue to monitor the expansion of telehealth services in the state of Utah, and other states across the nation in accordance with our “State” of Telehealth” series.

Copyright © 2021, Sheppard Mullin Richter & Hampton LLP.National Law Review, Volume XI, Number 75
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About this Author

Matthew Shatzkes Attorney New York Sheppard Mullin
Partner

Matthew Shatzkes is a partner in the Corporate Practice Group in the New York office of Sheppard Mullin and is a member of the firm’s healthcare practice team.

Areas of Practice

Matthew provides strategic, regulatory, compliance, and transactional advice to all manner of health care clients, including health systems, hospitals, academic medical centers, long-term care providers, ambulatory surgery centers, diagnostic and treatment centers, physician practices, digital health companies and investors....

212-634-3062
Ehiguina L. Borha Corporate Attorney Sheppard Mullin New York, NY
Associate

Ehi Borha is an associate in the Corporate Practice Group in the firm's New York office. 

Areas of Practice

Ehi's practice focuses on healthcare M&A and regulatory matters. He is a former member of the New York Due Diligence Group where he worked on the diligence aspect of a number of M&A transactions. Ehi is a 2019 graduate of New York Law School, where he served as a member of the mediation and negotiation clinic and completed a concentration in business and corporate law. He received his Bachelor of Arts in English Literature & Sociology from...

212-896-0628
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