Psychotherapy practice and Coronavirus
Update: March 20, 2020
There are reports that the Governor of Illinois JB Pritzker, just opened the door much wider in certain cases. More specifically, his announcement applies to “all health insurance issuers regulated by the Department of Insurance to cover telehealth services.” He is allowing Teletherapy to be utilized by these policies. And apparently all HIPAA requirements are waived as well for this group of insurance policies. That means that cell phones, Facebook Messenger, Google Hangout, FaceTime, or Skype can all be used under these rules.
But be careful. By no means does this apply to all health insurance. Just the ones regulated by the Department of Insurance in Illinois. While not a small group, there are many policies that are regulated under ERISA laws and they would be regulated by a different set of rules.
My recommendation is to still verify every client’s insurance policy on teletherapy restrictions. There are too many different regulating authorities to be confident without that verification. Chins up.
Update: March 19, 2020
Well, the rumors were not all correct, at least regarding BCBS of Illinois. BCBSIL posted an updated policy here. It references an older document from March 10 that only allowed 30-minute teletherapy sessions. The new document, dated March 18, extends that coverage to basically all the mental health codes we typically use. This is good news. The document makes no mention of which telehealth platforms will be accepted. Most are presuming that they will not check nor care as long as it is HIPAA compliant. Also good news.
Of course, there is still the need to verify each client’s plan to be sure it does not exclude teletherapy. Some employer-funded plans administered by BCBS may exclude teletherapy though there will be lots of pressure to change that limitation.
Update: March 18, 2020
Rumors, rumors, and more rumors. Yes, insurance companies are getting onboard with teletherapy but they are giving little firm guidance on billing for them or which teletherapy platforms will be acceptable. For example, BCBSIL posted a one-page sheet and took it down in 8-hrs saying they will post something on Friday. Will it happen that way? No one knows.
And the teletherapy platforms are crashing and unstable. No doubt the teletherapy companies are scrambling to increase capacity ASAP.
The bottom line, this is not going to go smoothly. For more on how to lead in a crisis see: Matching one’s leadership style to the environment. I wrote it a couple of years ago but the principles remain the same.
Hang in there.
Update: March 17, 2020
As expected, insurance companies are getting onboard with teletherapy. From what I heard yesterday, Aetna, Cigna, Magellan, United Behavioral Health (with a signed attestation form), BCBSIL, and Medicare have all signed on.[Update 3/17/2020 at 10:00 am. BCBSIL took down the document that was posted last night saying that they are updating it. But they are now saying they will pay for only a 30-minute session (90832). Stay tuned.]
These are rumors and you should check in your state and with your provider relations department in each insurance company. Guidelines are changing by the minute.
Those of you that are new to teletherapy, some practices are creating two versions of “cheat sheets”–one for clients and one for clinicians.
Again, for those new to teletherapy, I have heard people sign up with Zoom.us, Doxy.me, and Thera-link.com but there are many others that are available, good, HIPAA compliant, and encrypted from device-to-device. That is what you want. Regular Facetime and Skype will not due. I am also hearing that these sites are crashing as they ramp up for the new loads. Fun for all.
One more idea: Some have been having those in the most vulnerable populations wait in there car. Then the therapist texts them when they are ready. Extraordinary times.
Send a message on how it is going. david@GrowingOurPractice.com. Stay safe.
Update: March 16, 2020
Today I am hearing about practices that are going to a fully online presence. In other words, no in-office psychotherapy. And I know some practices that are starting a teletherapy practice for the first time. That is to say, they have never done online therapy before.
Why? The CDC came out with a new notice:
CDC, in accordance with its guidance for large events and mass gatherings, recommends that for the next 8 weeks, organizers (whether groups or individuals) cancel or postpone in-person events that consist of 50 people or more throughout the United States.Get your mass gatherings or large community events ready as of 3/15/2020
Could this be a game-changer for teletherapy? Stay tuned.
Psychotherapy practice and Coronavirus. March 15, 2020.
No mental health practice had a ready-made plan for these times. No one has a file called “Psychotherapy practice and Coronavirus: Just in case.” Practicing mental health in the age of the Coronavirus is new for everyone. (Here is a link to what the Center for Disease Control (CDC) is saying about the Coronavirus.) It is truly one of those “Black Swan events” that financial people talk about.
Practice owners and leadership teams are gathering every day to develop policies to make their offices sanitary. They want to instill confidence that the office is safe and germ-free. The goal is that we will be able to continue providing psychotherapy to those that need it.
Here is what I am hearing from mental health practice owners on some of their actions.
Notices to existing and former clients
Some practices have email address lists of existing and former clients. They are sending out emails saying some of these things.
- Closely monitoring guidelines from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and county health departments
- Increasing the frequency of cleaning our public areas. (Some are spelling out that they are cleaning 3 times a day. Some are just leaving a general message.)
- Highlighting the option of teletherapy, if they have a system in place. Along with this option, they are letting clients know that this requires checking with their insurance carrier to verify teletherapy benefits.
More on teletherapy and phone therapy
I cannot think of a more practical time for teletherapy and phone sessions. But this requires some planning and training. For instance, below are links to organizations with guidelines for teletherapy. There are more:
- American Psychological Association Guidelines
- Association of Marriage and Family Therapy Regulatory Boards Guidelines
- Here is a link to sign-up for Free Guidelines from the American Association of Marriage and Family Therapists
- Here is a list of the State Rules and Regulations for teletherapy from the Telehealth Certification Institute
FYI, on March 6, 2020, H.R. 6074 (“Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020”) was signed into law. It did reduce some restrictions for telehealth and Medicare. Unfortunately, it is NOT clear that they apply to teletherapy. Read more here.
Meanwhile, we are in a very fluid place right now. That said, I would not be the least surprised to see updated notices from insurance companies and government entities. I hope that they open things up. Certainly, it is clear that those in charge at all levels are figuring it out as they go. While this is frustrating, we are in new territory. No doubt we will figure this out over the next few months.
And on telephone therapy? That too is pretty fluid. About three years ago, insurance companies in my area, Chicagoland, came up with a CPT code for teletherapy and a reimbursement schedule that paid much less than a regular session. They clearly were tightening things up. Will that change? We will have to wait and see. Unfortunately, nothing is clear yet.
What are practices doing in their offices?
Daily, new policies are getting established in many mental health practices. Some of the more common things I am hearing are these:
- More hand sanitizer and disinfectant wipes in the lobby and public areas
- CDC posters in public areas that encourage good behavior for fighting the Coronavirus. (Here is a link to a great CDC poster).
- Removal of magazines, children’s toys, and books from our waiting areas
- Elimination of late cancel fees for any signs of illness
- Permission for therapists to send ill clients home
- Commitment from management to keep the staff informed.
- Informing all staff if a client becomes ill with the coronavirus
Psychotherapy practice and Coronavirus. Doing our best
There are multiple reasons for taking these measures for a psychotherapy practice at this time of the Coronavirus. First, we want our staff to feel confident and safe in coming to work. Second, we want our clients to know we are keeping the environment clean for them. Furthermore, we know this is a stressful time. We want to be part of the solution. And finally, crises can bring out the best or worst. Therefore we want to be in the “best” camp.
Meanwhile, if you are looking for more resources, consider these:
While psychotherapy practice and Coronavirusthis is a new crisis, practice owners are no strangers to managing crises. I have written on crisis management in mental health in these posts:
Mental health has faced many other challenging situations, and we are still here. For example, here is a post on challenges in the last decade or so.
And on a smaller scale, here is a post about outgrowing our office space.