Attention Massachusetts Psychiatrists

The Massachusetts Medicaid Program (MassHealth) recently set forth new policies permitting coverage and reimbursement for certain mental health and substance use disorder services delivered via telehealth by MassHealth-participating Community Health Centers, Community Mental Health Centers and Outpatient Substance Use Disorder providers.

Under the new policies, the telehealth modality utilized must “conform to industry-wide compressed audio-video communication standards for real-time, two-way, interactive audio-video transmission.” Asynchronous or interactive audio with store & forward is not an eligible modality under the new policies, and only behavioral health professionals who have been trained in the provision of telehealth services, including training in the use of the telehealth equipment, may provide telehealth services. Moreover, providers delivering services via telehealth must have a training program in place to ensure the competency of all staff members involved in the delivery of services via telehealth.

Additionally, the new policies set forth additional requirements for prescribing via telehealth. For more information, see: MassHealth All Provider Bulletin 281 (January 2019), https://www.mass.gov/files/documents/2019/01/23/all-provider-bulletin-281.pdf.

Attention Oklahoma Psychiatrists

Oklahoma recently enacted a new law limiting the common insurance practice known as “Step Therapy.” Step Therapy, also known as “Fail First,” is an insurance policy process that requires the cheapest drug to be prescribed to a patient first, rather than the medicine the doctor originally prescribed based upon clinical judgement. Oklahoma’s new law requires any health insurance plan that utilizes a step therapy protocol to use clinical practice guidelines based on peer-reviewed and widely accepted medical practices when implementing the protocol, to ensure that step therapy protocols are based on the most accurate, up-to-date, evidence-based standards for disease treatment. Additionally, the new law requires that insurance companies grant step therapy exceptions in cases when:

• the prescribed drug will likely cause an adverse reaction or harm;
• the prescription drug will likely be ineffective;
• the patient has already tried the prescription drug and discontinued use;
• the prescription drug is not in the best interest of the patient; or
• the patient is stable on another prescription drug.

Further, insurance providers must respond to requests for exceptions or appeals within 72 hours, unless urgent circumstances exist, in which case insurers must respond within 24 hours. Patients may appeal any exception decision. For more information, see: http://webserver1.lsb.state.ok.us/cf_pdf/2019-20%20ENR/SB/SB509%20ENR.PDF

FDA Reclassifies Electroconvulsive Therapy Devices as Moderate Risk in Certain Cases

The U.S. Food and Drug Administration (FDA) recently reclassified electroconvulsive therapy (ECT) devices from Class III (higher risk) to Class II (moderate risk). The reclassification applies to ECT devices used in treating catatonia or a severe major depressive episode (MDE) associated with major depressive disorder (MDD) or bipolar disorder (BPD) in patients age 13 years and older who are treatment-resistant or who require a rapid response due to the severity of their psychiatric or medical condition. The FDA first proposed reclassifying these devices in 2016.