Support for Mental Health Coverage Gains Momentum

Amy Lerman

More federal and state lawmakers are now increasingly supporting coverage for mental health services provided by telemedicine, according to the 2019 Telemental Health Laws survey conducted by Epstein Becker Green (EBG) law firm. 

The survey highlights the following milestones achieved in 2019:

• All 50 states and the District of Columbia now provide some level of coverage for telehealth services for their Medicaid members.

• Earlier this year, Massachusetts approved coverage of telehealth services for its 1.9 million Medicaid members seeking access to psychologists, psychiatrists, psychoanalysts, clinical social workers, behavioral health nurses, nurse practitioners, and professional counselors.

• Kentucky adopted legislation that went into effect July 1, which allows telehealth visits to take place in a patient’s home, and home-based telemental health also has bipartisan support in Congress in the Mental Health Telemedicine Expansion Act (H.R. 1301), which was reintroduced earlier this year.

• Arizona expanded its telehealth law to include coverage of treatment services for substance-abuse disorders.

“We are excited to see telehealth services more widely accepted at the state and federal level,” says Amy F. Lerman, a Member of Epstein Becker Green in the Health Care and Life Sciences practice. “Telehealth is a viable and efficient method of care for patients who require quality treatment that may not be close by. It also gives providers an opportunity to share their services and expertise with underserved segments and geographies they couldn’t serve otherwise.”

Lerman says that since the survey’s original publication in 2016, the primary goal always has been to provide a state-by-state breakdown of the rules and requirements pertaining to provision of telebehavioral health services.

Related: Virtual Care Services Becomes More Mainstream

EBG has collected their information by tracking changes to this research constantly and working on an annual basis to compile these changes and update their survey content, which since 2018 has been available via their free app, Lerman says.

Information to support this survey can be found from Doximity, an online networking service for medical professionals. Doximity found that radiology and psychiatry were the top two specialties most interested in telemedicine opportunities. Mental health services via telemedicine are used in a variety of settings, including private practice, outpatient clinics, hospitals, schools, nursing homes, and correctional facilities.

“Despite a continued shortage of behavioral health providers in the United States, increased use of telehealth technologies as a strategy to increase access to psychiatrists, psychologists, counselors, therapists and other behavioral health professionals continues to gain attention and validation as an alternative model of care delivery,” she says.

Barriers continue

While acceptance of telehealth services continues to grow, obstacles remain that limit participation of providers and patients. These barriers, according to EBG, are:

• State parity laws remain loose and ineffective. Telehealth parity laws are intended to ensure the same coverage of services provided in person. Yet the laws themselves are often not very robust, simply stating telehealth services must be medically necessary (in order to be covered) or that payors should not exclude services solely because they were provided through telehealth.

• 20% of U.S. states lack parity laws. Telehealth parity laws are currently in effect in 39 states and the District of Columbia. Momentum came to a halt last year, as payers, providers, and legislators in several states could not reach agreements on reimbursement levels.

• Treatment options are limited. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prohibits remote prescribing of controlled substances (except under very restricted exemptions), unless an in-person examination between the prescribing physician and the patient has taken place.

Progress to continue into 2020

Current events and issues, such as the opioid epidemic, have put more pressure than ever before on federal and state legislators to pass laws that promote access to telehealth services. Providers should continue to monitor developments in federal and state laws, regulations, and policies to capitalize on telehealth opportunities while maintaining compliance with applicable laws.

According to EBG, areas for opportunity and expansion include: 

• State professional licensure boards beyond state Boards of Medicine expanding access to telehealth services.

• Medicare reimbursement for telehealth services to treat opioid use disorder.

• DEA regulations that would allow for the long-awaited “special telemedicine registration,” which would enable physicians to prescribe controlled substances without conducting a prior in-person examination first, to become a reality.

Lerman says that healthcare executives can benefit from reviewing EBG’s survey because it provides both a micro and macro view of the changes in the healthcare landscape if they were to adopt telehealth technology into their care delivery models.