States Lead the Way in Adapting Telehealth to Meet Mental Health Needs

Faced with a nationwide opioid abuse crisis and a surge of people needing mental health services, states are moving to embrace telehealth as a means of expanding access to treatment. But the path to better care is still bumpy.

State adoption of telemental health guidelines “is obviously continuing to grow, (and) trending in the right direction,” says Amy Lerman, a member of the Epstein Becker Green law firm who specializes in telehealth and telemedicine law. “But every state has its own set of rules.”

Lerman, the lead author of Epstein Becker Green’s fourth annual Telemental Health Laws Survey, which was released last October, says there was little state guidance in telehealth for mental and behavioral health services four years ago. Few providers were using connected health platforms, and state medical boards weren’t feeling the pressure to develop guidelines.

But all that has changed, she said during a recent episode of Healthcare Strategies, the Xtelligent Healthcare Media podcast series. Now, with the opioid abuse crisis and a nationwide mental health crisis, there’s a real demand for those services,

“In an effort to solve the problem, states are trying to be very creative, very flexible,” she says.

The challenge with behavioral health is that there are so many different types of care providers who could potentially use telehealth to deliver care, starting with psychiatrists and psychologists but also including therapists, counselors and social workers.

State professional boards “have taken notice of the fact that providers who hold the licenses in these states would like to have guidance,” Lerman says. But there’s limited guidance from the federal ranks, and restrictions on everything from prescribing controlled substances to the designation of the patient’s home as a telehealth site.

“Prescribing is, i think, from a lot of professional standpoints, a necessary component that they want to be able to enhance that care experience - they want to be able to do it,” Lerman says, but they’re hamstrung by US Drug Enforcement Agency rules that limit the use of telemedicine to prescribe controlled substances. Congress and the DEA are moving toward easing those rules, she says, but that hasn’t happened yet.

Reimbursement is also an issue, particularly in Medicare. Coverage parameters haven’t changed, she says, and ”that’s a significant population of patients, many of whom would probably benefit a lot from being able to receive certain types of care in the comfort of their home, but a patient’s home is not an appropriate site of care yet under Medicare.”

And that’s where the states are stepping in and loosening the restrictions around Medicaid and private payer coverage.

 “It is a long, slow climb for providers of telehealth services to figure out how they can secure the various contracts and really be able to work with a population that depends on whatever the insurance coverage that they may have to get access to healthcare because otherwise that’s a segment of the population that these providers are probably not going to have easy access to.”

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