Telehealth Access for Behavioral Health Expands, But Regulatory Issues Remain

Telehealth services are becoming increasingly accessible for behavioral health providers and the patients they serve. However, regulatory barriers continue to prevent the technology from becoming more widespread.

All 50 states and the District of Columbia now provide some degree of coverage for telehealth services for their Medicaid members, according to the latest Telemental Health Laws Survey from Epstein Becker Green, who recently released its annual state-by-state breakdown of behavioral telehealth services nationwide. And beyond that, Medicare recently expanded coverage for telehealth treatment of beneficiaries with opioid use disorder (OUD).

Broadly, the survey suggests that there’s more interest and acceptance for using telehealth to address behavioral health needs than ever before, largely thanks to the opioid epidemic and the legislation it has helped inspire.


“The significant value derived from utilizing telehealth technology in tackling mental and behavioral issues, such as substance use disorders (SUDs), is apparent in the number of bills introduced before the U.S. Congress that include the use of telehealth technology as a strategy,” co-authors Amy Lerman and Francesca Ozinal wrote. “These bills have been introduced at a constant pace, through both the federal and state legislatures.”

For the most part, this movement is a good sign for providers, Lerman told Behavioral Health Business in an email.

“This expansion of telehealth availability promises greater flexibility in how professionals can deliver critically important behavioral health services, as well as the potential to increase the reach that providers have into specific populations of patients in need of behavioral health services,” Lerman said.


However, in many areas and for certain populations, regulatory roadblocks are preventing behavioral telehealth services from becoming more widespread.

For the most part, telehealth regulations vary by state, which can create problems for providers when it comes to getting certified, as they must be licensed in the state in which they operate, as well as in the states where the patients they serve reside.

As a result, it can be complicated and time consuming for providers to enter new areas via telehealth, according to Liberty Eberly, chief medical officer at InnovaTel Telepsychiatry, a nationwide network of behavioral health professionals who provide care remotely.

“By the time a clinic contacts us and says, ‘We need 40 hours of psychiatric time,’ [before] we could get that going, it could be six months,” Eberly said. “It shouldn’t take that long.”

Eberly made those comments earlier this month at the Payer’s Behavioral Health Management and Policy Summit in Washington, D.C., hosted by World Congress, a global health care conference provider, and the Association for Behavioral Health and Wellness (ABHW), a national group for behavioral health insurers.

There, she sat on a panel about the opportunities and challenges that telehealth presents for the behavioral health industry.

Fellow panelist William England — the directory of the office for the advancement of telehealth in the federal office of rural health policy at the Health Resources & Services Administration (HRSA) — echoed Eberly’s sentiments.

In addition to the patchwork of state telehealth rules, England pointed to the regulatory uncertainty created by the direct-to-consumer economy as a pain point for providers.

“That’s where things are going, and that presents a whole host of new problems,” he told conference attendees. “Your smartphone is quite adequate as a telehealth device, but who regulates that?”

In instances such as that — when a patient is receiving services on their private phone through an app — it can be unclear who should be paying for services.

In other cases, regulations prevent certain reimbursement for telehealth services that providers believe are necessary, such as medication-assisted treatment (MAT).

Currently, the Ryan Haight Act says doctors can’t prescribe controlled substances electronically until after they’ve conducted an in-person examination. But that’s not always possible for those living in rural areas who may need medications to help kick opioid use disorder (OUD).

While there are some exceptions for telehealth services, providers agree they’re insufficient. The Drug Enforcement Administration (DEA), who enforces the act, is working on a proposal to fix that, which was set to come out in October 2019. It would create a special registration process for telehealth providers offering MAT for OUD patients.

“We are waiting for that special registration grant to come out from the DEA right now,” panelist Max Isaacoff, government affairs and policy manager at the National Rural Health Association, said. “They’re a little behind on that, so that should be coming out shortly.”

While providers must wait on the DEA, they shouldn’t hesitate to contact their state representatives in an effort to improve telehealth regulations on a larger scale, Lerman, author of the aforementioned telehealth survey, told BHB.

“To help further access, and more importantly, regulatory clarity as to how these services can be delivered compliantly, behavioral health providers can advocate for continued focus on these issues by the state professional boards, so that the conversations not only continue at the state board level but also so that the state boards have assurance from their members that greater access to telehealth technology is a profession-desired priority,” she said.

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