The Trump administration continues to loosen health care regulations in an attempt to better equip providers to deal with COVID-19.
For the behavioral health industry, the newfound flexibilities make it much easier for providers to deliver comprehensive telehealth services. Due to the crisis, the government is looking past certain HIPAA rules, allowing providers to deliver services in new ways, waiving some restrictions on medication administration and giving states more power to add additional flexibilities of their own.
With new rules coming out every day, it’s likely providers will see even more regulatory relief down the line.
“We’ll continue to see more changes,” Chuck Ingoglia, president and CEO of the National Council for Behavioral Health, told Behavioral Health Business. “We’re just at the tip of the iceberg. My impression is that the White House and the Centers for Medicare and Medicaid Services are committed to giving as much flexibility as possible to keep vital health care services available.”
For now, though, here’s what behavioral health providers need to know.
The Ryan Haight Act usually prohibits providers from prescribing drugs to patients they haven’t first seen in-person, except under special circumstances. But the Drug Enforcement Administrations (DEA) says licensed clinicians don’t have to worry about that rule right now due to the current public health emergency.
Now, providers can prescribe medications to patients they haven’t seen in person, as long as they’ve connected with them via audio and video first.
That means behavioral health providers have the go ahead to prescribe antidepressants, medication-assisted treatment (MAT) medications and other drugs after virtual visits.
“We and many others have been advocating for a change in that policy for about three years,” Ingoglia said. “Yesterday in light of the COVID-19 outbreak, that was finally [temporarily] changed.”
Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has relaxed regulations to make it easier for certain patients to take home MAT medication like buprenorphine and methadone. The rules allow patients to take 28 days worth of medication home at a time to cut down on clinic trips.
SAMHSA also advised addiction treatment providers they can use their discretion in certain instances on 42 CFR Part 2 — which limits what substance use disorder records and information can be shared without patient consent. With the flexibilities, providers can share information to get patients necessary telehealth services if they believe a medical emergency exists.
Providers don’t have to worry about certain HIPAA rules when delivering telehealth services either.
The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced it won’t go after providers for violations associated with using everyday technology to serve patients remotely during the COVID-19 public health emergency.
In other words, providers can use technologies such as tablets and cellphones to serve patients, even if they’re not HIPAA compliant.
Medicaid, state-by-state rules
The federal government is also giving states newfound power to introduce telehealth flexibilities of their own.
“[It’s] fascinating is to see what’s happening at the state level and how quickly states are changing their telehealth policies,” Ingoglia said. “That’s both in terms of what kind of services can be delivered by telehealth, to what patients, by what types of providers and in what settings, as well as by what mode of communication.”
For example, most state Medicaid programs usually require telehealth to have both a telephonic and video component, but in light of COVID-19, some states are allowing providers to contact patients by telephone only.
“That is huge,” Ingoglia said.
Additionally, CMS recently issued an 1135 waiver to relax certain rules and Conditions of Participation (CoPs) for Medicare and Medicaid health care providers. Tuesday, Florida became the first state to have its waiver granted.
“States have the ability to use them in a lot of different ways,” Ingoglia said. “It can have broad implications for behavioral health if states want it to.”
While Medicare isn’t the largest payer in the behavioral health space, the Trump administration expanded Medicare telehealth coverage for seniors and encouraged private insurance companies to follow suit.
“[Usually] within Medicare, there are a lot of restrictions on when telehealth can be used, where that provider is located and where the client is located,” Ingoglia said. “And a lot of those rules have been loosen up.”
That includes for mental health counseling, which is now be available to Medicare beneficiaries via telehealth.
Room for improvement
Despite all the recent regulatory changes that benefit behavioral health providers, there’s still room for improvement, Ingoglia said.
For one, he’d like to see more guidance from the federal government on what kind of flexibilities states can implement, as well as for federal agencies to pay more attention to the residential behavioral health sector.
On top of that, he’s hoping for financial relief for nonprofit behavioral health organizations, who won’t benefit from initiatives such as temporary tax relief.
“We need resources to help make sure that the behavioral health system remains stable during and after this crisis,” Ingoglia said.
On top of that, he wants private insurers to step up.
“There’s a lot of activity happening from Medicare and Medicaid, but we need to see private insurers kind of following this lead and making telehealth more accessible and reimbursable.”