Telehealth in behavioral health is here to stay.

The behavioral health industry must now double down on efforts to ensure post-COVID era telehealth regulations don’t inadvertently make telehealth a second-class care modality, according to a panel at the Behavioral Health & Well-Being Congress.

“We are in a chicken and an egg situation where if we’re concerned about telehealth and we put a bunch of restrictions on telehealth … we will create the [situation] that we were worried about because then we create telehealth that is substandard care and then it can’t be equal to in-person care,” Chris Adamec, vice president at the advocacy group Alliance for Connected Care and the health care-focused lobbying firm Sirona Strategies, said.

The critical aspects of the conversation about go-forward telehealth regulation include concerns about the quality of care offered, its accessibility and its safety.

For instance, potential regulations around how providers prescribe medication and interact with new patients, Adamec said, could limit the utility of telehealth based on unfounded concerns.

“I think that the big risk for telehealth and telemental health is that without adequate data we make rash policies that undermine the ability of clinicians to practice through telehealth.” Adamec said.

The transition out of the present post-COVID-onset moment and the regulatory framework of the federal public health emergency will frame up much of the future for behavioral health.

Telehealth and behavioral health have become so closely intertwined following the onset of the pandemic that 41% of commercial and Medicare telehealth claims in June were mental health-related procedures. Additionally, mental health was included in 63% of diagnoses, according to the nonprofit health claims data clearinghouse Fair Health.

“From a research standpoint, tele-behavioral health is here to stay,” Dr. Tisamarie Sherry, deputy assistant secretary for planning and evaluation for the Office of Behavioral Health, Disability and Aging Policy (ASPE), said.

But what telehealth looks like as a part of behavioral health and how it’s regulated and paid for are vital open questions at the federal and state levels. Panelists called for additional study and data to best inform policy decisions moving forward. However, this might be a problem with only a few years of widespread adoption of telehealth under the industry’s belt.

“It has tremendous staying power and is clearly something that patients and providers like,” Sherry said, adding that telehealth use is in a transition period. “What needs to help inform that transition going forward is some evidence to guide us about what’s the optimal delivery model to do this.”

The federal government has an additional interest in the future of telehealth regulation given its impact on Medicare beneficiaries.

Earlier in the year, the Office of Inspector General for the U.S. Health and Human Services Department released a report finding that telehealth was vital to Medicare beneficiaries’ access to behavioral health and found that 43% of behavioral health visits were conducted via telehealth and accounted for about 12% of all telehealth visits regardless of care type from March 1, 2020, to February 28, 2021.

The increase in rates has had a number of positive impacts on behavioral health. A few include drops in no-show rates, higher retention, better medication adherence and lower treated overdoses, said Shelley Doumani-Semino, senior behavioral health medical director for Aetna, citing a joint study released by several federal health agencies.

Random drug testing is a bit of a hang-up for telehealth, Doumani-Semino, a practicing addiction-boarded provider and psychiatrist who works exclusively via telehealth, said.

“We really need to make sure that these waived regulations don’t stay waived and it’s done forever,” Doumani-Semino said. “I have patients who are already talking to me about what happens when this goes away and no one likes to see that anxiety in patients … I hate to see them starting to worry about their treatment because if I have to close my panel of patients down because I can no longer do this and I don’t have an office where are they going to go?

“There just are not enough practitioners who can pick up this treatment.”