COVID has impacted every aspect of daily life, and these changes have affected people’s mental health, making telehealth services for behavioral health more important than ever. Decreased physical activity due to disruption in exercise routines, increased social isolation, and economic decline all have the potential to adversely affect behavioral health. Unfortunately, some people manage social isolation and pandemic-related stress by increasing adverse health behaviors such as smoking, alcohol, or drug use. Others may become susceptible to mental health issues, such as depression or anxiety.

In light of these challenges, digital telemental health has become an increasingly valuable tool for improving access to behavioral health practitioners. The use of telemedicine in the U.S. was minimal prior to COVID, but since 2020 expansion of telemedicine has skyrocketed as policymakers, insurers, and health systems sought ways to deliver care to patients in their homes. According to the U.S. Department of Health and Human Services (HHS), telehealth services had a 63-fold increase with Medicare patients in 2020. In response to the growing demand for telemedicine, lawmakers have introduced new telehealth policies across the spectrum of healthcare. Telepsychiatry in particular has benefited from these changes.

Let’s take a look at how many aspects of telehealth for behavioral health — its popularity, its challenges, some best practices, and even credentialing — have changed over the past couple of years.

From Skeptics to Fans

Just a few years ago, telemedicine had many skeptics, including those who wanted to have a physical examination and in-person interaction with their physicians, those who were intimidated by technology, and those who doubted the quality of care through telehealth services. Since COVID, patients have experienced many benefits of telemedicine, such as eliminating travel, receiving care from the comfort of their homes, shorter wait times, quicker access, and more affordable care.

Credentials verification of telehealth providers has also changed throughout the pandemic. For example, waivers were put into place temporarily lifting the requirement that providers be licensed in the states that they provide telehealth services (see below). These license verification requirements have continued to change, so keeping up with regulations in telehealth is vital to compliance.

Regulations and credentialing for telehealth have been adjusted to meet the growing demand for remote healthcare. In the Comprehensive Accreditation Manual for Behavioral Health Care, the Joint Commission requires credentials verification of telehealth providers, including all who provide care, those who volunteer, and behavioral health students. Three important regulations outlined by the Joint Commission include:

1. Telehealth visits must be conducted using non-public facing applications as telemedicine communication platforms. Providers are encouraged to notify patients that these third-party applications potentially pose privacy risks and should enable all available encryption and privacy modes when using such applications. Public-facing applications such as Facebook Live and TikTok are not allowed for telehealth communications.
2. Telepsychiatry services where digital intervention is allowed include:

• Treatment of COVID-related symptoms
• Mental health counseling for individuals or groups
• Psychiatric consultations
• Psychological evaluations
• Adjustment of prescriptions

3. Audio-only telehealth is allowed for specific services. The Centers for Medicaid and Medicare Services (CMS) has waived video technology for certain services, and audio-only telehealth is authorized for telephone evaluations, management services, behavioral health counseling, and educational services.

Top Telehealth Challenges for Behavioral Healthcare

Although telemedicine provides increased access to mental health services, digital visits also present challenges. Organizations should be aware of these challenges in order to mitigate risk in the following areas:

• Digital Security in The Medical Facility. Note the approach of the American Psychological Association: “Psychologists are encouraged to conduct an analysis of the risks to their practice setting, telecommunication technologies, and administrative staff, to ensure that client/patient data and information is accessible only to appropriate and authorized individuals.”
• Limited Access to Technology or Outdated Technology. Rural areas with limited internet access or outdated technology may impair video or audio quality or prevent patients from accessing services entirely.
• Reimbursements With No Federal Statutes. Parity (equality or uniformity) is a significant issue as telepsychiatry is implemented. Currently, no federal statute requires payers to reimburse telemedicine encounters at the same rate as in-person services or even secure payment at all. Currently, only 10 states have true payment parity laws for reimbursement rates for in-person and telehealth visits: Arkansas, Delaware, Georgia, Hawaii, Kentucky, Minnesota, Missouri, New Mexico, Utah, and Virginia.

Telemental Health Best Practices 

To help address challenges and provide safe, effective services, the American Psychological Association and the American Psychiatric Association have issued best practice guidelines for telemental health or telepsychiatry. These guidelines span from privacy and security to infrastructure to accessibility. Some guidelines for best practices in telemental health include (but are not limited to) clinical, administrative, and technical dimensions.

• Privacy During the Visit. Psychologists should discuss the clients’ role in ensuring privacy and security within their environments because the psychologist cannot control those factors remotely.
• Clear Communication on Consent and Fees. The APA advises that clients/patients may have varying degrees of technological skills or ability to thoroughly read and understand informed consent and billing. Due to limited access or outdated technology, verbal explanations and consent may be necessary to augment written consent and billing. Verbal discussions around fee structure may “also include discussion about the charges incurred for any service interruptions or failures encountered, responsibility for overage charges on data plans, fee reductions for technology failures, and any other costs associated with the telemedicine services that will be provided.”
• Ongoing Changes in Regulations. As the pandemic continues, regulations affecting telehealth have changed many times and continue to change. Interjurisdictional practice has become more prevalent with telehealth providers. At the start of the public health emergency, HHS waived requirements for physicians or other healthcare professionals to hold licenses in the state in which they provide telemedicine services with respect to Medicare and Medicaid services. While laws and regulations around credentialing and multi-state licenses in telemedicine are being streamlined, healthcare organizations should be aware that laws and regulations also vary by state.

Credentialing and reimbursement for telehealth will continue to change as remote healthcare grows. Verisys will monitor changes in telehealth regulations and will keep you informed and in compliance.

Is your organization prepared for the future of telemedicine? Contact Verisys today to learn how we can get you prepared.

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