The current need for telebehavioral health care

Here’s why telebehavioral health care is needed now more than ever:

• Increased anxiety, isolation and financial stress are heightening the need for MD/SUD services at a time when in-person contact is discouraged.
• There’s growing recognition of the serious MD/SUD implications related to COVID-19, including the expectation of both short-term and long-term impacts.
• COVID-19 has a higher impact on vulnerable populations who have comorbidities like diabetes, hypertension, depression, anxiety and substance use disorder. (See COVID-19: Potential Implications for Individuals with Substance Use Disorders and “Coronavirus Disease 2019 (COVID-19): Psychiatric Symptoms and Disorders.” For statistics on diabetes, hypertension and obesity among COVID-19 patients, see “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area,” an article published on the JAMA website on April 22, 2020.)
• Telebehavioral health care integrated with your medical plan can improve access to and use of cost-effective, high-quality care.

In the current environment, telebehavioral health is proving to be a meaningful alternative to in-person care. Telemedicine providers are reporting a significant increase in the demand for their services, including telebehavioral health services since the start of 2020. (See our April 14, 2020 article, “COVID-19 Drives Digital Health Trends,” and recent research on the U.S. telehealth market.)

Initiatives to promote telehealth

Recent laws have encouraged coverage of telemedicine and loosened regulatory constraints to allow expansion, including the ability for plans to expand telebehavioral health services at least during the health emergency. 

Under the Families First and CARES Acts, when telehealth is available, telehealth related to COVID-19 testing must be paid without cost sharing. (We covered this news in “New Law Addresses Coronavirus Testing, FMLA and Sick Leave.”)

High-deductible health plans with health savings accounts (HSAs) may now provide remote-care services before the deductible is met without jeopardizing the ability of individuals to contribute to their HSAs. (See our web post, “Impact of CARES Act on Health Plans.”) Notice 2020-29 clarified that this change is effective January 1, 2020, but it is temporary and only applies to plan years beginning on or before December 31, 2021.

Medicare has significantly expanded telehealth, including for mental health and substance use disorder conditions, to beneficiaries regardless of where they live. (This policy change is discussed in our web post, “Medicare Telehealth Expansion in COVID-19 Spending Law.”) 

The Department of Health and Human Services (HHS) has provided temporary relief for healthcare providers that use telecommunication methods that may not fully comply with HIPAA.

In addition to federal laws, most states have laws governing telemedicine. State-specific requirements can include provider licensure and state prescribing laws. Many state law requirements have been waived during the COVID-19 health emergency.

While some of these measures are temporary and additional legislation or guidance will be required to address the application of certain rules to telemedicine in the long-term (after the COIVD-19 pandemic), current guidance is enabling plans to make telemedicine more broadly available immediately. 

The importance of this in the behavioral health context is not lost. In answers to frequently asked questions, the Departments of Labor, HHS and Treasury encouraged plan sponsors to promote use of telehealth, including for mental health and substance use disorders.

Implementing telebehavioral health

When implementing telebehavioral health, plan sponsors have options to consider. Some plans may offer telebehavioral health directly through their network providers. These plans may also allow payment for telebehavioral health provided by out-of-network providers under the plan’s regular out-of-network benefits or may allow use of any provider in or out-of-network for delivery of telehealth. Alternatively, plans may offer services through a separate telebehavioral provider network.

Telebehavioral health care programs and providers must be thoroughly vetted. Plan sponsors must carefully evaluate offerings for significant differences. Things to look for include adequate access to evidence-based, medically appropriate care and compliance with applicable laws and regulations. For example, it is important that telemedicine be offered in compliance with the Mental Health Parity and Addiction Equity Act. Plan sponsors should look for the vendor to offer performance guarantees around getting appointments within a reasonable amount of time and having adequate provider specialists (e.g., adult and child psychologists). 

Plan sponsors should also look at the depth and diversity of each vendor’s provider panel. When contracting with a telemedicine network, plan sponsors should ensure that the telebehavioral health networks provide access to both licensed psychologists and psychiatrists who are able to write prescriptions. Moreover, telebehavioral health providers should be able to create customized treatment plans for existing and new mental health conditions. If an individual needs more intense treatment or requires a crisis intervention, possibly requiring hospitalization, the telemedicine provider or practitioner should be able to assist in identifying a center of excellence within the plan’s network. Plan sponsors should also consider how treatment is communicated, including protection of patient privacy.

Successful engagement strategies hinge on individuals being well informed on the program’s existence, perceived benefits for participation and convenience. Plan sponsors should educate participants on availability of the service and illustrate the potential for reducing the participants’ cost share as an effective alternative to face-to-face services. Additionally, telebehavioral health requires a level of tech literacy to engage with the platform via smartphones, browsers or other technical equipment. Since telebehavioral visits may consist of sensitive discussions, individuals should ensure they have a safe and private space to engage with their practitioner.

Segal can assist in navigating the service provider landscape, working with your existing network to implement telebehavioral health and verifying compliance with specific federal and state requirements.