Report: Telemental Health Expands, but Barriers to Widespread Participation Remain

Support for mental health services provided by telehealth continues to rise across the U.S., but obstacles to participation remain in several areas, per a recent report from the law firm Epstein Becker Green.

EBG’s fourth annual Telemental Health Laws Survey noted that all 50 states and Washington, D.C., now provide at least some level of coverage for telehealth services for Medicaid members. A combination of a shortage of behavioral healthcare providers and a continued shift toward a digital, mobile-friendly society overall has fueled the emergence of telehealth-based treatment options, says Amy F. Lerman, a member of the EBG Health Care and Life Sciences practice who co-authored the study.

“Telehealth technology … we’ve seen even in just the last year continue to be an appreciated strategy to increase access to different types of behavioral health providers,” Lerman says. “It’s gaining a lot of validation, and is supported by the fact that states are continuing to provide guidance and to regulate this area.

The opioid epidemic is also driving an increase in telehealth activity in several states, Lerman says. Arizona, for example, expanded its coverage to include treatment for substance use disorders, following in the footsteps of states such as Indiana, Michigan and Missouri which in recent years have passed legislation to expand remote prescribing of controlled substances for the treatment of SUD.

“As we’ve watched over the past year to see where states are regulating and the sub-issues they are regulating in, quite a bit of it does appear to focus on strategies to help deliver substance abuse disorder treatment and services to patients using telehealth,” Lerman says. “That definitely seems to be a driver for a lot of what we’re seeing.”

Barriers remain

The report outlined several factors that are still impeding the progress toward more widespread participation in telehealth initiatives by providers and patients:

Parity laws: Telehealth parity laws, designed to ensure equal coverage for remote services as those provided in person are, in many states, loose and ineffective, EBG said in its report, adding that 11 states still lack telehealth parity laws entirely.

Limited options: With few exceptions, remote prescribing of controlled substances is prohibited without patients first receiving an in-person examination, per the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.

“Remote prescribing is a really good area for us to continue to watch in the coming year,” Lerman says. “While states have spoken in their guidelines about remote prescribing parameters and what providers desiring to prescribe need to be doing, we do have still a federal-state conflict between what the Controlled Substance Act says and what states may be saying with respect to prescribing practices.”