Telepsychiatry’s Future: COVID-19’s Public Health Emergency End Explained

During the COVID-19 pandemic, use of telehealth exploded, due largely in part to the public health emergency that eased some prescribing restrictions and made virtual healthcare an attractive financial option to both clinicians and patients.

As of May 11, 2023, though, that public health emergency will come to an end, as announced by the Biden administration. Psych Congress Network connected with Edward Kaftarian, MD, founder and executive chairman of Orbit Health Telepsychiatry, to hear more about the implications of this policy decision for telehealth providers.

In Part 1 of this video interview series, Dr Kaftarian explains the flexibilities that will continue and which will not. He also covers the relationship between the public health emergency, the Ryan Haight Act, and provider prescribing powers.

Don't miss Part 2 of this important video series--find it here! In the meantime, visit our Telehealth Excellence Forum for more expert insights on practicing psychiatry in a virtual setting.

Read the Transcript:

Edward Kaftarian, MD: Hi, my name is Dr. Edward Kaftarian. I'm a psychiatrist and also on the steering committee for Psych Congress. I'm the Executive Chairman and Founder of Orbit Health Telepsychiatry.

So we're entering a really interesting time right now. On January 30, 2023 the Biden administration announced that the public health emergency is going to end officially May 11, 2023. So if you're like me and you're a telehealth provider, you have some questions about what the post-pandemic world is going to look like, how the public health emergency ending is going to affect your practice. And I can tell you that it will affect your practice. There are some flexibilities that will continue, but I think there's going to be some things that we got to do differently as well.

So let me talk about some of the telehealth flexibilities that will continue. Number one, and this is all basically about the Centers of Medicaid and Medicare Services (CMS) and how they are leading the way for the rest of the market and the rest of the industry to follow. So whatever CMS does, the industry typically follows. So this is really important.

One of the things that will continue is that CMS will continue to reimburse for remote visits regardless of where the provider and the patient are located. So that's good news. Part of this is the acute hospital care program that CMS allows reimbursement for, that will also continue. [Federally qualified health centers (FQHCs)] and rural health clinics will still be able to get reimbursement for telehealth services. So telehealth services will continue to be part of these programs.

Most importantly, we're going to continue to be able to get reimbursement for mental health services without having an in-person requirement for mental health services.

Now, there are some other flexibilities that will continue that may not be very relevant to your practice, but still helpful. For example, the range of accepted eligible providers will continue to stay expanded. For example, occupational therapists, speech and language pathologists, physical therapists--they will all still be able to get reimbursement for their services and that may affect the partners that you have in your practice. And so those are some of the flexibilities that will continue.

Now, unfortunately, not all of the flexibilities will continue. As of May 11, 2023, when the public health emergency ends, the exception for controlled substances, i.e. The Ryan Haight Act that allowed for the public health emergency exception to prescribe controlled substances remotely, that's going to end. So we're not going to be able to prescribe controlled substances via telehealth unless we meet some other exception as it pertains to the Ryan Haight Act.

The other thing that will end is CMS will no longer have payment parity. So the reimbursement for telehealth services are going to be lower than the reimbursement for in-person visits. And this will actively discourage the use of telehealth, unfortunately.

Another area that is going away is the so-called enforcement discretion for HIPAA. So during the pandemic, providers were able to use non-HIPAA secure technologies, such as the regular Zoom, the non-HIPAA compliant Zoom version, FaceTime, and Google Hangouts. So until May 11, 2023, we are able to use these non-HIPAA compliant technologies without fear of enforcement. In other words, HIPAA had discretion, like the Office of Civil Rights had discretion on how HIPAA was going to be enforced. Not that it wouldn't be enforced at all, but that perhaps the good faith of the providers would be taken into consideration for certain technologies.

There were certain technologies that were never allowed and continue to not be allowed for telehealth visits such as TikTok, Facebook, and Instagram. So that has not been approved and will not be approved. So keep in mind that these technologies come May 11, 2023, there's going to be a stricter enforcement of HIPAA-compliant technologies.

Another area that is going to be problematic is virtual supervision. So until now, CMS was allowing supervision of providers remotely through video conferencing technology. And that is no longer going to be something that is reimbursed or approved by CMS.

Remote patient monitoring is going to change as well. So during the pandemic, during the public health emergency, remote patient monitoring was allowed for both established and new patients. Now when the public health emergency ends, it's going to only be allowed for established patients. And what I mean by remote patient monitoring is remotely monitoring things like vital signs and other metrics. And there are mental health remote monitoring metrics as well. That will now only be allowed for established patients, not for new patients.

Finally, you're going to see an end to the cost sharing flexibility. So during the public health emergency, providers could waive copays and deductibles for patients, and they no longer can do that.

So these are some of the areas that are going to change when the public health emergency ends May 11, 2023.

Now that the public health emergency is ending effective May 11, 2023, a lot of providers have questions about how that's going to affect their ability to prescribe controlled substances. I share this concern. Now there is such a thing called the Ryan Haight Act which requires a provider to do an in-person visit with the patient prior to prescribing controlled substances. Now the Ryan Haight Act offers exceptions to this rule and one of them is the telehealth exception that has to do with a public health emergency. Now when there's a public health emergency declared by the Department of Health and Human Services, providers can prescribe controlled substances remotely.

Now this public health emergency exception is going to end and now we're looking for the [Drug Enforcement Agency (DEA)] to provide a special registration so that we can meet the exception to the Ryan Haight Act. So Congress, a couple of years ago, mandated the DEA to come up with a special registration process, which would allow us to continue prescribing controlled substances via telehealth. Unfortunately, the DEA has not done that despite Congress mandating them to do so, and a lot of organizations are trying to put pressure on the DEA to come up with that special registration process.

Now at the time of this recording, the DEA has not come up with that special registration process and so effective May 11, 2023 providers will no longer be able to provide controlled substances to patients unless they meet some other exceptions, such as if the patient is in a DEA-registered hospital or clinic or some other exceptions such as they're part of the [Veterans Administration (VA)]. And there are a number of other exceptions that you can look at. But the main problem is that the DEA has not come up with a special registration process.

Edward Kaftarian, MD, is found and executive chairman of Orbit Health Telepsychiatry. Dr Kaftarian is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the world-renowned Johns Hopkins Hospital, he is board-certified in psychiatry, forensic psychiatry and addiction medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world.