Telehealth services have made tremendous strides in the behavioral health sector, offering patients more flexible, accessible, and convenient options for receiving care. Behavioral health providers are increasingly embracing telehealth to meet the growing demand for services, particularly in light of the ongoing opioid epidemic and the rise in mental health issues. Despite the rapid advancements, regulatory barriers continue to hinder the widespread adoption of telehealth, preventing it from reaching its full potential. While progress is being made, further changes are needed to ensure that telehealth services can be delivered seamlessly across state lines and to all populations in need.
The Growth of Telehealth for Behavioral Health
Recent research shows that telehealth is becoming more accessible for behavioral health providers and their patients. According to the latest Telemental Health Laws Survey from Epstein Becker Green, all 50 states and the District of Columbia now provide some degree of coverage for telehealth services for Medicaid members. This expansion is a significant milestone in making telehealth services more available to underserved populations. In addition, Medicare recently expanded its coverage for telehealth treatment specifically aimed at beneficiaries with opioid use disorder (OUD).
The increased availability of telehealth services reflects growing interest and acceptance of telehealth as a viable option for treating behavioral health conditions. The opioid epidemic, in particular, has played a crucial role in driving the expansion of telehealth coverage. As lawmakers recognize the need for effective treatment options, the use of telehealth technology has been increasingly embraced as part of the solution to the crisis.
In their co-authored report on telehealth legislation, Amy Lerman and Francesca Ozinal noted, “The significant value derived from utilizing telehealth technology in tackling mental and behavioral issues, such as substance use disorders (SUDs), is apparent in the number of bills introduced before the U.S. Congress that include the use of telehealth technology as a strategy.” This growing acceptance of telehealth as a critical tool in the behavioral health field has resulted in more federal and state bills addressing telehealth access and funding.
The Benefits of Telehealth for Behavioral Health Providers
Telehealth presents a wide range of benefits for both behavioral health providers and their patients. One of the most significant advantages is the increased flexibility it provides for how services can be delivered. Patients in rural or underserved areas, where mental health services are often limited or non-existent, can access care remotely, which reduces the barriers posed by geography and transportation. For many individuals facing mental health issues or substance use disorders, traveling long distances to see a provider can be a significant obstacle to care. Telehealth helps eliminate this challenge, allowing patients to engage in therapy, counseling, and treatment sessions from the comfort of their own homes.
Telehealth also enables providers to reach a wider range of patients, particularly in areas with a shortage of mental health professionals. For example, a telehealth psychiatrist can treat patients in multiple states or rural communities, significantly expanding the reach of care. As Dr. Amy Lerman, one of the authors of the survey, pointed out, “This expansion of telehealth availability promises greater flexibility in how professionals can deliver critically important behavioral health services, as well as the potential to increase the reach that providers have into specific populations of patients in need of behavioral health services.”
The flexibility of telehealth is particularly critical as behavioral health providers increasingly address a variety of issues, including anxiety, depression, substance use disorders, and post-traumatic stress disorder (PTSD). The COVID-19 pandemic further accelerated the adoption of telehealth, showcasing its ability to provide continuity of care even during times of crisis.
Regulatory Barriers Preventing Wider Adoption
While telehealth for behavioral health has expanded, regulatory roadblocks still prevent it from reaching its full potential. One of the key challenges is that telehealth regulations vary from state to state. This patchwork of state-specific rules presents difficulties for behavioral health providers who wish to expand their practice into new areas or offer services across state lines. To provide telehealth care, a provider must be licensed not only in their own state but also in the state where the patient resides. This can create significant delays, as providers must navigate the process of obtaining licensure in each new state where they wish to offer services.
Liberty Eberly, Chief Medical Officer at InnovaTel Telepsychiatry, which offers telehealth services nationwide, discussed the frustration this creates. She noted that it can take months for providers to get certified and ready to serve patients in new areas. “By the time a clinic contacts us and says, ‘We need 40 hours of psychiatric time,’ it could be six months before we could get that going,” Eberly explained. “It shouldn’t take that long.”
This regulatory uncertainty can also impact providers in rural or underserved areas, where the need for mental health services is often the greatest. Delays in obtaining licensure or navigating state-specific regulations only exacerbate the problem, preventing patients from accessing timely care.
The Impact of the Direct-to-Consumer Economy
Another challenge facing telehealth providers is the rise of the direct-to-consumer economy. The increasing use of smartphones and other personal devices for telehealth services creates additional complexity for both providers and regulators. While smartphones are perfectly adequate for telehealth consultations, it is unclear who should regulate these services and how reimbursement should be handled. As William England, Director of the Office for the Advancement of Telehealth at the Health Resources & Services Administration (HRSA), pointed out, “Your smartphone is quite adequate as a telehealth device, but who regulates that?”
The direct-to-consumer model is still evolving, and the regulatory framework needed to support it remains in flux. Providers and regulators must collaborate to establish clear guidelines on how telehealth services should be delivered through personal devices and how reimbursement structures will work.
Barriers to Medication-Assisted Treatment (MAT) for Opioid Use Disorder
One of the most critical areas where regulatory barriers persist is in the treatment of opioid use disorder (OUD). Medication-assisted treatment (MAT) is an evidence-based approach that combines medication with counseling and behavioral therapies to treat OUD. However, under the current law, the Ryan Haight Act prohibits physicians from prescribing controlled substances, including MAT medications like buprenorphine, electronically unless the patient has had an in-person examination. This regulation has been particularly challenging for patients in rural areas, where access to in-person care may be limited or non-existent.
While there are some exceptions for telehealth services, they are insufficient to meet the needs of patients in rural communities. The Drug Enforcement Administration (DEA) has been working on a proposal to create a special registration process for telehealth providers offering MAT for OUD, but the process has been delayed. Providers and advocates are anxiously awaiting this proposal, which could improve access to MAT and ensure that more patients can receive the care they need to overcome OUD.
Advocating for Change: A Call to Action
Despite these regulatory barriers, behavioral health providers can play an essential role in advocating for change. Lerman suggests that providers contact their state representatives and advocate for clearer regulations and expanded telehealth access. “To help further access, and more importantly, regulatory clarity as to how these services can be delivered compliantly, behavioral health providers can advocate for continued focus on these issues by the state professional boards,” Lerman explained.
As telehealth continues to evolve, policymakers must work to ensure that regulations keep pace with technological advancements. By advocating for changes at the state and federal levels, behavioral health providers can help drive the regulatory reforms needed to expand access to care for patients across the country.
The Future of Telehealth in Behavioral Health
The future of telehealth in behavioral health is bright, but it depends on continued efforts to overcome regulatory barriers and streamline processes for providers. The expansion of telehealth coverage by Medicaid and Medicare is a critical step in improving access to care, particularly for underserved populations. However, more work is needed to create a unified and clear regulatory framework that supports the delivery of telehealth services across state lines and ensures that providers can offer the full spectrum of services, including MAT for OUD.
As the demand for behavioral health services grows, telehealth will play an increasingly important role in meeting the needs of patients across the country. By removing regulatory roadblocks and creating a more cohesive policy landscape, we can ensure that telehealth becomes a widespread and effective solution for addressing the behavioral health crisis in the United States.
