The COVID-19 pandemic has disrupted nearly every aspect of life in the United States, including behavioral health care. As cases surged and hospitals prepared for overwhelming demand, policymakers, providers, and organizations rushed to adapt. A critical piece of this adaptation has been telehealth, which allows patients to continue receiving care while reducing the risk of spreading the virus. On March 24, 2020, the American Psychological Association (APA) called on states and insurers to remove barriers that make it difficult for providers to deliver these services. This plea highlights how essential telehealth has become for maintaining access to behavioral health care during this unprecedented crisis.
This blog will provide a comprehensive look at the developments in March 2020, highlighting key policy changes, provider adaptations, and the challenges behavioral health professionals faced.
Congress Passes $2 Trillion Economic Stabilization Package
On March 25, Congress and the Trump administration struck a deal on a $2 trillion economic stabilization package, the largest in U.S. history. The Senate passed the bill that evening, and the House was expected to approve it by Friday. The package aimed to support families, businesses, and health care systems struggling under the weight of the pandemic. For behavioral health providers, this legislation offered critical financial relief at a time when patient access and revenues were highly uncertain.
APA Pushes for Telehealth Flexibility
On March 24, the APA urged states and insurers to eliminate roadblocks that made telehealth services difficult for behavioral health providers. These barriers included restrictive state laws, inconsistent reimbursement policies, and outdated technology requirements. The APA emphasized that telehealth was not just a convenience during the pandemic but a lifeline, allowing patients to continue receiving therapy, psychiatric care, and other essential services without risking exposure to COVID-19.
Senate Struggles and WHO Warning
Just one day earlier, on March 23, the Senate had failed for the second time to pass the nearly $2 trillion stimulus package. At the same time, the World Health Organization warned that the pandemic was accelerating globally. Meanwhile, the Centers for Medicare & Medicaid Services (CMS) continued approving Section 1135 waivers, granting states more flexibility to adjust Medicaid requirements during the crisis.
Medicaid and CHIP Relief
Between March 20 and 22, the Trump administration released new tools to support Medicaid and CHIP programs. CMS also allowed providers in Medicare quality reporting programs more flexibility, granting exceptions and extensions for required data submissions. This included relief for the Inpatient Psychiatric Facility Quality Reporting Program, which helped reduce administrative burdens on behavioral health providers at a time when they needed to focus on patient care.
Stay-at-Home Orders and PPE Shortages
By late March, a growing number of states and cities issued stay-at-home orders, limiting residents’ movement except for essential tasks like grocery shopping or exercising outdoors. Governors also raised concerns about shortages of personal protective equipment (PPE) for health care workers. Some even clashed with federal officials over distribution. In Washington state, reports surfaced that a patient and a worker at a psychiatric hospital tested positive for COVID-19, underscoring the risks behavioral health facilities faced.
Updated OUD Treatment Guidelines
On March 20, the American Society of Addiction Medicine (ASAM) released updated guidelines for treating opioid use disorder. These updates were particularly relevant during the pandemic, as many patients faced disruptions in care and increased risks of relapse. The guidelines emphasized flexibility, including the use of telehealth and medication take-home policies, to help patients continue treatment safely.
SAMHSA Guidance on Confidentiality
On March 19, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued new guidance on 42 CFR Part 2, a regulation that normally restricts what information addiction treatment providers can share. In light of the public health emergency, providers were given more flexibility to share information without patient consent if it supported telehealth access or emergency care. This change helped ensure continuity of care while still prioritizing patient safety.
Medicaid Waivers Expand
CMS approved Washington state’s 1135 Medicaid waiver request on March 19. This approval allowed providers in the state to operate with fewer administrative burdens, giving them greater flexibility to respond quickly to patient needs. In the days following, more states would receive similar approvals, creating a patchwork of temporary policy shifts across the country.
Business Impacts on Behavioral Health
The pandemic also disrupted the business side of behavioral health. For example, Acadia Healthcare announced on March 19 that it would temporarily suspend the sale of its UK business due to uncertainties caused by COVID-19. This move reflected broader industry concerns about financial stability during the crisis.
Recovery Centers of America Steps In
On March 18, Recovery Centers of America (RCA) proposed a plan to assist hospitals overwhelmed with COVID-19 patients. RCA offered to transfer patients with substance use disorders from hospitals to its treatment facilities, freeing up critical hospital beds for coronavirus patients. This initiative underscored the interconnectedness of behavioral health and general health care during the pandemic.
Expanding Telehealth and HIPAA Flexibility
Telehealth expansion was one of the most significant developments in March. On March 17, the Drug Enforcement Administration (DEA) announced that clinicians could prescribe medications after virtual visits, even without prior in-person appointments. The Department of Health and Human Services (HHS) Office for Civil Rights also announced it would not penalize providers for HIPAA violations related to using everyday technology, such as smartphones or video chat apps, to deliver telehealth services. These changes removed major barriers and made it easier for behavioral health providers to continue supporting patients.
Medicare and Medicaid Telehealth Coverage
Also on March 17, the Trump administration expanded Medicare coverage for telehealth services, temporarily paying clinicians nationwide to provide virtual care. CMS released Medicaid telehealth guidance for states, and private insurers were encouraged to follow suit. This marked a turning point in telehealth adoption, giving behavioral health providers new tools to maintain patient connections.
Early Signs of Economic Fallout
By mid-March, financial markets reflected the growing anxiety. On March 16, the Dow Jones Industrial Average dropped nearly 3,000 points, one of the largest single-day declines in history. Trading was halted briefly as a result. At the same time, public health officials issued increasingly strict guidelines to limit gatherings, further highlighting the seriousness of the pandemic.
Medication Flexibility for MAT
On March 16, SAMHSA relaxed regulations for medication-assisted treatment. Patients were allowed to take home up to 28 days of buprenorphine or methadone, reducing the need for frequent clinic visits. This policy shift reduced exposure risks for both patients and providers while ensuring continuity of care for individuals in recovery.
State-Level Actions
Also in mid-March, Connecticut Governor Ned Lamont issued an executive order allowing behavioral health providers to restrict entrance to their facilities if individuals posed a health risk. The order also permitted providers to disclose otherwise confidential information to report COVID-19 cases, reflecting the balance between patient privacy and public health needs during the crisis.
Conclusion
The early months of the COVID-19 pandemic forced rapid, unprecedented changes in behavioral health care. From the APA’s call for telehealth flexibility to federal and state policy shifts, providers faced constant adjustments. Telehealth quickly emerged as a vital tool for maintaining access to care, while financial relief packages and regulatory waivers provided some support during a time of uncertainty. As the pandemic unfolded, these developments set the stage for longer-term conversations about the role of telehealth, regulatory reform, and the importance of behavioral health in the broader health care system.
