The COVID-19 pandemic has prompted the federal government to implement significant regulatory flexibilities aimed at helping behavioral health providers continue delivering care. With social distancing and lockdown measures in place, these changes allow clinicians to use telehealth tools more broadly, prescribe medications remotely, and leverage technology in new ways to meet patient needs.
Prescribing Medications
Traditionally, the Ryan Haight Act prohibits providers from prescribing controlled substances to patients they haven’t seen in person, except under specific exceptions. During the COVID-19 public health emergency, the Drug Enforcement Administration (DEA) has temporarily waived this requirement. Providers can now prescribe medications, including antidepressants and medication-assisted treatment (MAT) drugs, following virtual visits conducted via audio and video.
Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has relaxed rules allowing patients to take home longer supplies of MAT medications, such as buprenorphine and methadone. Patients can now receive up to 28 days of medication at a time, reducing the need for frequent clinic visits. SAMHSA has also provided guidance allowing providers to share substance use disorder information under 42 CFR Part 2 when necessary to deliver telehealth services in emergencies.
HIPAA Flexibilities
The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced temporary waivers of certain HIPAA rules to allow behavioral health providers to use everyday technology for remote care. Clinicians can use tablets, smartphones, and other non-HIPAA-compliant tools to provide telehealth services without fear of penalties during the pandemic. This flexibility has enabled providers to reach patients who otherwise might not have access to care due to social distancing or travel restrictions.
State-by-State Medicaid Changes
States now have more authority to implement telehealth flexibilities within their Medicaid programs. Some states are allowing providers to use telephone-only visits instead of requiring both audio and video, significantly expanding access to behavioral health services. The Centers for Medicare & Medicaid Services (CMS) have also issued 1135 waivers, enabling states to relax certain rules and Conditions of Participation (CoPs) for providers. Florida was the first state to receive an 1135 waiver, illustrating how quickly states can adapt regulations to support behavioral health during the crisis.
Medicare Changes
Medicare has also expanded telehealth coverage for seniors, particularly for mental health counseling. These changes loosen restrictions on where the provider and patient must be located and allow more types of telehealth services. While Medicare is not the largest payer in behavioral health, these regulatory adjustments encourage private insurers to adopt similar policies, expanding access for a broader patient population.
Impact on Behavioral Health Providers
The regulatory changes provide essential tools for behavioral health providers facing increased demand amid COVID-19. With social isolation, stress, and uncertainty affecting patients’ mental health, telehealth has become a critical channel for delivering care safely. Providers can continue prescribing medications, conducting therapy sessions, and connecting patients with necessary services while minimizing in-person contact.
Telehealth adoption also helps providers maintain continuity of care for patients who might otherwise face interruptions due to quarantine or clinic closures. By allowing remote prescribing and flexible communication options, these regulatory shifts reduce barriers to accessing behavioral health treatment and medication-assisted therapy.
Remaining Challenges
Despite these regulatory improvements, challenges remain. Providers still need guidance on implementing telehealth flexibilities effectively, particularly in residential behavioral health settings. Nonprofit organizations may require additional financial support, as temporary tax relief and regulatory waivers do not fully address their operational needs. Private insurers also need to expand telehealth coverage and reimbursements to match the flexibility provided by Medicare and Medicaid.
Ensuring that all patients, including those in underserved areas or with limited technology access, can benefit from telehealth remains a critical concern. Providers must develop strategies to engage patients remotely while maintaining quality care, privacy, and compliance with evolving regulations.
The Road Ahead
The COVID-19 public health emergency has accelerated the adoption of telehealth and relaxed regulations for behavioral health providers. These changes allow clinicians to remotely prescribe medications, use tablets and other nontraditional tools, and access expanded resources to meet patient needs. While these measures are temporary, they demonstrate the potential for long-term improvements in telehealth delivery and accessibility.
Behavioral health organizations can take advantage of these flexibilities to provide continuous care, reach vulnerable populations, and reduce the risk of COVID-19 transmission. Providers are encouraged to monitor regulatory updates closely, implement telehealth solutions efficiently, and advocate for continued support and guidance from federal and state agencies.
The pandemic highlights the importance of adaptability in behavioral health care. By embracing telehealth and leveraging regulatory changes, providers can continue supporting patients through crises while potentially shaping the future of behavioral health delivery in the U.S. The temporary measures implemented during COVID-19 may pave the way for lasting policy shifts, improving access, safety, and efficiency in behavioral health services.
Conclusion
Behavioral health providers are navigating unprecedented challenges as COVID-19 changes the landscape of care delivery. Regulatory flexibilities allowing remote prescribing, telehealth via tablets, and expanded state and federal support have provided critical tools for clinicians to continue serving patients safely. These changes help maintain access to essential services, reduce the risk of virus exposure, and ensure continuity of care for those struggling with mental health and substance use disorders.
The current situation underscores the potential benefits of telehealth and the importance of ongoing advocacy for regulatory improvements. By leveraging these temporary flexibilities, behavioral health providers can meet increased patient demand, protect their staff, and continue providing high-quality care during the pandemic. The lessons learned during this crisis may ultimately shape a more accessible and resilient behavioral health system in the future.
