Annual nationwide survey reports increasing telehealth access legislation, bipartisan support

The Epstein Becker Green report pinpointed the opioid epidemic as a major driving force behind new laws and programs, but coverage restrictions and non-robust parity laws are still hampering adoption within Medicare.
By Dave Muoio
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Epstein Becker Green has released the annual update to its Telemental Health Laws Survey, a state-by-state breakdown of behavioral telehealth services coverage compiled (as of last year) into a free app.

Broadly, the 2019 update suggests increasing interest and acceptance of telehealth services for addressing behavioral health issues, according to an overview of the updates published by the survey’s authors. This support is largely bipartisan and at least partially driven by the U.S.’ ongoing opioid epidemic.

“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 US Congress that include the use of telehealth technology as a strategy,” Amy F. Lerman and Francesca R. Ozinal, both of whom are part of Epstein Becker Green’s Health Care and Life Sciences practice, wrote.

“In [addition], states have taken a variety of different approaches to addressing the opioid crisis, many of which involve the use of telehealth technology. Several states, including Indiana, Michigan, and Missouri, have introduced and/or passed legislation that would expand remote prescribing of controlled substances for treatment of SUDs. … Similarly, Michigan and Missouri permit the prescribing of controlled substances via telehealth as long as physicians adhere to the standards of care applicable to their profession relative to the act of prescribing controlled substances.”

Medicaid members living in all 50 states and the District of Columbia now have some level of coverage for telehealth services and “generally” allow for telehealth prescriptions of non-controlled substances. Around half have telehealth-specific privacy and confidentiality measures in place, and the federal government is encouraging broader use of the modality across state programs and the VA.

Despite this, Lerman and Ozinal pointed to generally low adoption and utilization of the technology within Medicare. Here, they pointed to various coverage restrictions tied to site or geographic requirements as potential barriers to uptake, as well as little education on the technology for beneficiaries.

Lerman and Ozinal also highlighted unspecific or non-robust telehealth parity laws active in many states as a stumbling block, but noted that more parity laws are continually being passed or expanded.

WHY IT MATTERS

Lawmakers have a substantial influence on when and how a physician can provide remote care to a patient, and government-run programs are easily among the largest payers of healthcare services. Both federal and state policies seem to be in a constant state of flux, so a micro-macro view of the landscape like this could be a key resource for those interested in exploring or deploying the technology.

THE LARGER TREND

There are still a number of major questions regarding telehealth services, ranging from whether these visits are truly cost-effective to whether they’re even being employed at a serious scale. Meanwhile, major government-backed initiatives like the FCC’s $100 million Connected Care Pilot Program are moving forward and promise to bring telehealth to even more patients across the country.

ON THE RECORD

“Public recognition of the benefits of utilizing telehealth technology to provide greater access to health care services has significantly increased,” Lerman and Ozinal wrote. “While the shortage of behavioral health providers in the [US] has long been acknowledged, increased utilization of telehealth technologies as a strategy to increase access to psychiatrists, psychologists, counselors, therapists and other behavioral health professionals continues to gain attention and validation as an alternative model of care delivery.”