The Year that Virtual Behavioral Health Became the New Normal
By Ellen Hallsworth, Director, Bradley REACH
“As we move forward, virtual care is just care.”
The Year that Virtual Behavioral Health Became the New Normal
If 2020 was the year that the pandemic catapulted telehealth into the mainstream of healthcare delivery, 2023 was the year that it became the new normal, especially in behavioral healthcare. But for telehealth, as for other aspects of post-pandemic life, settling into the new normal hasn’t always been easy.
Changing the Rules
In May 2023 the COVID-19 Public Health Emergency came to an end after more than three years. With the end of the PHE many of the flexibilities that it enabled also ended, at both federal and state levels.
Federally, the DEA announced in February that it would end the flexibility to prescribe controlled substances without an in-person evaluation. This would have importantly limited access to needed medication for substance use disorder and ADHD. Given the ongoing shortage of stimulants to treat ADHD the consequences for children and families could have been huge, particularly in rural and underserved areas where getting an in-person evaluation can be tough. The DEA received more than 38,000 public comments on the proposed policy change. In October 2023 the agency changed course and announced that they would extend telemedicine flexibilities and work to find a new solution.
At a state level, the uncertainty around what would remain and what would revert to pre-pandemic rules made the start of the year tough, particularly for providers trying to scale solutions across different geographies. Resources like the Center for Connected Health Policy and the regional telehealth resources centers have been crucial for navigating this landscape.
Licenses to Care
Before the pandemic, state-by-state licensure for providers had been a major barrier to delivering behavioral health care virtually across state lines. Licensing providers in a new state is costly and can take many months. Behavioral health care is a team sport, requiring input from psychiatrists, psychologists, social workers, nurses, and other licensed counselors. But licensing many provider types across many states is especially burdensome.
The national crisis in mental health has spurred bipartisan support for licensure reform as a way of reducing barriers to care. In total, more than 57 pieces of licensure compact legislation were enacted in 2023. There are now 39 states in PSYPACT, the psychology licensure compact, compared to 11 in 2019. This means that it’s now easier than ever before to get care where patients need it, regardless of state lines.
Parity and Uncertainty
Private and public insurance paid for telehealth during the pandemic because there was no alternative. When the pandemic ended, the future of reimbursement for telehealth seemed more uncertain. CMS announced that it would extend Medicare coverage of telehealth services through December 2024, but with an emphasis on using the extension to evaluate effectiveness. Other payers indicated that they might no longer reimburse for some virtual services.
More positive news on reimbursement for all behavioral health care came in the summer, when the federal government announced new rules on enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA). Essentially, better enforcement of parity for mental health and substance use would mean that payers would no longer be able to impose some limitations on access to behavioral health care. The policy around enforcement of the act puts the onus on payers to increase their networks and reduce access barriers. It recognizes the importance of telehealth in increasing access to care, especially in workforce shortage areas.
There’s an opportunity for providers and payers to work together to improve access and demonstrate value. At the Behavioral Health Tech Annual Conference last month, a major theme was the need not only to improve access but to demonstrate that we are delivering high-quality care. Clinicians need to show not only that we are getting care to patients, but that it’s helping them to lead meaningful lives and (as far as possible) keeping them in their homes and communities.
Virtual Care is Care
Just last year, a lot of the feedback we got from Bradley REACH families focused on their surprise at how well virtual care had worked. This year, most of the feedback focuses on the quality of the team, the level of communication and the helpfulness of peer relationships. This underlines the fact that, as we move forward, virtual care is just care.
In 2024 it will matter less whether mental health care is delivered on a screen or in a hospital or office, and more that it’s getting to the people who need it, and that it’s actually working.
