With the current public health emergency and the existing shortage of behavioral health clinicians, accessing behavioral health services requires significant departures from traditional means. During this rapidly changing landscape, telehealth resources can help reduce the impact of providers who are not able to see patients face to face. For providers who are quarantined at home due to potential exposure, it allows the capacity to provide care to be maintained, or at least reduce the impact of the quarantine. 1 For providers in private practice, it can allow them to continue to earn income, both with private pay and insurance reimbursements.
For many providers, this is an ideal time to begin using telemental health. In addition to patients not being able to attend face to face sessions, there are multiple opportunities for providers to gain education in using this platform---many at no cost. For example, APA is currently offering its series “Telepsychology Best Practice 101 Series” at no cost to both members and non-members. NASW is also offering “Key Developments in Medicare Telehealth Options during COVID-19” as a no-cost one-hour webinar. For larger organizations, Telebehavioral Health Institute is offering their courses at 30% off in order to assist them in immediately being able to implement telehealth in their organizations.
With reduced caseloads, this might be the perfect time to obtain free CEs from reputable organizations. Once this emergency has ended, and many of us return to face-to-face client sessions, it is likely that those interested in (and providing) telehealth will remain higher than pre-COVID-19 numbers.
This emergency is also forcing states to look at the delivery of health care and to make adaptations. For example, Indiana is utilizing SAMHSA funds to provide opioid treatment programs with lockboxes and naloxone kits. The lockboxes will prevent those in need from making daily trips to obtain the medication thus reducing their exposure to and the spread of COVID-19.
Professional organizations are also advocating for policy changes. For example, NASW is working to ensure that providers with patients who have been relocated due to the pandemic are able to provide telehealth across state lines.2
Government payers’ response:
In response to COVID-19, many payers are modifying and relaxing guidelines around telehealth. While it is common practice to require providers to use HIPAA-compliant platforms, payers indicate that there will be flexibility in using non-compliant technologies to allow more patients to receive the care they need. Check the specific payer guidelines for each company you work with to determine their rules.
TRICARE
Both TRICARE East and West have telemental health benefits. For active duty members, a referral is needed before they are able to access the benefit. For TRICARE, prime active duty and retirees do not need a referral before scheduling an appointment with their distant provider.
Referrals can be made by calling:
East: Humana Military at 1-800-444-5445
West: Health Net at 1-844-866-9378
More information about covered services can be found here: https://www.tricare.mil/CoveredServices/IsItCovered/TelementalHealth
Medicare/Medicaid
The Centers for Medicare and Medicaid Services (CMS) recently relaxed its guidelines for patients accessing telehealth services. Previously, reimbursement was offered in remote areas, but required patients travel to approved health care facilities. The relaxation of this requirement allows for patients to receive those same services in their homes as well as in approved health care facilities. These changes are viewed as in-person visits and will be reimbursed at the same rates. There is also some flexibility in the requirement for providers to collect cost-sharing during this time, which will also ease the burden of accessing care on patients. Additionally, the requirement that providers have established relationships with their patients prior to engaging in telehealth will not be audited by HHS during the public health emergency. This adjustment will allow patients who have not acquired behavioral health care prior to COVID-19 to access care in a safe way.
The new guidelines can be found here: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
Veterans Administration
VA patients who are eligible for VA healthcare may be able to access their behavioral health care using one of the many technologies the VA currently uses for telehealth. The Care Close to Home program allows patients to receive care in their homes. To determine their eligibility, patients should contact the VA at 1-800-827-1000 or access their benefits using www.ebenefits.va.gov.
For more information on VA's expanding services, click here.
Professional Organization Guidelines
You can find your professional organizations guidelines here:
APA: https://www.apa.org/practice/guidelines/telepsychology
NASW: https://www.socialworkers.org/LinkClick.aspx?fileticket=lcTcdsHUcng%3d&portalid=0
ACA: https://www.counseling.org/docs/default-source/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=fde89426_5
ASPPB: https://www.asppb.net/page/covid19
Reimbursement Opportunities
With the increased need for telemental health services, opportunities are expanding for clinicians who may have been reluctant to try this platform with patients. Many private payers are relaxing rules regarding additional credentialing to provide remote care (e.g. Cigna, United Healthcare). In addition to increasing access to care via telehealth, many companies are waiving out-of-pocket costs to ensure that subscribers are able to access the care they need. HHS indicated on March 17, 2020 that it will waive penalties for HIPAA-related violations for good faith use of telehealth during this public health emergency. This waiver will allow providers the ability to immediately offer telehealth services to those patients in need. More guidance about the use of everyday technologies can be found here: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html
Conclusion
While it is not easy to identify all of the obstacles during this time of crisis, it is uplifting (but not surprising) to see the behavioral health field adapting to continue to meet the needs of their patients. By modifying and relaxing rules, we are able to reduce the impact of the crisis both on the delivery of services and the ability for clinicians to earn a living. This crisis is providing opportunities for professional development that will enhance the skill sets of clinicians and ultimately benefit those we serve. This information is accurate as of 3/23/2020, but with the quickly changing landscape, please check for up-to-date information on the individual websites.
This information is accurate as of 21 July 2020, but with the quickly changing landscape, please check for up-to-date infomation on the individual websites.
References
Bryant, B. (2020, March 16). COVID-19 Likely to Worsen Behavioral Health Workforce Shortage.
Retrieved from https://bhbusiness.com/2020/03/13/covid-19-likely-to-worsen-behavioral-health-workforce-shortage/.
1 Hollander, J. E., & Carr, B. G. (2020). Virtually Perfect? Telemedicine for Covid-19. The New
England Journal of Medicine. Advance online publication. https://doi.org/10.1056/NEJMp2003539
2Practice. (n.d.). Retrieved from https://www.socialworkers.org/Practice/Infectious-Diseases/Coronavirus