Brief Telehealth: Improving Behavioral Health From Afar

The term "behavioral health" includes both mental health and substance use disorders. More than 1 in 5 U.S. adults-57.8 million- live with a mental illness. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 21.5 million adults have co-occurring mental health and substance use disorders (SUDs).

Many experience barriers to accessing treatment. Of these adults with co-occurring disorders, more than 40% did not receive treatment for either disorder and only 17% received treatment for both. Barriers to treatment-such as proximity to services and behavioral health provider shortages, among others-may lead to increased adverse outcomes, especially for those living in rural and underserved communities.

Telebehavioral health is one strategy state policymakers may use as they explore ways to address gaps and increase access to essential behavioral health services. Such services can take many forms, such as treatment through video conferencing, provider-to-provider consultation and education, medication management and continuity of care.

State Actions

Changes in federal regulations have made it easier for behavioral health providers to offer services through telehealth, including the types of providers and services provided. States can adopt these changes and other policy options, like expanding the kinds of providers that can participate in telehealth or requiring insurance providers and other payers to cover telehealth services, to improve access to telebehavioral health services. For example:

Massachusetts implemented payment parity for behavioral health services provided via telehealth. This means that health plans must reimburse at the same rate or higher for behavioral health services delivered through telehealth as they do for in-person behavioral health services.

South Carolina specified that they would continue to cover an array of behavioral health services through their state Medicaid program despite the conclusion of the public health emergency.

State laws also govern a provider's authority to prescribe medications electronically, including provider board rules and regulations that set the standard of care for prescribing. Some states require real-time telehealth interactions before a provider can write prescriptions. However, there are many exceptions to these policies, including medication-assisted therapy (MAT) designed to address the opioid epidemic. MAT uses medications (e.g., buprenorphine, methadone, etc.) together with counseling for the treatment of substance use disorders. Many state policies allow remote prescribing of MAT without an initial in-person office visit or without recurring in-person office visits to authorize refills. For example:

Oklahoma restricts telemedicine encounters from establishing a patient-provider relationship for prescribing certain opiates, except when the encounter is for prescribing controlled substances used in medication-assisted treatment or detoxification for substance use disorders

Vermont allows certain health professionals to prescribe controlled substances via telehealth for use in treatment of opioid use disorder in accordance with federal requirements.