Federal Telehealth Policy Changes After COVID-19 Public Health Emergency

Health technologies, especially the use of telehealth, have revolutionized the practice of psychiatry, and it can be difficult to adapt clinical practices in the face of ever-changing policy governing its use. Federal, state, payer, and facility policies all play a role in regulating the use of telehealth. In this article, we will focus on federal policy and provide a brief overview of relevant rules.

The Department of Health and Human Services (HHS) took a range of administrative steps to support the adoption of telehealth during the COVID-19 public health emergency (PHE). Since the end of the PHE, some telehealth flexibilities have been made permanent while others are temporary.

Several key Medicare flexibilities have been made permanent. Medicare beneficiaries can receive behavioral health care via telehealth in their homes or other community settings in any part of the country, while prior to the PHE Medicare beneficiaries had to be located in rural locations and receive services from designated sites. Additionally, telehealth services for mental health can be delivered using audio-only communication platforms for Medicare patients. Coverage for telehealth by other payers varies, and state Medicaid policies are tracked by The Center for Connected Health Policy.

Many policies remain in flux. Under the Consolidated Appropriations Act of 2023 and other rules including the 2024 Medicare Physician Fee Schedule, the following policies are in place only until December 31, 2024:

• The Drug Enforcement Administration (DEA), jointly with HHS, has extended telemedicine flexibilities regarding the prescribing of controlled medications that were in place during the COVID-19 PHE. This allows practitioners to prescribe controlled medications via telemedicine without a prior in-person exam within their scope of practice and clinical judgment.

• Resident physicians can be under virtual supervision when delivering telehealth to Medicare beneficiaries.

• Medicare patients are not required to be seen in person prior to initiating telehealth services for mental health.

• Medicare reimbursement rates for outpatient telehealth delivered to the patient’s home setting are the same as rates for in-person care.

Most mental health providers that are eligible to bill Medicare for their professional services can provide telehealth. Covered services include many of our most routine types of encounters such as psychiatric diagnostic evaluations, follow-up appointments, and psychotherapy. Additionally, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can provide telehealth services to patients wherever they are located. FQHCs and RHCs are now eligible Medicare originating sites for telehealth as well.

A common area of concern regarding telehealth policy is licensure and cross-state care, which are primarily administered at the state level. During the PHE, Medicare allowed practitioners to bill for services provided in states in which they were not licensed, and most states waived state licensure requirements. We now have a patchwork of different policies across states, creating uncertainty for practitioners and patients who moved during or after the pandemic or now work remotely. Some of policies include enacting temporary practice laws to support existing provider-patient relationships across state lines and minimize gaps in care, streamlining the process of full licensure by means of interstate compacts, and the creation of telehealth-specific licenses for out-of-state providers.

There are ongoing efforts in Congress to alleviate the uncertainty around the future of telehealth policy, including efforts to expand telehealth broadly through the CONNECT for Health Act of 2023 as well as address the prescribing of medications for opioid use disorder specifically. APA will continue to provide updates as the telehealth landscape evolves. ■

Christian Moser, M.D., is a Jeanne Spurlock Congressional Fellow in the office of Sen. Lisa Murkowski. Sy Saeed, M.D., M.S., is a professor and chair emeritus of the Department of Psychiatry and Behavioral Medicine at East Carolina University. Both are members of APA’s Committee on Telepsychiatry.