Member Article

The COVID-19 crisis has increased the need for behavioral services and has also led to some opportunities for providers. In order to comply with social-distancing guidelines from the Centers for Disease Control, and to encourage the use of telehealth so that more urgent cases may utilize ERs and clinics, states, the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have instituted some significant changes which affect: 1) access to behavioral health services, 2) the types of professionals who may deliver them, and 3) the types of technology available for care. Many states have waived licensure requirements and telehealth restrictions to address the same issues. The opening of these federal and state delivery doors should enable providers to engage behavioral patients more quickly, get them into treatment, and more effectively continue to serve them while also facilitating easier reimbursement.

The following is a brief summary of some changes currently impacting behavioral health providers.

Who May Provide Services

Current CMS guidance says distant site practitioners for telehealth will now include physicians, advanced practice nurses, physician assistants, clinical social workers, and clinical psychologists, among others. (The CMS Telehealth Provider Fact Sheet is availablehere.)

• Services requiring direct supervision may now have that supervision provided virtually.
• Inpatient facilities and hospitals (including psychiatric) will be encouraged to use PAs and NPs to the fullest extent possible under state law to order tests and medications. (CMS Guidance from March 30 can be foundhere.)
• Most U.S. states have loosened provider licensure regulations to allow either compensated or volunteer healthcare professionals to practice in the state during an emergency. In addition, state Medicaid programs have issued state-specific guidelines, some of which are discussed below.
  
  

Telehealth Services

Medicare has previously covered telehealth on a limited basis. Now, under the Coronavirus Preparedness and Response Supplemental Appropriations Act and CMS regulatory waiver authority (especially the use of §1135 Waivers), Medicare will temporarily pay clinicians to provide expanded telehealth services in order to facilitate greater access to care under more circumstances. Here are some significant changes:

• Patients may be seen by video conference in their homes without travel to a qualifying “originating site.”
• Visits are no longer limited to live interactive audio and video telecommunications, but (subject to state requirements) may be by audio alone (telephonic) or email alone.
• Under its enforcement discretion authority, HHS will not conduct audits to ensure that a prior established relationship exists between the particular provider and the patients, clearing the way for initial consults via telehealth without a physical exam.
• CMS is temporarily reducing paperwork requirements to allow clinicians to spend more time with patients.

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