The Revised Regulations Regarding Telehealth and How That Could Affect Your Practice

During the COVID-19 pandemic, regulations pertaining to the provision of telehealth services were relaxed, mostly out of necessity, to allow for continued service access in the midst of stay-at-home orders. As the public health emergency surrounding the pandemic officially comes to an end, some regulations are being revised. If you own a private practice, or you provide teletherapy services in the course of your work, it’s essential to stay informed of the most recent regulations. Some of the most important changes to be aware of are outlined below.?

Changes Under the Consolidated Appropriations Act

The 2023 Consolidated Appropriations Act introduces some changes that will impact the way that teletherapy providers deliver their services.? Some important changes to pandemic-era flexibilities, as well as policies that will remain in place permanently, are as follows:

• During the pandemic, Medicare regulations were relaxed to allow patients to receive teletherapy services from their homes, without first having an in-person visit with the provider. This policy of allowing teletherapy services to occur from home without a previous in-person visit will continue until December 31, 2024, after which time a person must have an in-person appointment before participating in telehealth services. In addition to having an in-person appointment within six months of seeing a provider via telehealth, patients must also meet with their provider in-person once annually.?

• Flexibilities in regulations allowed all states to provide Medicaid patients with audio-only teletherapy services during the pandemic. This change will continue permanently. Patients will also be permitted to receive services for behavioral or mental health in their homes on a permanent basis.?

• Consistent with pandemic-era flexibilities, patients will continue to be permitted to receive teletherapy services in their homes, and there will be no geographic restrictions on the originating site of these services. Rural Emergency Hospitals (REHs) continue to be eligibile originating sites for telehealth services.?

Changes to Prescribing Regulations

In addition to changes to regulations associated with behavioral and mental health services such as counseling and therapy, new policies will change what is permitted when it comes to prescribing medications, particularly controlled substances.?

During the pandemic, the DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA) temporarily allowed the prescribing of controlled substances via telehealth platforms. This meant that patients taking medications like Ritalin for ADHD, as well as those being prescribed buprenorphine for opioid addiction, could receive their medications after completing a virtual appointment with a provider.?

Updates to policy mean that pandemic-era flexibilities, which allowed providers to prescribe controlled substances to patients via telemedicine, even if they were not at a hospital or clinic registered with the DEA, will continue until November 11, 2023.? Furthermore, providers will be permitted to prescribe buprenorphine to new and established patients via telephone until this same date. Finally, any patient who has an established relationship with a telemedicine provider as of November 11, 2023, will be permitted to continue to receive services virtually until November 11, 2024.?

What These Changes Mean for Professionals?

If you’re working in the behavioral health arena, and you offer telehealth services to your patients or clients, you’re likely to be impacted by changes to COVID-19 regulations. First, if you’re providing counseling or therapy services virtually, it’s important to be aware of when you’re required to see patients in-person, under new requirements. While you will have some flexibility to continue providing services without first seeing a patient in-person, this freedom will come to an end at the close of 2024. You’ll also be required to see patients in-person once per year after the end of 2024.

If you’re providing psychiatry or addiction medicine services via telehealth, changes will begin to take place even sooner. As of November 2023, you’ll no longer be able to complete telephone evaluations for new patients seeking buprenorphine for opioid use disorder, nor will you be permitted to prescribe controlled substances to new patients via telemedicine if you aren’t at a hospital or clinic registered with the DEA. Established patients will continue to be eligible for telemedicine appointments until November 2024.

Even if you aren’t using telemedicine to prescribe controlled substances, it’s important to be prepared for these changes, as they can affect your patients. For instance, if you regularly counsel patients who take psychostimulants to treat ADHD, or patients in buprenorphine treatment for opioid addiction, they are likely to be affected by these changes. You may be required to provide patients with information and referral to in-person options for pharmacotherapy, or to remind them of upcoming changes, so they do not experience lapses in their medications.?

Preparing for the Changes

As changes to Federal regulations occur, it’s important to remain up-to-date with changes in your jurisdiction. Some states have different rules and regulations, so it’s critical that you’re aware of laws that govern practice in your location.?

It’s also important to prepare to become compliant with regulations. While there is some time before many COVID-era flexibilities end, some new regulations will take place within six months of the writing of this article. Now is a good time to talk with patients about changes to regulations concerning the prescription of controlled substances via telemedicine.

If you’re seeing patients for virtual counseling or therapy, it’s not too soon to notify them that they will need to begin seeing you in-person on an annual basis once new regulations take effect. Furthermore, new patients should be informed of the fact that beginning after December 2024, they must see you in-person for an initial visit, and annually thereafter.

If you have questions about any of these regulations, and what they mean for your practice, it’s important to consult with legal experts in your jurisdiction. The information in this article should not take the place of advice or consultation from a licensed attorney.?

Mission Harbor Behavioral Health provides telehealth services out of the state of California. We have office locations in both Los Angeles and Santa Barbara, to allow patients to comply with required in-person appointments once pandemic-era regulations come to an end. Contact us today to learn more about our services or to schedule an appointment.?

Sources:

1) https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

2)https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-during-the-covid-19-pandemic/

3)https://telehealth.hhs.gov/providers/telehealth-policy/policy-changes-after-the-covid-19-public-health-emergency

4)https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth