This article was updated with additional comments.

The Kaiser Family Foundation recently looked at state trends with regard to expanding access to telehealth-based behavioral care during the pandemic and found that states see telemedicine as a key component of maintaining access to behavioral healthcare for Medicaid enrollees.

WHY IT MATTERS

KFF's survey of state Medicaid programs found them not only expanding telehealth benefits – for example, providing audio-only coverage of behavioral health services, group therapy and medication-assisted treatment – but also adding several provider types, researchers said in the issue brief.

They found that utilization declined from peak levels, but remains higher than before the pandemic. 

Some states experienced higher use of behavioral telehealth in rural areas, among younger enrollees or among white individuals. 

Most states reported that they are likely to keep many of the pandemic-driven telehealth policy expansions in place, and all responding states took at least one policy action, says KFF. Notably, by July 2022, all state Medicaid programs provided at least some audio-only coverage for behavioral wellness.

The researchers also found that Medicaid policies regarding allowable services, providers and originating sites varied widely and that "telehealth payment policies were unclear in many states." Some states reported "limiting or adding guardrails to pandemic-era behavioral health telehealth flexibilities," the researchers added.

State Medicaid programs have broad authority to cover telehealth without federal approval, and they are assessing telehealth quality. The process is likely to inform their future policy decisions, explained Madeline Guth, policy analyst with KFF’s Program on Medicaid and the Uninsured.

"States report valuing the enhanced access to behavioral health and other services that telehealth can foster, but they also have a range of concerns about the quality of services delivered via telehealth," she told Healthcare IT News by email.

Guth also said that Medicaid program respondents also indicated that they are awaiting federal guidance to inform their long-term telehealth policy decisions, such as Medicare policies.

"In particular, [Centers for Medicare and Medicaid Services] is expected to release updated guidance on Medicaid telehealth policy and flexibilities by the end of 2023, per a provision in the Bipartisan Safer Communities Act passed last June."

THE LARGER TREND

KFF noted that the 2022 Bipartisan Safer Communities Act legislation requires the federal government to issue telehealth guidance by the end of 2023. The omnibus spending bill that Congress passed last month included several provisions affecting for behavioral telehealth.

States differ in how they regulate synchronous and asynchronous telehealth. The American Telehealth Association is advocating for fair payment for telehealth, and for licensure flexibility across state lines.

"The ATA is committed to modality-neutral policies," said Quinn Shean, strategic advisor at Tusk Ventures, and the state policy advisor for ATA and ATA Action, during a virtual discussion about telehealth policy after the pandemic.

ATA applauded telehealth flexibilities in the recent bipartisan omnibus appropriations bill, thanking Congressional leaders specifically for including provisions delaying the Medicare telemental health in-person requirement for two years.

"Hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the telehealth cliff," said Kyle Zebley, ATA senior vice president for public policy at ATA Action and executive director in a statement about the legislation.

ON THE RECORD

"Consistent with responses to KFF’s 2022 Medicaid budget survey, many states reported permanent (i.e. non-emergency) adoption of telehealth policy expansions that were initially enacted during the pandemic on a temporary basis," said researchers in the briefing.

"In particular," they said, "states frequently noted that all or most expansions of behavioral health providers and/or services allowed for telehealth would be maintained after the public health emergency."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS publication.