As Cyber-Counseling Booms, Complex Legal and Regulatory Issues Grow; Survey Breaks New Ground in Tracking Related Laws
WASHINGTON, DC – May 11, 2016 – Epstein Becker Green (EBG), has released a groundbreaking, comprehensive survey on the laws, regulations, and regulatory policies impacting telemental health in all 50 states and the District of Columbia. The “50-State Survey of Telemental/Telebehavioral Health (2016)” details the rapid growth of telemental health (mental health care delivered via interactive audio or video, computer programs, or mobile applications) and the increasingly complex legal issues associated with this trend.
While other telehealth studies exist, this survey focuses solely on the remote delivery of behavioral health care. The survey was spearheaded by René Y. Quashie and Amy F. Lerman, both EBG Senior Counsel in the Health Care and Life Sciences practice in the firm’s Washington, DC, office.
“As telemental health care gains in popularity, it gives rise to a number of significant legal and regulatory issues, including privacy and security, follow-up care, emergency care, treatment of minors, and reimbursement, among other things,” said Quashie. “While some federal laws and regulations (such as HIPAA) apply, most of the issues involve state law, which has resulted in an inconsistent patchwork of laws and regulations that vary widely by state. And there are a number of states that don’t address telemental health specifically in their laws.”
Bridging the Care Gap
The survey begins with a report on the state of telemental health in 2016, highlighting its growing legitimacy (and acceptance by payers) as a treatment option, the barriers to delivery that persist, the high costs of care and prescription drugs, and insurance reimbursement parity issues.
Mental health care lends itself particularly well to remote delivery, since the provider usually need not lay hands on the patient to provide care. In addition, this method helps bridge the gap between the large numbers of Americans (about 60 million) experiencing mental illness and the significant shortage of qualified mental health care providers. Only 40 percent of Americans with mental illness report receiving treatment, and there is one mental health care provider for every 790 individuals.
The EBG survey also reports that new technologies are driving the boom in telemental health, with a significant increase in mobile applications related to mental health (now almost 6 percent of all mobile health apps) and another 11 percent devoted to stress management. There is also a growing number of companies providing “text therapy” services, which allow users, for a flat-rate fee, to text chat with any number of licensed mental health providers.
“Accessing mental health care is a significant challenge for most Americans, with wait times to see a provider measured in weeks and months, rather than days. In addition to long wait times, distance, cost, and stigma present significant barriers to getting care. These are all challenges that telemedicine is uniquely equipped to solve,” said Dr. Ian Tong, Chief Medical Officer at Doctor On Demand.
Deep Dive into Legal Issues
The survey provides a detailed state-by-state analysis of legal issues related to telemental health, such as:
- Definitions of “telehealth” or “telemedicine”
- Licensure requirements
- Governing bodies
- Reimbursement and coverage issues
- The establishment of the provider-patient relationship
- Provider prescribing authority
- Accepted modalities for delivery (e.g., telephone, video) to meet standards of care
There is also comprehensive data tracking telehealth legislation and rulemaking in progress for each state. Highlights include the following:
- Psychiatrists, as practicing physicians, must comply with all the obligations that apply to physicians practicing telehealth generally. Very few states exempt mental health from physician requirements despite the fact that many psychiatrists never lay hands on patients. Ironically, Texas is one of the few states that explicitly carves out mental health services from other telehealth requirements.
- In New York, psychologists may engage in telepractice so long as, among other things, they obtain informed consent from patients describing the benefits and risks of telepractice, and they conduct an initial assessment of each client to determine whether telepractice is appropriate.
- In Delaware, an individual practicing “telepsychology” must conduct a risk-benefit analysis and document findings specific to issues such as whether a patient’s presenting problems and apparent condition are consistent with the use of telepsychology to the patient’s benefit, and whether the patient has sufficient knowledge and skills in the use of technology involved in rendering the service or can use a personal aid or assistive device to benefit from the service.
- Kansas requires psychologists and social workers providing telemental health services to obtain the informed consent of the patient before services are provided.
- In Maryland, physicians (psychiatrists) are required to develop a procedure to prevent access to data by unauthorized persons through password protection, encryption, or other means and to create a policy on how soon an individual can expect a response from the physician to questions or other requests included in transmission.
“As telemental health continues to grow and evolve, it will increasingly be viewed as a viable solution by clinicians, payers, and policymakers,” said Lerman. “At the same time, legal and regulatory issues will continue to proliferate. The survey breaks new ground for anyone navigating this multifaceted legal landscape.”