Stephanie Raborn

Despite Mental Health Parity laws, access to mental health services in the United States is limited.[1] A combination of cost, providers’ preferences for cash-based practices, and ongoing stigma about psychological and psychiatric services make it harder for individuals to access mental health services.[2] This problem is exacerbated by the global pandemic in terms of increased anxiety caused by physical and economic uncertainty and loss of income, including loss of health coverage benefits through employer-sponsored insurance.[3] But there is some good news—regulators’ and providers’ increased flexibility is making it easier to obtain mental health services through telemedicine.[4]

There are further improvements needed—like creating a pathway for individuals to obtain prescriptions currently blocked by the Ryan Haight Act[5]—but the legislative and regulatory response to access issues occurring as a result of the COVID-19 pandemic are a step in the right direction. For example, Pennsylvania has temporarily suspended program limits on the amount of services that can be provided through telehealth.[6] Maryland is allowing residential substance use disorder treatment programs to provide telehealth services to Medicaid patients and qualified uninsured Marylanders.[7] And Connecticut, while still requiring that participants be at Medicaid-enrolled originating sites to receive certain services­­—such as opioid treatment programs—via telemedicine, has removed limitations for originating sites for individual therapy, family therapy, or psychotherapy with medication management.[8]

Further, the Department of Health and Human Services as released guidance encouraging the use of telehealth for provision of various health services.[9] Insurers are getting on board, too. In July, Blue Cross Blue Shield of Massachusetts announced a plan to expand access to telehealth services by releasing a new incentive plan that reimburses child psychiatrists at a rate fifty percent higher than the standard rate schedule in exchange for agreeing to maintain availability in their practices for Blue Cross Blue Shield Members.[10] Cigna eliminated cost-sharing not only for telehealth visits from primary-care providers, but also for telehealth visits for behavioral health.[11] And Optum, a subsidiary of UnitedHealth Group, expanded availability of telehealth visits including growing its number of behavioral health providers.[12]

And indeed, there has been a dramatic increase in utilization of telehealth services overall amidst the pandemic.[13] Whether these measures take root and further expand access to mental health services remains to be seen, but they are a small victory, and as such are worth celebrating.

[1] New Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America, National Council for Behavioral Health (Oct. 10, 2018), https://www.thenationalcouncil.org/press-releases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-america/#:~:text=These%20beliefs%20are%20driven%20by,for%20accessing%20mental%20health%20care..

[2]Mental Health in America: Access to Care Data, Mental Health America, https://www.mhanational.org/issues/mental-health-america-access-care-data  (last visited Aug. 2, 2020) (reporting that in 2020, 10.7%, or over 4.7 million, adults with mental illness remained uninsured).

[3] Alvin Powell, Feeling more anxious and stressed? You’re not alone, The Harvard Gazette (Apr. 16, 2020), https://news.harvard.edu/gazette/story/2020/04/rising-mental-health-concerns-in-the-coronavirus-era/ (highlighting individual responses reporting increased stress and anxiety being linked to the Covid-19 pandemic). See also Nirmita Panchal et al., The Implications of Covid-19 for Mental Health and Substance Use, Kaiser Family Foundation (Apr. 21, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ (noting that in a Kaiser Family Foundation poll, forty-five percent of polled individuals reported a negative impact on their mental health “over worry and stress over the virus”).

[4] Madeline Guth and Elizabeth Hinton, State Efforts to Expand Medicaid Coverage & Access to Telehealth in Response to COVID-19, Kaiser Family Foundation (June 22, 2020),  https://www.kff.org/coronavirus-covid-19/issue-brief/state-efforts-to-expand-medicaid-coverage-access-to-telehealth-in-response-to-covid-19/.

[5] See Kierin Bernard, Telemedicine and the Ryan Haight Act: An Analysis of the Ryan Haight Act’s Statutory Purpose, its Inadvertently Negative Impact on the Telemedicine Industry, and the Future of Telemedicine, 10 Wake Forest J. L. & Pol’y 59, 64 (2019) (noting that “[o]ne of the most significant legislative limitations of telemedicine . . . is the requirement of the Ryan Haight Act that providers must conduct an in-person exam before they can prescribe controlled medications to their patients.”).

[6] Memorandum from the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) (Mar. 15, 2020), https://www.dos.pa.gov/ProfessionalLicensing/Documents/OMHSAS-COVID-19-Telehealth-Expansion.pdf.

[7] Telehealth Guidance for SUD Residential Treatment Services During the COVID-19 Outbreak, Maryland Dep’t of Health (Apr. 15, 2020), https://maryland.optum.com/content/dam/ops-maryland/documents/provider/Alerts/april2020/Telehealth%20SUD%20Residential%20Treatment%20Guidance_041520.pdf.

[8] Connecticut Medical Assistance Program Provider Bulletin (Mar. 13, 2020), https://www.ctdssmap.com/CTPortal/Information/Get%20Download%20File/tabid/44/Default.aspx?Filename=pb20_09.pdf&URI=Bulletins/pb20_09.pdf.

[9] Telehealth: Delivering Care Safely During COVID-19, HHS.gov, https://www.hhs.gov/coronavirus/telehealth/index.html (last visited Aug. 2, 2020).

[10] Blue Cross Blue Shield of Massachusetts Announces Bold New Action To Expand Members’ Access to Mental Health Services, Blue Cross Blue Shield of Massachusetts (July 23, 2020),  http://newsroom.bluecrossma.com/2020-07-23-Blue-Cross-Blue-Shield-of-Massachusetts-Announces-Bold-New-Action-To-Expand-Members-Access-to-Mental-Health-Services.

[11] Cigna Expands and Extends its COVID-19 Relief for Medicare Advantage and Individual and Family Plans, Cigna Newsroom (June 1, 2020), https://www.cigna.com/newsroom/news-releases/2020/cigna-expands-and-extends-its-covid-19-relief-efforts-for-medicare-advantage-and-individual-and-family-plans.

[12] Optum Helping People Stay Connected with Needed Behavioral Health Support During COVID-19, BusinessWire (May 11, 2020), https://www.businesswire.com/news/home/20200511005259/en/Optum-Helping-People-Stay-Connected-Needed-Behavioral (discussing Optum’s expansion of behavioral health by adding more telehealth providers and expanding the availability of telehealth visits).

[13] Assistant Sec’y Plan. Educ., Medicare Beneficiary Use of Telehealth Visits: Early Data from the Start of the Covid-19 Pandemic, HHS.gov, 3 (July 2020) https://aspe.hhs.gov/system/files/pdf/263866/HP_IssueBrief_MedicareTelehealth_final7.29.20.pdf.