Mental Telehealth Services Have Declined Since End Of Pandemic Emergency: Study

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Dive Brief:

• Mental telehealth coverage has contracted slightly since the government declared an end to the COVID-19 public health emergency last year, according to a new study published in JAMA.
• The study, which analyzed over 1,000 outpatient mental health treatment facilities, found that publicly owned mental health treatment facilities were less likely to have adopted telehealth services at all, and more likely to have discontinued them after the Biden administration ended the COVID PHE, compared to privately owned facilities.
• The results come as lawmakers are considering whether to permanently expand telehealth flexibilities to providers this year, after the federal government enacted temporary policies that expanded access to telehealth services during the pandemic.

Dive Insight:

Telehealth usage skyrocketed during the pandemic as people sought medical care at home and lawmakers made it easier for providers to offer virtual services.

The federal government gave flexibilities to providers using telehealth after declaring COVID a public health emergency in 2020. Those flexibilities included ending geographic site restrictions for telehealth services, allowing Medicare to reimburse virtual services and paying providers the same rates for telehealth and in-person services.

While some telehealth flexibilities were made permanent through legislation, others lapsed or were set to expire at the end of this year after the Biden administration ended the COVID public health emergency in May 2023 — including one policy that removes requirements for in-person visits for behavioral telehealth.

Lawmakers have scrambled to decide which policies should expire and which should become permanent before the end-of-year deadline. Experts told House lawmakers during an Energy and Commerce subcommittee hearing earlier this year that expiring policies could set off a crisis for providers and patients who have grown used to them.

For its part, the JAMA study found that telehealth utilization for mental healthcare decreased slightly after some flexibilities expired last year.

Of the mental health facilities surveyed in two waves from December 2022 to November 2023, 2.6% offered fewer telehealth services after the expiration of the PHE, compared to a period when the PHE was in effect.

While that number is slight, researchers noted facilities still offering telehealth after the PHE had more limited services, such as requiring video-based therapy or placing limitations on telehealth for psychotherapy or medication management.

Facilities who said they offered telehealth psychotherapy services decreased by 19.3%. Alongside that decrease, 18.4% more facilities responded with “it depends” after the PHE expired. A similar trend was observed in facilities that offered virtual medication management, according to the study.

The study noted the importance of research as federal and state policies shift following the pandemic.

“Our results emphasize the importance of monitoring access to mental health care in a postpandemic era, especially against the backdrop of the federal and state policy landscape,” the report said.