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Responding to the COVID-19 pandemic has required rapid and far-reaching changes in health care delivery, including changes in services for patients with mental and substance use disorders. These changes were enabled by a surge of policies made at the local, state, and federal levels, policies that the authors of an article in press in Psychiatric Services say should be evaluated for use in a post-pandemic world.
“Seldom in recent history have so many policies evolved so quickly as in this period of COVID-19 crisis response. These circumstances raise a critically important question: What evidence for new policies and approaches have been born from the COVID-19 crisis that should—or should not—be sustained in the future?” wrote Matthew L. Goldman, M.D., M.S., of the University of California, San Francisco, and colleagues. “As we continue to move through the unique challenges presented by this global pandemic, we can and should be opportunistic when it serves the public interest and the well-being of people with mental illness.”
The authors highlighted pandemic-related changes in mental health policy in several areas: legislation, regulation, financing, accountability, and workforce development.
Legislation. The Families First Coronavirus Response Act provides paid sick leave for people affected by COVID-19. The Coronavirus Aid, Relief, and Economic Security (CARES) Act is a $2 trillion stimulus package that includes appropriations for the Substance Abuse and Mental Health Services Administration, the Department of Health and Human Services, the Federal Communications Commission, and others to use to create programs or disseminate to various stakeholders affected by the pandemic.
Regulation. The majority of the regulations issued in response to the pandemic aim to reduce requirements for face-to-face contact between patients and health care professionals. These regulations include an exception regarding the maximum take-home methadone doses for patients with opioid use disorder enrolled in an Opioid Treatment Program and an easing of Medicare telehealth rules.
Financing. The Centers for Medicare and Medicaid Services (CMS) has made several changes that help professionals and organizations that provide mental health services remain afloat. These changes include reimbursements for telehealth services that are equivalent to that of in-person appointments and a blanket waiver that allows more flexibility in Medicare and Medicaid reimbursements, reduces prior authorizations, and affords easier transfer of patients between facilities.
Accountability. CMS has delayed quality reporting requirements for programs such as the Merit-based Incentive Payment System. While accountability mechanisms are essential, the pandemic crisis justifies the relaxation of burdensome reporting requirements.
Workforce Development. Several measures address issues concerning credentialing, licensure, scope of practice, training and technical assistance, and incentives such as loan repayment programs. For example, many states have temporarily waived state licensing and renewal requirements, CMS has temporarily exempted requirements for physician supervision of nurse practitioners and physician assistants, and the Drug Enforcement Agency waived the requirement to register in new states to prescribe controlled substances.
“[These] major areas of mental health policy … encompass a large range of stakeholders, each of whom [has] unique perspectives and incentives,” the authors wrote. “Engaging a diverse coalition of partners can help ensure the success of a policy regardless of the lever involved.”
(Image: iStock/monkeybusinessimages)
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