Wednesday, April 26, 2023

Prepare Now for End of Public Health Emergency, Telepsychiatry Experts Advise

In a webinar today, APA leaders in telepsychiatry urged psychiatrists to start working with their telepsychiatry patients now to prepare for the end of COVID-19 Public Health Emergency (PHE) on May 11.

Shaban Khan, M.D., director of child and adolescent telepsychiatry at NYU Langone and chair of the APA Committee on Telepsychiatry, and John Torous, M.D., director of the Digital Psychiatry Division at Beth Israel Deaconess Medical Center and chair of the APA Committee on Mental Health Information Technology, outlined what psychiatrists need to know about the status of telepsychiatry in terms of prescribing medications, licensing, HIPA-compliant modalities for telepsychiatry, and coverage and reimbursement.

“We know that the landscape of psychiatry has fundamentally changed with the rapid increase in telehealth modalities throughout the COVID-19 public health emergency,” said Khan. “Federal and state governments have some authority to maintain elements of these flexibilities, but cannot—or in some cases, choose not to—maintain them all. So, when the PHE ends on May 11, 2023, some flexibilities will remain on a permanent basis, some will phase out, and some remain uncertain.”

During the webinar, Khan shared one important new piece of information: The Centers for Medicare and Medicaid Services (CMS) will not reimburse for partial hospitalization services delivered in the patient’s residence beyond the PHE. Partial hospitalization services can be delivered only in hospitals and community mental health centers starting May 12.

Some PHE flexibilities were extended or made permanent under Medicare. These include the following:

  • Audio-only telehealth services for mental health and substance use disorders will be reimbursed on a permanent basis.
  • In-person visit requirements for mental health services have been deferred through the end of 2024.
  • Restrictions on geographic originating sites (the location where a Medicare patient gets medical services through a telecommunications system) have been permanently removed, including patients’ homes.
  • Psychiatrists will be reimbursed for telepsychiatry services at nonfacility rates through the end of 2023, but beginning on January 1, 2024, Medicare will revert to paying the lower facility rates.

Other Medicare policies will revert to their pre-PHE status. For instance, after May 11 psychiatrists cannot bill Medicare for services delivered in states in which they are not licensed (in fact, most states have already ended those licensure flexibilities). Additionally, psychiatrists must use HIPAA-compliant technology, although the government announced an extension on enforcing this for 90 days after the end of the PHE to August 9. “You can help your patients by starting now to adopt and teach them about HIPAA-compliant communications platforms,” Torous said.

Finally, virtual supervision of psychiatry residents treating Medicare beneficiaries is scheduled to end on May 11, though APA has asked CMS to reconsider this provision.

Still other policies, especially the details of prescribing controlled substances to telepsychiatry patients, are still to be determined. In February the Drug Enforcement Administration (DEA) proposed rules about how to maintain some telehealth prescribing flexibilities after the PHE. 

“APA submitted comments suggesting extensive revisions to these rules, but we will not know the final contents or timeline of the rules until the final rules are published in the Federal Register,” Torous said. “If not finalized, the rules will revert to pre-public health emergency rules.

“In addition, the current rules are vague on where you have to be to prescribe controlled substances, but it is safe to proceed under the assumption that you will continue to need a physical location in order to obtain a DEA registration in any given state and that you will need a DEA registration in order to prescribe in the state,” Torous said. “Like controlled substances prescribing, assume that you will need to be licensed where your patients are.”

Look to Psychiatric News for further updates and to the Telepsychiatry Toolkit, Telepsychiatry Blog, and COVID-19 and Telepsychiatry Frequently Asked Questions. Members may also register for a webinar in May titled “Telepsychiatry Reimbursement: Who Pays for What?”

(Image: iStock/nensuria)

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