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Analyzing Telemental Health: 50 States, 50 Policies

A new report by Epstein Becker Green sheds light on the growing telemental health industry - and the barriers it faces.

By Eric Wicklund

- Mental health providers have long seen telehealth as a much-needed solution to dealing with the nation’s growing numbers of people with behavioral issues. Now a national healthcare law firm has published a state-by-state guide to telemental health resources.

The 602-page report from Epstein Becker Green targets an industry that’s facing a severe provider shortage, at the same time that experts estimate that only 40 percent of Americans with mental illness are receiving care. It points out that providers generally view telehealth as a viable means of improving that rate and reaching people who are often reluctant to seek help.

But like any other emerging telehealth practice, the report says, each state seems to have a different way of keeping tabs on mental health providers.

“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,” Rene Y. Quashie, senior counsel in the law firm’s healthcare and life sciences practice, said in a recent release. “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.”

For example, the report finds that most states treat psychiatrists as practicing physicians, so that they must comply with all guidelines applied to physicians using telehealth. One of the few states to create a separate set of guidelines for telemental health providers is Texas.

The report highlights three programs with strong telemental health platforms: The Veterans Health Administration, whose National Telemental Health Center, established i in 2010, enabled about 3,000 videoconference encounters to 1,000 patients at 53 sites in 24 states in 2013; South Carolina, whose Department of Mental Health and Hospital Association used a Duke endowment to launch a statewide telepsychiatry network; and North Carolina, which has used Duke endowment funding to launch regional telepsychiatric networks. Also seeing growth ore prison and school-based telemental health programs and home-based telemental health platforms.

Also driving growth in the industry is the development of new technology, such as mHealth apps. Some 6 percent of mHealth apps on the market are focused on mental health services, the report found, while another 11 percent offer stress management services.

The report also notes that recent studies have shown that telemental health services can reduce psychiatric hospitalization rates, especially for underserved and rural populations. Between 2006 and 2010, the report said, telehealth helped reduce psychiatric admissions by some 24 percent and patient stays by about 26 percent. Other studies have found that telemental health services compare favorably to in-person care.

Finally, the report makes note of legal and regulatory issues affecting telemental health, as well as a pair of concerns that providers have for the technology:

  • Some mental health providers worry that online platforms may make it more difficult for them to establish a good rapport with their patients; and
  • Providers also have concerns about the integration of a telehealth platform into their daily clinical workflow, ranging from the cost of buying new technology to new procedures that might create more work than value.

The Epstein Becker Green report follows two other publications designed to give a state-by-state accounting of telehealth practices and regulations. In February, the American Telemedicine Association issued its annual report cards on state telemedicine efforts, focusing on coverage & reimbursement and standards & licensure. Last month, the Center for Connected Health Policy issued its fourth annual report on state telehealth and Medicaid reimbursement policies. 

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