- The American Telemedicine Association is giving much of the nation a good grade for its support of telemental health.
Eight states have received an A in the ATA’s latest state-by-state analysis of telehealth standards and licensure, released in June, while one state – Colorado – flunked.
“Our analysis indicates that decades of evidence-based research highlighting patient adherence to treatment, positive clinical outcomes and increasing telehealth utilization have been met with overwhelmingly supportive scope of practice policies for psychologists,” ATA Chief Policy Officer Gary Capistrant and Latoya Thomas, director of the ATA’s State Policy Resource Center, wrote in their summary of the 50-page report. “However, psychology boards, much like other health professional licensing boards, remain mired in a fragmented state-by-state licensure approach which stifles collaboration, service access, and availability.”
The report grades each state on three factors – psychologist-patient encounters, informed consent guidelines and licensure policies – then issues a composite grade. Mississippi, Missouri, Nebraska, Nevada, Oklahoma, Texas, West Virginia and Wisconsin scored the highest grade from the ATA, while 41 states and the District of Columbia received either a B or C.
“State Telemedicine Gaps Analysis: Psychologist Clinical Practice Standards & Licensure” is the third report card to be issued by the ATA. The previous two, one focusing on practice standards and licensure and the other on coverage and reimbursement, were first issued in 2014 and have been updated annually, most recently in February.
According to the ATA, 49 state Medicaid programs now reimburse for telemental health services, while 30 states and the District of Columbia mandate that private payers provide coverage regardless of the delivery method.
Telemental health is also one of the more popular topics on conversation in state legislatures these days, with some 25 states debating new proposals for practice standards in the past year. States have debated how to compare telemental care against in-person care, with some opting for stricter standards that include a mandated face-to-face visit before telehealth can be used. Other issues of debate include requirements for informed consent and licensure portability.
“Most states require a health professional to have a license in the state where they physically are located as well as where their patients are located,” the report notes. “Some psychology boards have also adopted policies permitting an expedited licensure process and triggering reciprocity agreements with other states. However, these state-by-state approaches prevent people from receiving critical mental health services that may be available to their neighbors living just across the state line. They can also be bad for patients – restricting patient choice and provider competition.”
In its analysis, the ATA gave Texas the only A for its licensure policies, since the state has a reciprocity agreement in place with Louisiana. The District of Columbia and 31 other states do make the process easier, though a full license is still required in each state, while a majority of states “impose policies that make practicing psychology across state lines difficult regardless of whether or not telehealth is used.”
The Association of State and Provincial Psychology Boards (ASPPB) has created an interstate licensure compact – called PSYPACT - similar to that now being touted by the Federation of State Medical Boards for doctors wishing to practice telemedicine in other states. To date, only Arizona has signed onto the compact, which will take effect once seven states have voted their approval.