- Telehealth’s value to mental health counseling scored an important victory last week when a Texas regulatory board shot down new restrictions to distance counseling.
In a case closely watched in dozens of states and at the national level, the Texas State Board of Examiners of Professional Counselors denied a proposal to require an in-person relationship between a therapist and a new patient before the therapist could use telehealth.
As reported in the Austin American Statesman, the board said there was no need to prevent counselors from seeing patients via video consults or some other telehealth [platform, especially when such a ban would negatively affect rural and underserved Texans.
“We haven’t really seen a pattern of complaints,” Stephen Christopherson, the board’s chairman, reportedly told the board. “Show us a pattern of complaints, we’ll show you a rule.”
The board’s earlier actions to restrict telemedicine had drawn strong reactions from behavioral healthcare providers, media and the American Telemedicine Association. In a Feb. 10 letter to the board, ATA CEO Jonathan Linkous said the restrictions would make a tenuous situation even worse.
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“All telemental or behavioral health encounters, whether conducted in-person or remotely, should be based on the provider’s clinical competence and professional decision making using sufficient, appropriate clinical and non-clinical information to provide the health service,” he wrote. “Yet, the board’s proposal would enforce clinically unnecessary and ethically questionable standards and severely limit client access to mental health and behavioral healthcare.”
Kate Murphy, a mental health policy fellow contributing to the Center for Health Care Policy at the Texas Public Policy Foundation, criticized the state for its “draconian telemedicine regulations” and urged officials to “just get out of the way.”
“Texas is dead last in the nation in access to healthcare and in expanding the use of innovative technology, like telemedicine, to meet that need,” she wrote in a letter to the Statesman. “(T)hese protectionist policies undermine Texas’ efforts to increase access to medical care through telemedicine at a time when Texas desperately needs it.”
The board’s action is the latest victory for telehealth advocates in a long-running debate, and one that won’t go away any time soon. The argument focuses on whether a clinician can effectively treat a new patient by telehealth – whether it be through video, telephone or online or text messaging – without first meeting that patient in person and establishing a physician-patient relationship.
Several states are debating legislation that would mandate the face-to-face meeting in certain circumstances – including Alaska, Alabama, Arkansas, Texas and Mississippi, which has seen some 80 telemedicine-based bills filed already this year.
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In Arkansas, the House rejected an effort last year to loosen that restriction, with State Rep. Michelle Gray, R-Melbourne, saying it was “not the intent of the Legislature to take away that initial face-to-face visit.”
"They (legislators) latched on to that very quickly and were very concerned that we not move too quickly, that we slow down and think about what we're doing and make sure that the interests of the patients and safety come before everything else," David Wroten, of the Arkansas Medical Society, told Arkansas Online following a November public hearing.
In Mississippi, a bill introduced January 26 would amend the state’s definition of telemedicine to give providers the option of using it for first-time consults and to issue prescriptions. The bill followed a 2015 attempt by the Mississippi Board of Medical Licensure to, among other things, compel telehealth providers to establish a formal relationship with a healthcare provider in the state and use only secure video conferencing when prescriptions are issued.
At the center of the Mississippi debate is Teladoc, a national telehealth provider that does a great deal of business via the telephone, though its providers can access a patient’s medical records online before, during and after the consult. Teladoc, which recently launched a behavioral telehealth platform, has long argued that telehealth should be held to the same standards as an in-person visit.
In Texas – Teladoc’s home state – the battle lines are even more sharply drawn. The company has been fighting the Texas Medical Board for several years, and succeeded last year in getting a judge to stay the board’s efforts to enforce stricter rules on telemedicine. That case is now headed to a federal trial over antitrust charges, with Teladoc arguing that the state board’s actions are a deliberate attempt to interfere with the company’s right to conduct business.