State Policy Levers to Improve Access to Telebehavioral Health

Article written by Jacqueline D. Marks, Maria Andrade, Benjamin Ahmad, and Jared Augenstein for Manatt Health.

The United States continues to face a behavioral health crisis that has worsened due to the COVID-19 pandemic. In 2021, nearly 40% of adults reported symptoms of depression or anxiety, an increase from 10% in 2019. The behavioral health crisis is acutely impacting children; a 2020 national survey found that 71% of parents felt the pandemic had affected their child’s mental health. Limited access to behavioral health services for children was an issue prior to the pandemic; CDC data from 2019 indicated that nearly 20% of children faced a mental, emotional, or behavioral disorder, yet only 1 in 5 of these children received treatment.

Despite the clear need for increased access to behavioral health services for both adults and children, there is a persistent and severe shortage of behavioral health providers. The Health Resources and Services Administration estimates that by 2025 there will be a shortage of more than 250,000 behavioral health providers, including psychiatrists; clinical, counseling, and school psychologists; substance use and behavioral disorder counselors; mental health and substance use social workers; mental health counselors; and school counselors.

Telehealth has been an essential method of behavioral health care delivery during the pandemic. A recent report published by the Kaiser Family Foundation illustrates the critical role that telehealth has played in meeting the nation’s behavioral health needs during the pandemic. The report found that from March–August 2020, telehealth accounted for 40% of behavioral health visits. Rates of telehealth use have declined slightly since then, but use of telehealth for behavioral health still outpaces other outpatient visits; between March–August 2021, 36% of behavioral health visits were conducted via telehealth, compared to only 5% of other outpatient visits, and utilization remains high compared to pre-pandemic levels.

Through our ongoing telehealth policy tracking, Manatt has identified that at both the federal and state levels, policymakers are designing their post-public-health-emergency (PHE) telehealth policies to ensure continued access to telebehavioral health going forward. At the federal level, the Centers for Medicare & Medicaid Services finalized several changes within the CY 2022 Medicare Physician Fee Schedule that enable permanent coverage of telebehavioral health services delivered to Medicare enrollees in their homes via both video and audio-only modalities.

States are utilizing a variety of policy levers to maintain access to telebehavioral health services. To read about commonly used levers CLICK HERE for the full article.