Administrators offered the following explanations for telemental health programs that were successful. ● There was a high demand for the services and high patient enrollment. ● There were good relationships between providers, administrators, and rural health workers. ● There was strong community integration and support. Funding Issues Agency administrators and practitioners can be faced with many challenges when providing telemental health services. A common hurdle is funding. Programs often secure startup money through grants, but reimbursement issues are barriers to sustainability (Lambert et al., 2016; Lauckner & Whitten, 2016; Lustgarten, 2017). Some third-party payers have historically not reimbursed for telemental health services or have been inconsistent about reimbursement (Lerman & Quashie, 2016; Lambert et al., 2016; Lauckner & Whitten, 2016). Originating sites incur costs, including equipment, broadband access, use of space, and staff time to help clients get set up, compared to distant sites, where the provider is located, which can bill for services (Lambert et al., 2016). It is unclear how exceptions for telemental health during the COVID-19 pandemic will generalize in the future; however, it does appear that many of the overhead costs will remain reduced due to the increase in available, cost-effective avenues for providing HIPAA-compliant telemental health. Currently, Medicare reimburses live video services. Audio-only services are currently covered by Medicare Clinical Issues Some providers of telemental health services complain of the high number of clients who miss their appointments. Similar to traditional face-to-face sessions, managing client no-shows is a challenge that impacts not only the therapeutic process but also the financial sustainability of services (Lambert et al., 2016). Examples specific to telemental health include some telemental health vendors selling access to telemental health equipment to psychiatrists and other behavioral health providers on an hourly basis; when clients do not attend appointments, the providers may still have to pay the telemental health vendor for the use of the service. In addition, if clients have unpaid balances, the providers still must pay the vendors. Equipment maintenance is another issue that must be clarified between vendors and service providers. Therefore, it can be essential to discuss no-show payment policies when individuals consent to telemental health services (so that they are aware that they will have to pay for the session, even if they miss it, to cover the costs associated with the session if that is the case). Some clinicians report discomfort using telemental health technology (Lambert et al., 2016). Some report concerns that it is more difficult to establish and maintain client rapport over video compared with face-to-face treatment (Lerman & Quashie, 2016). Some clinicians report that it is difficult to balance practice schedules with a telemental health schedule (Lerman & Quashie, 2016; Lambert et al., 2016). They report a lack of time for preparation and establishment of routine services (Martin-Khan et al., 2015). In addition, some agencies may lack the additional staffing Licensure and Malpractice Licensure is a challenge when providing telemental health services to adults and children (Kramer & Luxton, 2016). Because states often require licensure in the area where the client resides, practitioners may find it burdensome to hold multiple licenses. Some states have proposed solutions,
When asked what they needed to continue, the interviewees responded that they needed more funding, expanded offerings or telehealth uses, extra staff with more training, and improved or extended technology.
as well; however, these provisions are based on changes made during the COVID-19 pandemic, and it is unclear if these provisions will be permanent. Medicaid coverage varies by state, but most provisions align with Medicare practices. It is important to note that for private insurance, some reimbursement standards vary based on permanent telehealth policies versus temporary COVID-19 reimbursement policies (Billing for Telebehavioral Health). Regulatory oversight for telemental health reimbursement is established by each state. Twenty-four states and the District of Columbia have enacted laws that mandate coverage of telemental health services by private health insurance companies (Lambert et al., 2016). Similarly, facility fee payments also vary by state. Unfortunately, there is not uniform coverage across health plans, including Medicare and Medicaid. Often, the reimbursement rates from federal, state, and private payers do not cover the full cost of telemental health services (Lauckner & Whitten, 2016; Lambert et al., 2016). Some states have started to allow telemental health practice across state lines, for example, through the Psychology Interjurisdictional Compact. needed to support telemental health services (Lauckner & Whitten, 2016). To address these issues and to ensure that they are comfortable with the equipment and establishing rapport over video, it can be helpful for providers to practice telemental health delivery prior to delivering telemental health to patients. Some clinicians report a lack of communication between providers when utilizing telemental health. This can result in a disjointed continuum of care (Lauckner & Whitten, 2016). Because additional training and technical knowledge are needed, some clinicians are reluctant to provide telemental health services, which results in the lack of a specialized workforce (Lauckner & Whitten, 2016). That being said, positive attitudes toward providing telemental health appear to be increasing (Connolly et al., 2020), with increasing numbers of providers looking for full-time telework or hybrid opportunities. Complicated, vague, inconsistent, and burdensome regulations can present many challenges to implementing an effective telemental health practice. Professional organizations are releasing more guidelines for telebehavioral health practices, but legislation, regulations, and reimbursement guidance does not necessarily offer parallel guidance. These issues can cause some clinicians to decide not to provide telemental health services, favoring instead services that are familiar and reimbursable. However, with the necessary utilization of telemental health during the COVID-19 pandemic, the majority of clinicians now have familiarity with the technology and guidelines that appear to be expanding the availability of telemental health services. such as allowing interstate licensure agreements, but ongoing debate and bureaucratic issues hinder fast progress (Kramer & Luxton, 2016). Practitioners who disregard the licensure issues have been held legally liable for practicing without licenses. Practitioners should know the jurisdictional
Page 177
Book Code: PYCA2725
EliteLearning.com/Psychology
Powered by FlippingBook