Telehealth use among behavioral health providers has increased substantially in recent years. Eighty-seven percent of psychologists in the United States leveraged non-face-to-face technologies in communication with their patients. Further, a growing body of literature has found that patient outcomes for individuals who engage in behavioral telehealth was as beneficial as in-person care across different patient populations.

One chief barrier to more fully implementing behavioral telehealth has been the failure of the regulatory environment governing its use. Discrepancies between states include who can practice behavioral telehealth, what a clinician can do, and who the states define who may or may not practice. This project seeks to determine how telehealth supports or expands SOPs for different provider types, and whether telehealth training criteria exists in states as part of SOPs or through other mechanisms.

Key Findings

Behavioral telehealth services can expand access to behavioral health professionals (BHPs) for Americans, potentially narrowing the nation’s current service gap. In 2017, statutes and administrative rules detailing scope of practice authorization for psychiatrists, advanced practice registered nurses (APRNs), psychologists, marriage and family therapists, licensed professional counselors, addiction counselors, and social workers were extracted from state government websites in all fifty states and D.C., as were state Medicaid statutes, provider handbooks, and fee schedules. These documents were used to summarize and identify variability in telehealth authorization across the country for BHPs.
Key findings include:

  • Medicaid often authorizes telehealth services to be provided and reimbursed, even when legal scopes of practice licensure laws do not include telehealth.
  • Psychiatrists, psychologists, and APRNs are compensated at a higher rate than other BHPs for the same service codes.
  • Twenty-nine states have telehealth parity laws in place for private payers.
  • Fourteen states deny out-of-state providers the authority to offer telehealth services within their state, while 18 states have language in place to either allow out-of-state providers to provide behavioral telehealth, or to acquire an expedited state license to do so.

Understanding current laws and policies can provide insight into needed future policies for expanding telehealth, and inform research into the efficacy of existing telehealth policies.

Publications

An Analysis of Behavioral Telehealth Authorization in Scopes of Practice

Policy Brief
Full Report