Telehealth is “the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.” A variety of services can be provided via telehealth, such as general wellness visits, nutrition counseling, and behavioral health services. Before the coronavirus 2019 (COVID-19) pandemic, telehealth services were widely underutilized despite the proliferation of Internet-enabled telecommunications technology. However, in March 2020, the federal government recommended the use of telehealth services to mitigate public health risks associated with COVID-19. Additionally, the Centers for Medicare and Medicaid Services adjusted regulations and reimbursement requirements for telehealth.
In addition to federal efforts to support telehealth utilization, 30 states passed emergency orders to permit expansion of telehealth services. In Michigan, two executive orders issued after a March 2020 declaration of a COVID-19 State of Emergency supported telehealth expansion in the state by providing “temporary relief from certain restrictions and requirements governing the provision of medical services” and “encouraging the use of telehealth services during the COVID-19 emergency”. The orders also permitted defined expansions of some providers’ statutory scope of practice. In addition, the Medical Services Administration, Michigan’s Medicaid authority, released new Medicaid guidance in March 2020 in line with federal changes and10,11 several bills were passed by the Michigan broaden how telehealth is defined and regulated.
These policies facilitated changes in behavioral health service delivery to improve access to care for those seeking treatment for mental health and substance use disorders.
Analysis of the key informant interviews produced the following primary themes:
- Use of telebehavioral health has increased since March 2020.
- State policies to expand telehealth services positively impacted continuation of behavioral health service delivery.
- Telebehavioral health expansion improved access to mental health care.
- Quality of care and patient satisfaction with telebehavioral health services may vary depending on service type.
- Barriers to effective telebehavioral health provision still exist.
- Providers were supportive of continued telebehavioral expansion.