Behavioral Health Provider Experiences with Telehealth during COVID-19

Takeaways from our study

Between late July and mid-August 2020, a team at the University of Michigan Behavioral Health Workforce Research Center conducted in-depth interviews with 31 Michigan behavioral health providers* across the state providing telebehavioral health services. A summary of Michigan behavioral health providers’ experiences with telebehavioral health during the COVID-19 pandemic is below (the number of respondents who spoke to each theme is noted):

*The interviewees included: a psychiatrist, psychologists, registered nurses, clinical social workers, mental health counselors, substance use disorder counselors, applied behavior analysts, and peer support providers, among others.

What are the implications for state policy?

All providers interviewed indicated that they would like to see telebehavioral health continue moving forward after the pandemic to allow them to best meet their clients’ diverse needs. Looking past the pandemic, as policymakers consider which policies should remain permanent, the following policy options could be considered:

Continuing audio-only telehealth authorization

• Currently, private insurers in Michigan can choose to cover audio-only services if they deem that they can be appropriately provided. Legislators could consider amending the Insurance Code² to instead mandate such coverage. This would allow providers to use their professional judgement when determining which services are appropriate for audio-only provision.
• Michigan did not cover audio-only services via Medicaid historically. The state received time-limited authorization to cover audio-only services during the public health emergency.³ Michigan Medicaid could consider requesting authorization of these services to continue after the pandemic.

Improving telebehavioral health coverage

• For private payers, telehealth service parity existed historically in Michigan⁴ and was expanded during the pandemic.⁵ However, insurers may interpret the word “cover” as requiring service parity but not service and reimbursement parity, for example. Policymakers could consider amending the Insurance Code to mandate equivalent reimbursement.
• For Medicaid, telehealth reimbursement parity existed historically and is still in place, with the same procedural codes being billed for in-person and telehealth services.⁶ However, service parity could be expanded to cover more services. Michigan Medicaid could allow providers to bill for all services via telehealth, provided the service is of equivalent quality as in-person care (disqualifying some services, such as injections) and in-person care is not feasible for the client. This added flexibility may empower providers to offer services to their clients via the most appropriate modality.

Service parity laws: These laws require insurers to cover the same services for telehealth as in-person services, as long as they can be provided appropriately via telehealth.

Reimbursement parity laws: These laws require insurers to reimburse health care providers for telehealth services at rates that are similar or equal to rates for the same in-person services.

Approving verbal consent for treatment

• The Michigan Public Health Code⁷ allows written or verbal consent for treatment. However, providers may be unaware that verbal consent is allowed. Policymakers, including insurers, could further clarify that verbal consent is permitted.