The Office of Inspector General of the U.S. Department of Health & Human Services recently issued a data brief highlighting the multiple challenges state governments report providing behavioral health services via telehealth to Medicaid enrollees.
The OIG noted that states are increasingly relying on telehealth to provide behavioral health services to Medicaid enrollees. Even before the COVID-19 pandemic, telehealth was an important tool for states to increase access to behavioral health services for enrollees in rural or underserved areas with provider shortages.
The OIG conducted a survey of state Medicaid directors from 37 states that provide behavioral health services via telehealth through managed care organizations. It also conducted structured interviews with relevant stakeholders.
In data gathered in early 2020 before the pandemic, most states reported challenges with using telehealth, including a lack of training for providers and enrollees, limited Internet connectivity for providers and enrollees, difficulties with providers’ protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers.
Some states also reported a lack of licensing reciprocity and difficulties with providers obtaining informed consent from enrollees. These challenges limit states’ ability to use telehealth to meet the behavioral health needs of Medicaid enrollees, the OIG said.
OIG Recommendations
The OIG recommended that the Centers for Medicare & Medicaid Services (CMS) share information to help states address the challenges they face with using telehealth. This information could include examples from states that describe how they have responded to these challenges. It could also include best practices from states as well as information about working with other state and federal partners. Further, CMS could collect information from states detailing their experiences and lessons learned in response to the COVID-19 pandemic that address these challenges.
In a related data brief, the OIG noted that evaluating the effects of telehealth on access, cost, and quality is important in helping states make decisions about how to best use telehealth and about which populations benefit most from these services. It found, however, that only a few states have evaluated the effects of telehealth in their state. It recommends that CMS ensure that the three states that are unable to distinguish telehealth from in-person services implement indicators to identify which services are provided via telehealth. It also suggests that CMS conduct evaluations, and support state efforts to evaluate the effects of telehealth on access, cost, and quality of behavioral health services; and conduct monitoring for fraud, waste, and abuse, and support state efforts to oversee telehealth for behavioral health services.
