HHS watchdog: State oversight needed for behavioral telehealth

The U.S. Department of Health and Human Services Office of Inspector General issued a data brief this month aimed at providing insight into state evaluations and oversight of tele-behavioral services.   

The brief, which examined oversight efforts as of January and February 2020, stemmed from a survey of Medicaid directors from 37 states, as well as structured interviews with relevant stakeholders.  

“CMS and state efforts to evaluate and oversee telehealth are critical to meeting Medicaid enrollees’ behavioral health needs and to safeguarding the Medicaid program from potential fraud, waste and abuse,” wrote OIG officials.  

WHY IT MATTERS  

In response to COVID-19, patients have regularly turned to telemedicine for behavioral health needs. 

Although tele-behavioral health is most commonly provided via live, two-way video, some states allow the use of audio-only, text-only or email-only communications.  

The services are highly necessary: According to OIG, Medicaid enrollees experience higher rates of behavioral health disorders than the general population, and many may go undiagnosed.  

OIG found that while most states can identify which services are provided via telehealth, a few reported being unable to, limiting their ability to evaluate and oversee such programs.   

In addition, only a few states have evaluated the effects of telehealth, said the agency; these states found increased access and reduced costs. Others believe that virtual care increases access, has uncertain impacts on costs and raises concerns about quality.   

“No state has evaluated the effects of telehealth specifically on the quality of behavioral health services,” said OIG. “For example, no state reported looking at the effects of telehealth on continuity of care or patient safety.   

“Given the increased use of telehealth during the COVID-19 pandemic, it is important that states evaluate the effects of telehealth specifically,” OIG added.  

The agency also noted that 23 out of 37 states reported that fraud, waste and abuse are a concern with using telehealth to provide behavioral health services.  

Even so, only 11 conduct telehealth-specific monitoring and oversight.  

OIG issued three recommendations for the U.S. Centers for Medicare and Medicaid services:  

1. Ensure that the three states unable to distinguish telehealth from in-person services implement necessary indicators to do so
2. Conduct evaluations and support state efforts to evaluate the effects of telehealth on access, cost and quality of behavioral health services
3. Conduct monitoring for fraud, waste and abuse, and support state efforts to oversee telehealth for behavioral health services 

Although CMS concurred with the first recommendation, it did not indicate whether it concurred with the other two, said OIG.  

THE LARGER TREND

Fraud is a concern for many stakeholders when it comes to the future of telehealth.   

A few months ago, OIG said that it was conducting “significant work” to assess telehealth services during the public health emergency, reiterating the need to ensure virtual care will not be compromised by fraud.  

The concern is not without merit. Just this past week, the DOJ charged dozens of people for fraud schemes relating to telemedicine, resulting in about $1.1 billion in alleged losses.  

ON THE RECORD  

“States’ experiences with telehealth expansion during the COVID-19 pandemic offer a valuable opportunity for evaluating what worked well and what could be improved with using telehealth for behavioral health, while safeguarding against poor quality of care or inappropriate billing for these services,” said OIG representatives in the data brief.   

“To leverage this opportunity, CMS should continue to build on its efforts and work with States to gain a better understanding of the effects of telehealth on access, cost and quality and to monitor and oversee telehealth for behavioral health services for Medicaid enrollees,” they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.