Changes coming to psychology practice after COVID-19

The federal covid-19 public health emergency (PHE) enacted in 2020 ended on May 11, 2023. Having the PHE in place offered many benefits to consumers and providers, making it easier for patients to access a variety of health care services from their own homes via video calls or audio-only phone. The end of the PHE marks the end of several pandemic era flexibilities in health care.

For psychologists treating Medicare beneficiaries, there are no immediate changes regarding coverage and reimbursement of psychological services, both in-person and via telehealth. However, psychologists should be aware that several of the flexibilities extended by the Centers for Medicare and Medicaid Services (CMS) during the PHE are temporary and scheduled to end in the next 6 to 18 months. Now that the PHE has ended, here’s what psychologists should know:

• Patients can continue receiving audio-only telehealth services for evaluation and management as well as therapy and counseling in opioid treatment programs. Audio-only services for other mental and behavioral health treatments are permanent in Medicare.
• Telehealth services can be provided in Federally Qualified Health Centers and Rural Health Clinics.
• CMS expanded the types of providers who can furnish telehealth (e.g., physical therapists, occupational therapists, speech/language pathologists).

Psychologists should be aware that the following changes are scheduled to take effect on January 1, 2024:

• Outpatient telehealth services (e.g., from a psychologist’s office), will revert to being paid at Medicare’s facility rate, which is lower than the nonfacility rate currently in effect.
• Medicare will no longer reimburse telehealth services on its Category 3 (temporary) list. The Category 3 list includes codes for psychological and neuropsychological testing (96130–96139).
• Direct supervision will require the supervising provider to be present in-person, not virtually.

During the PHE, the Office of Civil Rights (OCR) for the U.S. Department of Health and Human Services announced that it would not impose penalties for noncompliance with HIPAA requirements against health care providers who provided good faith telehealth services with noncompliant technologies during the pandemic. As a result, providers could use popular, nonpublic video communication applications, such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth services without penalty during the PHE. They would not be penalized for using such apps without a business associate agreement (BAA) in place. However, OCR strongly cautioned health care providers against using public-facing apps such as Facebook Live, Twitch, TikTok, to provide telehealth services.

Now that the PHE has expired, health care providers have until August 9, 2023, to transition to using HIPAA-compliant platforms. This includes telehealth technology platforms, electronic record systems, and practice management software. Providers should also have copies of executed BAAs with third-party technology vendors as well as updated compliance policies and procedures.

This includes having the necessary BAAs with third-party technology vendors. OCR offers examples of telehealth videoconferencing app vendors that provide HIPAA BAAs:

• Skype for Business / Microsoft Teams
• Updox
• VSee
• Zoom for Healthcare
• Doxy.me
• Google G Suite Hangouts Meet
• Cisco Webex Meetings / Webex Teams
• Amazon Chime
• GoToMeeting
• Spruce Health Care Messenger

Therefore, it’s important for providers to ensure that by August 9, 2023, they are in full compliance with HIPAA requirements in terms of using compliant technologies, having BAAs with third party vendors, and maintaining updated HIPAA compliance policies and procedures.

State emergency telehealth policies adopted during the covid-19 pandemic have since lapsed or expired. What does this mean for patients and providers? It is important to check the individual payer’s policies to confirm what telehealth services are covered and requirements for coding and billing telehealth services. Your state’s laws may specify whether telehealth services are limited to videoconferencing or include asynchronous communications or audio-only phone; whether there are originating site restrictions for where the patient may receive services; and whether payers are permitted to limit coverage of telehealth services to in-network providers or telehealth-only providers. You can find more detailed information about states’ telehealth policies on the Center for Connected Health Policy website.

In addition, while many states had allowed for emergency temporary licensing or interstate practice by out-of-state providers during the pandemic, those emergency orders have also since been terminated. Some states have enacted a telehealth registry system for out-of-state providers to deliver telehealth services. But most states have adopted the Psychology Interjurisdictional Compact (PSYPACT) as the means for eligible, credentialed psychologists in PSYPACT states to deliver telehealth services (or temporary, in-person services) to patients in other PSYPACT states. More information about PSYPACT (including which states have joined the compact and how to become credentialed) can be found online.