Telehealth has become an integral part of behavioral healthcare delivery, but regulatory changes may shape how providers can use telehealth to prescribe medications. Current telehealth prescribing flexibilities allow providers to prescribe controlled substances without an initial in-person evaluation. These flexibilities, extended by the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), are set to expire December 31, 2024. With the deadline approaching, providers must prepare for potential changes in telehealth prescribing rules.

The Second Temporary Rule, published October 10, 2023, extended these flexibilities to all practitioner-patient relationships, regardless of when they were established. This eliminates the distinction between existing and new patient relationships, allowing providers to initiate controlled substance prescriptions via telehealth for both long-term patients and those seeking care for the first time. It also ensures continuity of care for established patients while also improving access for individuals who may be new to telehealth or who have recently changed providers.

The Impact of Schedule II Telehealth Prescribing on Behavioral Health

Controlled substances, particularly Schedule II medications, play a crucial role in mental health treatment. Many patients rely on these medications to manage conditions such as ADHD, severe depression, and anxiety disorders. Telehealth has improved access to care, especially for patients in rural or underserved areas.

The ability to prescribe Schedule II medications via telehealth has ensured continuity of care for patients who might otherwise struggle to access treatment. This has been particularly important for maintaining treatment regimens and preventing potential relapses or exacerbations of symptoms.

The Gridlock: Understanding the Debate

Proponents of Continued Flexibility

Advocates for maintaining expanded access argue that Schedule II telehealth prescribing has been crucial in addressing mental health needs. They emphasize improved treatment adherence, reduced barriers to care, and the ability to reach underserved populations. The current flexibilities have meant access to necessary medications and regular check-ins with providers.

Concerns and Opposition

Critics of continued Schedule II telehealth prescribing flexibilities cite concerns about potential misuse and diversion of controlled substances. They argue that in-person evaluations are necessary for proper assessment, especially when prescribing powerful medications. There are also worries about the risk of “pill mills” exploiting looser regulations.

Potential Consequences for Behavioral Health Practices

Behavioral health practices may face challenges if the current flexibilities are not extended. Established telehealth treatment plans could be disrupted, forcing patients to transition to in-person care. This could have a particular impact on patient access in underserved areas, or on patients with conditions that make regular in-person visits difficult.

These patients may struggle to maintain consistent care if required to attend in-person appointments, potentially leading to interruptions in treatment and medication management. Practices may face administrative challenges, such as potentially restructuring their care delivery models.

Navigating the Uncertainty: Best Practices for Behavioral Health Providers

Providers should monitor official channels to stay informed about regulatory updates. Developing contingency plans for patient care, including strategies for transitioning telehealth patients to in-person care, is key. Electronic health record (EHR) systems can help ensure compliance and continuity of care, regardless of regulatory outcomes.

The Role of Specialized EHR Systems in Adapting to Regulatory Changes

EHR systems tailored for behavioral health can help practices stay compliant with changing regulations. Features such as integrated telehealth platforms, robust documentation tools, and flexible prescription management systems are particularly beneficial.

Specialized EHRs can help ensure proper documentation and facilitate transitions between telehealth and in-person care. These systems also have data analytics capabilities, helping practices track prescribing patterns and patient outcomes to support evidence-based decision-making.

Looking Ahead: The Future of Telehealth in Behavioral Health

The future of Schedule II telehealth prescribing remains uncertain. Potential scenarios include a return to pre-pandemic regulations, a hybrid model with additional safeguards, or continuation of expanded access with enhanced monitoring.

The DEA has said they anticipate publishing final rules by fall 2024. Advocacy and engagement in the regulatory process will be crucial in shaping these outcomes, with behavioral health organizations and professional associations likely to play a significant role by providing their input.

Navigating Schedule II Telehealth Prescribing

As the December 31, 2024 deadline approaches, providers must stay engaged with the regulatory process and prepare for potential changes. It is also essential for providers to maintain clear communication with patients and to develop strategies for ensuring continuity of care regardless of regulatory outcomes.