Mel Rising Dawn Cordeiro
Medical experts have begun pushing harder for out-of-state telehealth services to address the mental health care worker shortage. During the pandemic, quite a few states relaxed their barriers to interstate health. Normally, practitioners in any field are not allowed to practice in a state where they do not hold a license. This ー of course makes sense.
According to the Goldwater Institute, seven states including Arizona, Florida, Kansas, West Virginia, Minnesota, Indiana and Delaware are allowing out-of-state physicians and other healthcare providers to offer telemedicine services without a state license; granted they register with the state they are going to provide services to.
Telemedicine also referred to as telehealth, or more simply, telemed, allows for patients to meet with healthcare providers remotely. This can come in the form of a Zoom call or even a phone call. One of the main goals in implementing telemed is ease of access. Services such as virtual visits are offered in nursing homes and to other people who are homebound.
Data from the federal government shows that about 100 million Americans are living in areas where there is a shortage of mental health care. This means that there are fewer practitioners as well as resources available. It’s an even bigger issue in rural areas.
Pre-pandemic, telemed services in Rhode Island were practically unheard of. In 2021, the RI General Assembly passed a bill allowing to expand telemed services, therefore allowing healthcare providers to see patients. This also means that Medicaid is now required to cover telemed services at a cost that is consistent with the copays of any other traditional visit. Doctors were granted the ability to prescribe medications over electronic services as well as evaluate and employ different forms of treatment. This bill was intended to surpass the pandemic and provide Rhode Islanders with the opportunity to gain greater access to services and to take control of their health.
Telemed is not the perfect answer, nor will it solve every issue. For most people living in rural and lower-income areas, this could be another barrier due to a lack of or limited access to the internet.
Another issue that has been raised, but has yet to be addressed satisfactorily is payment. Most insurances, especially state insurance providers such as Blue Cross Blue Shield, United Health and Neighborhood Health Plan of Rhode Island, do not allow for out-of-state services. On the rare occasion they do, it takes an act of Congress to have it approved. Federal programs such as Medicare and Medicaid do, however the number of practitioners accepting those forms of insurance is dwindling due to a lack of timely or appropriate reimbursement.
There is also the issue of access in general. Patients living in rural areas may have limited access to different commodities, internet and Wi-Fi capabilities specifically. Most Americans have a cell phone and telemed services can certainly be accessed via cell phone. Access to the necessary working technology itself is also a concern. It is possible that insurance will not cover the expense of telemed, or may only cover a portion of it. Will the patient be able to afford out-of-pocket expenses?
At this time, there are more questions than there are answers. Perhaps it will now be a federal mandate that all Americans are automatically enrolled in Medicare and Medicaid programs. This would mean that Congress would need to re-evaluate the country’s budget. The government could also decide to mandate that all people have access to this service with no questions asked. Without a doubt, telemed will address the mental health worker shortage and will also potentially provide access to those people who otherwise may not have access.
Rhode Island College employs the use of telemed as well. We use our HOPE Line, which can be reached at 401-456-4673, to provide 24/7 support. The Counseling Center also offers telemed appointments via the TELUS app. If a clinician from RIC is not available, the TELUS app will connect with the next available clinician. This partnership also allows for RIC students to focus on their health and not on how they can afford care.
One thing we know for sure is that with the introduction of artificial intelligence, the medical field is certainly changing. The world in general is changing. We are all along for a ride where no one can predict the outcome.