The Consolidated Appropriations Act of 2023 allowed the use of 2-way, interactive and audio-only telehealth for behavioral or mental telehealth. Congress extended these telehealth flexibilities under the Medicare during the COVID-19 PHE through December 31, 2024. It included provisions that affect telehealth services, specifically allowing patients to access telehealth services without an in-person, every 6-month visit requirement. The Ryan Haight Act amended the Controlled Substances Act to restrict clinicians from prescribing controlled substances unless the clinician conducts an in-person exam of the patient. During the COVID-19 PHE, the DEA enacted certain flexibilities allowing clinicians to prescribe controlled substances without an in-person exam and with a DEA registration in just one state.

The potential end of these flexibilities on December 31, 2024, will mark a significant shift in the landscape of telemedicine. To prepare APA members for this shift, our Committee on Telepsychiatry provides you with the following guidance:

Practice Considerations

• Start your planning process early.
  • There may be additional needs for patients with co-occurring medical or surgical conditions who would be at increased risk for poor outcomes.
• Review your current patient list to identify those who may be affected by this change.
  • Collaborate with primary care physicians in your patient's local area.
  • Psychiatrists may need to be in direct contact with a patient’s specialty provider (i.e., oncologist, rheumatologist, etc.) rather than their PCP if the psychiatrist is providing psychiatric consultation or care for a patient requiring specialty service.
  • The APA Find a Psychiatrist provides a way to search by zip code, city, and state to help find a psychiatrist in the local area.
  • Provide patients with information about local support groups and peer support services.
• Consider adjustments to scheduling and staffing to accommodate more in-person appointments.
• Develop a communication plan to inform patients about the potential changes and discuss their options.
• Update telehealth and in-person policies, protocols, procedures, and safety measures to align with the new requirements.
  • Review the APA such as the Telepsychiatry Toolkit & the Resource Document on Best Practices in Sychronous Videoconferencing-Based Telemental Health
• Ensure that all telehealth sessions are documented accurately and comply with any existing regulations.
• Stay up-to-date on payer policies as some may change coverage for telehealth services.
  • Center for Connected Health provides a guide on Medicare billing (.pdf).

The time to plan and communicate is now. There is still uncertainty about the extension of telemedicine flexibilities going into 2025, including the tele-prescribing of controlled medications. APA will continue to provide updates as information becomes available.