Telebehavioral health is the provision of behavioral health services through HIPAA-secure software over the internet. Telebehavioral health is a mode of access to mental and substance abuse services and not a separate type of service. All DSM-5 conditions and just about all types of services provided in-person for behavioral and mental health can be provided through this mode of treatment access. A growing body of evidence dating back to the 1950s demonstrates efficacy, cost-effectiveness and patient satisfaction of telebehavioral health services.
Telebehavioral health services can include, but are not limited to, psychiatry, medication management, medication-assisted treatment (TeleMAT), emergency room triage, clinical assessment interviews, individual and group counseling or psychotherapy, case management, chronic care behavioral health management, alcohol/drug addiction and opioid use disorder treatment (TeleSUD), peer support, clinical supervision and case consultation and other clinical treatments. Telebehavioral health services may be used as the sole source of assessment and treatment or used in combination with in-person services or HIPAA-secure treatment apps. See laws and guidelines for state and profession-specific restrictions and requirements.
Financial - Reimbursement
Third party reimbursement for telebehavioral health is widespread and growing. Most third-party health insurances, Medicaid and Medicare reimburse for telebehavioral health services. Some health insurances have separate conditions for telebehavioral health reimbursement. A growing number of states require reimbursement for telebehavioral health services that are comparable to in-person services. Additionally, many healthcare entities privately contract telemental and telebehavioral health service providers to cover shortage areas. Grant funding is also available to establish and grow telebehavioral health services.
Guidelines and Ethics
Each profession that provides mental or substance abuse services has Clinical Guidelines for providing telebehavioral health services.
State license regulations for telemental and telebehavioral health vary by profession and from state-to-state. There are resources available to help you identify and maintain compliance with the State License Requirements for Telebehavioral Health.
Technology and HIPAA
Providing telebehavioral health services requires software that meets HIPAA-security standards and permits clinical staff to fulfill their HIPAA compliance duties. The software requirements for telebehavioral health will vary depending on the use-case, setting, record integration/sharing requirements (EHR/EMR integration) and other factors. In addition, no technology by itself is HIPAA compliant and each vendor may interpret their role and requirements differently. Identifying the appropriate software service provider can be overwhelming. It is highly advisable to speak with a mentor and clearly define a use-case and business model prior to selecting technology and software. (Technology Selection Toolkit, Comparison of Telebehavioral Health Software, Telemental Health Open Office Hours ).
After the initial setup of the practice, the role(s) needed to set up and facilitate telebehavioral health services will depend on many factors such as setting, size of the organization, the scope of services, business model and the support needs and preferences of the clinical staff and treatment population. In a busy clinic-to-clinic setting a clinical presenter (provider) will be on one side of the video call and a coordinator or facilitator will be on the patient side to facilitate the patient/client access.
The types of settings for telebehavioral health are clinic-to-clinic, direct-to-consumer, clinic-to-school, and clinic-to-organization. Clinical providers may be located either at a clinic or the provider’s home, depending on the payment model, technical setup and organizational policy.
Starting a new telebehavioral health service is simple, once established. However, it is challenging to design a new telebehavioral health service without experience and knowledge or a broad range of content areas that periodically change. Startup entails activities like creating clear use-cases, creating a telebehavioral health business model, building referral systems, selecting and setting up HIPAA-secure software and secure technology, creating telebehavioral health-specific content, creating new telebehavioral health HIPAA administrative procedures, creating service policies and procedures, and complying with telebehavioral health professional guidelines and state license laws for each profession. To overcome the complexity of starting up, it is recommended that the organization engage with a mentor or consultant to efficiently guide the startup through the initial steps to achieve profitability in the near term.
A large and growing body of peer-reviewed research has established the efficacy of telemental and telebehavioral health services. Part of the difficulty in identifying research comes from the wide variety of terms used to describe this mode of treatment (telebehavioral health). The NETRC maintains a database of research on telebehavioral health. Telehealth Resource Center advisors can help connect you to research resources and research partners.