How to Provide Remote Treatment for Behavioral Health and Addiction Patients

As the world reacts to the COVID-19 pandemic, shelter-in-place orders have made it difficult to treat patients with behavioral health and addiction disorders. Without face-to-face opportunities to meet with behavioral health specialists, patients can miss important treatment sessions, which can set back treatment or recovery. They can also miss out on time spent personally connecting to a support group, which provides important healthy relationships for patients struggling with behavioral health or substance abuse problems. To add to the difficulty of missing these sessions, regulations are changing quickly and it can be hard to stay up-to-date on current processes related to prescription medication and payments. 

Substance Use Disorder (SUD) is difficult to manage on its own, but many patients diagnosed with SUD also suffer from other mental health or behavioral disorders. According to the National Survey on Drug Use and Health (NSDUH), 45% of people with addiction have a co-occurring mental health disorder. Individuals with a dual diagnosis require integrated treatment plans that can address multiple disorders. While it’s possible to treat multiple disorders at once, treatment methods and regulations differ for behavioral health disorders and SUDs.

Important changes to the regulatory landscape

Unfortunately, only a small percentage of SUD patients receive treatment for the disorder. Care often requires attending in-person sessions with mental health experts and it can be difficult for patients to find an approved provider, particularly in rural areas or regions with few approved physicians. Among those who do receive treatment, it’s common to fall victim to expensive, ineffective opportunists that don’t provide the quality of care patients need. Underregulation of service providers and an increase in demand for SUD services has produced new for-profit centers that make strong claims about success without evidence that their methods are actually successful. In the current landscape, it’s been challenging for SUD victims to receive the quality mental health treatments they need to recover.

However, the impact of COVID-19 has recently prompted CMS to change telepsychiatry regulations. This eliminates barriers for patients who have found it hard to continue existing treatment plans and even makes it easier for victims who were previously untreated to find a new way to treat their mental health disorders. Here’s a brief summary of major regulation changes that have paved the way for an expansion of telepsychiatry:

• Medicare Part B expansion—New regulations now cover telepsychiatry treatment under Medicare Part B, enabling patients who are at home to make payments for these sessions with coinsurance and include those costs against a deductible. Previously, this coverage was only available for patients in remote locations.

• Ryan Haight Act of 2008 suspension—This regulation prohibited mental health professionals from prescribing controlled substances without an in-person visit. With orders for so many patients to stay home, this regulation has been suspended, allowing prescriptions to be made after telepsychiatry appointments.

In addition to the expansion of telepsychiatry, SAMHSA has updated rules to ensure that at-home patients have better access to take-home medications and that 42 CFR Part 2 does not impede SUD treatment services. Patients and their families should stay informed about new SAMHSA COVID-19 regulations to make sure that they’re getting the best treatment while sheltering in place.

The importance of patient consent

These regulation changes are great news for SUD and mental health patients who can benefit from telepsychiatry, but in order to receive that treatment, they still need to complete consent documents. Telepsychiatry, like any treatment for mental health disorders, also comes with potential risks. Before a patient is allowed to begin treatment sessions, they need to be informed of those risks and acknowledge that they still wish to proceed. That acknowledgement usually comes in the form of a patient signature on an informed consent document.

Informed consent documents contain crucial information about what a patient can expect during their treatment, especially important for someone trying telepsychiatry for the first time. These documents can be customized for each telehealth provider and patient, but generally these documents are used to:

• Inform patients of their rights in regards to telemedicine, including the right to stop or pause treatment at any time

• Instruct patients about their own responsibilities when receiving telepsychiatry treatment

• Describe potential benefits, constraints and risks (including privacy and security) involved with telemedicine

• Outline basic program policies around billing, scheduling, cancellation and more

• Prepare patients about contingency plans in the event of a technology/equipment failure during telemedicine sessions

With all the benefits of telepsychiatry, patients need a way to provide signed consent and start treatment with the fewest obstacles. Unfortunately, with so many patients and providers homebound, collecting signatures can be difficult. If patients can’t provide consent, they can’t start treatment.

How Docusign can help

Docusign has a suite of products that make it easy for SUD or mental health patients to complete the necessary paperwork and start receiving treatment from any location. Docusign eSignature includes important features that can help support HIPAA compliance efforts, including multiple layers of security and authentication built in, to ensure information remains private and secure. The patient consents, HIPAA releases and other critical documents can be signed through an emailed envelope or online.

One of the US’s largest behavioral healthcare providers needed to expand their treatment for outpatient addiction and mental healthcare virtually through telehealth.  Their vision is to no longer require patients to live or travel to the treatment center in order to get access to services, particularly in order to reach rural communities and to reduce the spread of COVID-19. 

Docusign eSignature is used for completing patients consents, releases of information, and other patient paperwork. Once the forms are signed, staff members download and save the forms to a secure folder where they then import and categorize them into their Cerner EHR.  “This process is definitely getting us through this time of need.” 

Telepsychiatry is a broad umbrella that includes a lot of different services each requiring unique consent forms and documentation. Any mental health provider needs to look for ways to effectively manage the steps between a patient requesting treatment and starting treatment. Efficiently managing the series of documents in that process is the best way to reduce administrative burden, ensure compliance and begin treatment for patients as fast as possible.

When it comes to making payments, telehealth can be complex. Insurance eligibility, benefit qualifications and co-pay amounts are all factors in determining the amount due for each treatment session. Adding to the complication is the fact that virtual sessions don’t have a physical check-in and checkout where payments are usually collected. Docusign Payments is perfect for companies of any size. Docusign’s Payments platform can integrate with Stripe, Paypal via Braintree, Auth.net, Cybersource, Elavon and Zuora. Telehealth providers can send a request for payment via the same means as any other document and the customer can pay with a credit card, debit card, Apple Pay or Google Pay. The payment record is then included in the agreement’s audit trail.

Telehealth providers no longer need to worry about wasting valuable resources chasing down payments, waiting for payments to clear or even missing out entirely on a payment because a patient left the session before paying. Key to success is implementing a solution quickly. Docusign’s Customer Success organization has helped hundreds/thousands of healthcare providers transition to telehealth care, and are able to help get your team successfully deployed remotely and quickly. The Docusign Agreement Cloud for Healthcare allows Telepsychiatry professionals to forget about administrative backend work and focus all of their efforts on helping patients improve their mental health.