When COVID policies end, what happens to mental health care?

‍Virtual care is here to stay

Lockdowns shifted our expectations for human connection. Therapy was no exception as people sought ways to manage their mental health online. Thankfully, virtual care proves just as effective as in-person therapy when it comes to mental health counseling.

In fact, virtual care might even make it easier for people to prioritize their mental health. Some research suggests retention rates are higher. 

Both clients and providers embraced easier online access to therapy, made more enticing by payers’ promising to match payment rates for in-person therapy. 

Though the Department of Health and Human Services continues to extend the public health emergency and the helpful policies that come with it, some states have already ended their state of emergency and rolled back policies. Across the country, relaxed COVID restrictions have people wondering what to expect for the future of mental health care.

PSYPACT’s far-reaching benefits

In the earlier days of the pandemic, people shuffled across state lines to lockdown with loved ones or to relocate to less expensive locations. The crisis led many states to waive some requirements for out-of-state providers, so clients could benefit from continuity of care while providers could keep practicing and earning. Unfortunately, many of these were temporary measures. 

The Psychology Interjurisdictional Compact—or PSYPACT—provides a longer term solution. States that enact PSYPACT legislation exchange information about psychologists’ licenses and disciplinary actions. Psychologists can practice virtual care in PSYPACT states where they aren’t licensed. They can also temporarily practice face-to-face therapy outside of where they’re licensed for 30 days every year 

Through PSYPACT, providers can reach people in isolated places where therapists are scarce or even reach people who need specialized care. A client with Bipolar Disorder can head home to their small town with the security of knowing they can still access expert support from a provider who specializes in their condition. 

PSYPACT is gradually gaining ground, with the compact effective in 35 states. 

Other licenses are left behind

PSYPACT’s powers are limited to therapists who are licensed as psychologists. That leaves out a whole spectrum of effective therapists and their specific kinds of counseling. Therapists with licenses as professional counselors, marriage and family therapists, or clinical social workers still struggle to practice across state lines. 

Acquiring an equivalent license to practice therapy in another state sounds simple but the path can be full of barriers. Therapists may need to retake courses they’ve already passed, complete superfluous supervised hours, and do redundant state licensing exams—wasting time and money. In essence, many feel trapped within their own state. 

Movements to advance license transfer exist, commonly called “licensure reciprocity” or “licensure portability.” Organizations such as the American Association for Marriage and Family Therapy and the American Counseling Association propose reasonable reciprocity policies that require equivalent state exams and withhold protections from providers with ethics violations. 

Same as for psychologists, many states relaxed rules around reciprocity during the public health emergency. These protections will fade when COVID policies do. Some already have, suddenly cutting off clients from support in many states. Unfortunately, the broader portability movement has yet to enjoy the same momentum as PSYPACT, jeopardizing the mental health of clients and the livelihood of providers nationwide.

Payment parity in perpetuity

Providers benefitted from payers expanding payments to include virtual care. Clients already received coverage for virtual care over video. Emergency measures raised the rates that insurance paid providers to equal in-person rates in many cases, establishing payment parity. Audio-only care joined the list of some plans’ covered services. 

Medicare and Medicaid were among the payers to establish that payment parity and the first to add audio-only. But the looming though often delayed deadline for the public health emergency threatened these rates. Recent legislation means Medicare will continue covering telehealth through 2024. What Medicaid covers will be left up to states but many are making plans.

Some states have already passed legislation to continue payment parity for virtual care. At the federal level, bills to continue payment parity—including audio-only services—have been introduced.

Lingering questions

Just as the pandemic prompted new questions and answers, the end of COVID restrictions raises new ones. Many mental health providers are navigating how to resume in-person therapy. 

One big question involves balancing in-person and virtual care, especially for clients who started as virtual only and may live further from their primary mental health provider. Emergency measures waived many payer requirements for clients and providers to meet face-to-face at least once every 6 months. These measures are slated to end when the public health emergency status does. Could this policy change? What would it take? 

Hopefully, the answers to questions such as these prove as promising as the ones we’ve seen so far. Mental health is no longer an afterthought. With effort, care has become more accessible than ever. 

It must be. After all, the effects of the collective trauma of COVID will also linger while other world problems grow in scope and complexity. Providers need support if we will meet that challenge.

Further Reading and Resources

• Track legislative priorities by state with ATA Action, the American Telemedicine Association’s advocacy organization.
• Support efforts by organizations like the American Counseling Association, the American Association for Marriage and Family Therapy, and the National Association of Social Workers.