Telemedicine has benefited from a steep COVID-19 learning curve. After restrictions on telemedicine were eased or eliminated to allow virtual treatment as a temporary replacement for in-person office visits during the pandemic, most patients are returning to in-person consults. However, as the formal pandemic emergency ends, public health officials are allowing many COVID-19 emergency rules to continue while states evaluate the successes and failures of pandemic era policies. Every state is addressing changes to telehealth access and payment systems. Improvements in mental health access through telehealth is one COVID-19 experiment that seemed to work.

The Interstate Counselors Compact has been adopted by a growing number of states. On April 22, 2022 Gov. Pete Ricketts signed legislation making Nebraska the 10th signatory of the compact, which allows states to begin issuing multistate licenses. South Carolina state Sen. Ron Cromer (R-District 18) is has introduced Senate Bill 610, which would add the Palmetto State to the growing compact. Patients can benefit from a greatly expanding pool of licensed counselors across the compact states, while practitioners similarly benefit by expanding their potential patients across all the compact states.

Proponents of the compact point to several advantages of extending mental health counseling licenses to multiple states. Three main advantages fuel the rapid expansion of this compact.

• License portability improves access to hard-to-reach patients in each state.
• Growing demand for mental health services can be met through telehealth.
• States experience mutual benefit in cooperatively addressing workforce shortages in mental health services.

Telehealth is the use telephones, tablets, and computers to remotely connect medical providers with each other or to patients. Telehealth is most commonly defined as video and audio telecommunication, but some legislation expands that to telephonic communications as well. Telehealth began in surgical suites and emergency rooms to bring the expertise of specialty physicians to complex surgeries and procedures. Over time, telehealth has expanded to replace some face-to-face primary care visits for the convenience of the patient. Patients in remote areas, or those who lacked the ability to travel could see their health care provider from their home, have also benefitted from expanded telemedicine in recent years.

Through 2019, telehealth grew slowly beyond early adopters. Then came COVID-19, and telehealth was given a trial by fire. In just a few short months, telehealth services skyrocketed.

Demand for mental health services grew during the pandemic as locked down patients became more isolated. Depression rates tripled, and symptoms of mental health struggles intensified during the first year of COVID-19. Although the pandemic emergency is over, mental health services remain in high demand. In South Carolina, the latest data show that one-third (33.1 percent) of South Carolinians report symptoms of anxiety or depression.

During the pandemic, 78 percent of mental health providers integrated telemedicine services into their practice. Telehealth utilization has expanded from 11 percent of U.S. consumers using telehealth in 2019 to 76 percent of consumers now interested in using telehealth to replace in-person health care visits.

After the COVID-19 hospital lockdown, in-person nonemergency visits resumed. Many patients justifiably feared entering hospitals and clinics as the virus raged across America. Protecting frontline emergency workers became the highest priority of policymakers who were given models showing a pandemic rivaling or eclipsing the worst pandemics in U.S. history. Telehealth visits became the alternative to bringing millions of sick and healthy people together. Now, bills like Senate Bill 610 are being considered to build on temporary emergency use of expanded telehealth services.

Telehealth can never replace in-person doctor visits even for counseling, as it is sometimes preferable to have a face to face consultation with a mental health provider. However, telehealth can better allow providers to prioritize office visits for patients who need to be seen. More than 20 states have enacted laws to allow or mandate telephonic consultations with providers to ensure those without internet access could speak with their health care provider.

The need to provide better access to primary care is an increasingly urgent challenge, particularly in rural areas. As of now, there are 7,200 federally designated health care professional shortage areas. Three-in-five of these are in rural areas. In fact, there are 13 physicians/10,000 people in rural areas vs 31/10,000 in urban America.

The Interstate Counselors Compact will be good for patients, providers, and their states. Many patients find the convenience of telehealth reason enough to replace in-person office visits. Nearly 80 percent of telehealth patients responded that they have a favorable opinion of the services in a recent telehealth patient survey. What’s more, telehealth visits can be completed in 15 minutes from anywhere, as opposed to in-office appointments, which includes losing time from work and sometimes long commutes. On a yearly basis, it is estimated that American workers lose $38 billion due to missing work for in-person medical appointments.

Providers and patients have more access to one another, while states enjoy a competitive advantage for professionals within a sector that is nearly 40 times larger than it was in January 2019.

Military spouses with state-based licenses to practice often pay a heavy price with moves across state lines. The compact specifically provides military spouses with the ability to continue working through moves with their enlisted spouse. Wisconsin state Sen. Joan Ballweg (R-District 14), who serves as the national chair of the Council of State Government’s Committee on State Compacts notes that, “Military spouses work hard to earn professional credentials and establish themselves in licensed occupations while also being willing to sacrifice their professional lives in support of their spouse so they can serve our country.”  Of the 276,000 military spouses in the workforce, more than 30 percent work in fields that require a state-based professional license or certification to practice. Licensure is a burden on these military spouses, and interstate compacts can show support and attract these professionals to member states.

The following resources provide additional information about addressing mental health access gaps through telemedicine and interstate licensure agreements

Research and Commentary: Telehealth Steps Across State Lines

In this Research and Commentary, Matt Dean looks at the extremely successful rollout of telehealth interstate counselor compacts to address the mental health access crisis emerging from the COVID-19 pandemic.

HCN News: Telehealth Helps Stop Overusing Health Services

AnnMarie Shieber examines telemedicine as a means of relieving overburdened clinics and hospitals.

State Telemedicine Coverage Requirements Continue to Evolve https://www.commonwealthfund.org/blog/2022/state-telemedicine-coverage-requirements-continue-evolve The Commonwealth Fund looks at how patient care is impacted by telemedicine, and what states are doing to make sure technology and policy don’t leave some people behind.

The Commonwealth Fund looks at how patient care is impacted by telemedicine, and what states are doing to make sure technology and policy don’t leave some people behind.

Testimony before the Colorado Senate Finance Committee on Interstate mental health treatment provided through licensure compact

March 2023 data from the Kaiser Foundation show that although the pandemic emergency may be over, the mental illness and substance abuse it fostered continue to be a crisis.

Don’t Dam the Telehealth Flood https://www.forbes.com/sites/sallypipes/2022/02/28/dont-dam-the-telehealth-flood/?sh=34dcf7097aa6 The Pacific Research Institute’s Sally Pipes warns against abandoning the freedoms granted to patients to access care through telehealth.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus, host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations team at governmentrelations@heartland.org or 312/377-4000