The Virginia Department of Behavioral Health and Developmental Services (DBHDS) are working very hard to help both children and adults with serious mental health disorders. Provider organizations are constantly struggling to recruit and retain mental health specialists and often find it necessary to arrange for regular visits by a mental health consultant entailing considerable travel costs. Often, non-mental health providers are placed in the position of serving patients with severe mental health problems with little or no specialty support.
Licensure requirements greatly affect the use of telemedicine in Virginia and contributes to the difficulty in expanding telemental health in the state. Most states require a provider to be licensed both in their state and in the patients’ state in order to practice telemedicine. However, in Virginia, a provider must be licensed in the Virginia to provide telemedicine to a patient also located in the state.
When it comes to telemental health, Medicare will reimburse for telemedicine encounters if the beneficiary lives in or uses the telehealth system in a locality that is located in a HPSA but not within a Metropolitan Statistical Area (MSA). This particular issue concerning payment in an MSA can be a deterrent to the expansion of telemental health.
Medicaid provides coverage for telemedicine services to include evaluations, office visits, individual psychotherapies, consultations, and mental health and substance abuse crisis intervention.
Medicaid allows states to reimburse the physician or licensed practitioner at the distant site and reimburse a facility fee to the originating site. Medicaid’s telemedicine coverage does not require the originating site to meet rural area definitions.
A good example of how telemental health can actually operate, the Bay Rivers Telehealth Alliance received a four year grant from HRSA and purchased and installed telemedicine equipment at 21 sites in the state. The funding has enabled telemental health to be established at long term care facilities, mental health clinics, and hospitals in rural areas to help diagnose and manage depression and dementia in geriatric populations.
The majority of state facilities administered by DBHDS do not use telemental health citing concerns over privacy, confidentiality and IT compatibility. However, several state facilities such as Central State Hospital in Petersburg now use video-conferencing for patient mental evaluations. In addition, the Commonwealth Center for Children & Adolescents in Staunton uses telemental health for some family therapy sessions, and Catawba hospital near Roanoke uses telemental health for prescreenings and for some forensic evaluations.
Hospitals are generally reporting that they have saved considerable amounts of money when small hospitals have used telemental health for assessments in their emergency departments. Both staff and patients are reporting positive feedback.
Telemental health is taking place in universities in the state. For example, the University of Virginia (UVA) Office of Telemedicine has facilitated 20,568 patient encounters from 80 sites across the Commonwealth in 35 specialty areas. About 4,407 patient encounters were for mental healthcare. UVA is bringing psychiatry to underserved rural youths where psychiatry fellows do much of the work supervised by attending psychiatrists.
At another university location, the Telemedicine Center at Virginia Commonwealth University has facilitated 16,098 patient encounters at 32 sites in 14 specialties. However, nearly all of the encounters occurred in State correctional facilities.