Episode 4: The Truth About The Future of Online Therapy
Navigating the Future of Online Therapy in a Post-Pandemic World
As the world transitions out of the pandemic, there have been major shifts in how we deliver and receive therapy services. Let's break down these changes and explore how we can confidently navigate the future of online therapy.
The End of the Public Health Emergency: What It Means for Telehealth
The Biden administration announced that the public health emergency will end on May 11, 2023. This raises many questions for those who have built or grown their practices during this time. What happens to telehealth?
Changes to Medicare and Medicaid
During the public health emergency, significant changes enabled us to reach more clients. For Medicare recipients, for example, geographical restrictions were lifted, allowing them to receive telehealth services from their homes regardless of location. Good news: Medicare will continue these changes until at least December 2024. Likely, this will become a permanent adjustment, so stay tuned.
On the other hand, Medicaid is more complex as it's governed state by state. Make sure to check your state's current policies and whether they plan to extend telehealth provisions.
Licensing and Cross-State Practice
One of the most significant changes during the pandemic was the temporary relaxation of licensing requirements, allowing us to see clients across state lines without additional licenses. These emergency measures are set to expire, so it's crucial to check the current licensing rules. Some states are considering permanent changes to offer more flexibility, but for now, ensure you’re complying with the regulations in your state or the state where your client resides.
HIPAA Compliance and Technology
During the pandemic, there was some leniency with HIPAA compliance, especially regarding the technology we used for sessions. Platforms like FaceTime or Skype were temporarily permissible. However, this flexibility is ending.
Starting in May, prioritize using HIPAA-compliant platforms. If you've been using non-compliant technologies, now is the time to switch. Look for platforms that offer a Business Associate Agreement (BAA) to ensure full compliance.
Insurance Co-Pays and Deductibles
Many private insurance companies waived co-pays and deductibles for telehealth sessions during the height of the pandemic. Most of these benefits ceased within the first year, but if you’re with an insurance panel still offering these benefits, prepare for potential changes.
Have open conversations with your clients about these potential changes so they aren't caught off guard.
Telehealth's Enduring Presence
Wondering if telehealth is here to stay? Absolutely. While the emergency period may be ending, the practice of telehealth isn’t going anywhere. Before the pandemic, 42 states and DC already had laws requiring insurance companies to cover telehealth.
The pandemic highlighted the benefits of telehealth—improved accessibility and convenience. Clients appreciate the flexibility and are likely to continue opting for online sessions. Even after the immediate crisis ends, demand for telehealth services will remain strong. Studies show that a significant portion of adults prefers to continue with telehealth beyond the pandemic.
Building a Sustainable Online Practice
Many of us transitioned to or started our practices virtually over the last three years. If you're passionate about maintaining or even beginning an online practice, go for it. The demand is real, and the future is promising. Whether you choose a hybrid model or a fully virtual setup, marketing yourself clearly is key.
Final Thoughts
The pandemic has opened doors that we never thought possible. As policy changes unfold, stay informed and be proactive. Online therapy has proven to be a sustainable and desirable option for both clinicians and clients. Don’t let fear or uncertainty hold you back—the virtual world is here to stay, and we are more than ready to thrive in it.
If you found this post helpful, share it with a colleague. To continue the conversation, join our Facebook community. We’re all in this together, and I'm here to support you every step of the way.
Transcript for Episode 3
Ashley Comegys:
You're listening to the Raise to Empower podcast. I'm your host, Ashley Comegys, a licensed clinical social worker with a multistate online therapy practice. I have a passion for empowering women and mom therapists to break free of the fear, overwhelm, and oppressive systems that hold them back from taking action and building the private practice of their dreams. My goal is for you to boldly believe in yourself as a clinician and business owner. If you're looking for a place to learn practice building strategy and skill while also claiming your own power as a woman and a therapist, then you're in the right place. Welcome to the show. Hey. Welcome to this week's episode of the Raise to Empower podcast.
I'm actually really excited to talk about today's topic because I feel like it's one that's been really misunderstood in our field and leads to many clinicians making decisions about their practice out of fear and not really out of a place of knowledge or strength, which is what we want. So in this episode, we're gonna be talking about what the future of online therapy looks like as we're heading towards the end of the global pandemic. So if you hadn't heard, I believe it was the end of January. The Biden administration announced that the end of the public health emergency and the national emergency that was triggered because of COVID is gonna be ending on May 11, 2023. So May of this year, all of the things that were established because of this public health and national emergency are gonna be ending. There's been a lot of confusion and uncertainty and worry about what does that mean when it comes to telehealth? What does that mean for the future of how so many of us have built our practices over the last 3 years? So we're gonna first look at what actually changed when this declaration was put into place back in 2020. So when the public health emergency was declared, there were some changes that were initially triggered and signaled. Prior to COVID, anybody who had Medicare in order to receive telehealth services, they had to meet certain qualifications.
So they had to live in what was considered a rural area. And for many of them, they actually would have to travel to a clinic to have that telehealth session. So say, for example, they needed to be seen by a cardiac specialist, but there wasn't one in their area. They would travel to a different doctor's office and have that telehealth appointment with a doctor located somewhere else and be seen by telehealth. So it wasn't necessarily being done in their home. They would have to still go to a doctor's office or a different provider's office. Maybe they needed to have a therapy session. And again, it could be that a clinic nearby didn't have a therapist, but they did have access to somebody elsewhere in the state.
So they would go to that specific clinic and have that telehealth session from there. That was prior to COVID. Once this declaration was put in place, Medicare recipients were then allowed to actually receive telehealth services by phone, so it didn't have to be by video, or they could do it by video. And then that travel requirement or that need to travel somewhere else or even live in a rural area was done away with. So regardless of whether you lived in a rural area, if you lived in a big city, you were able to finally have access to health telehealth services that previously were not available to you that you were not eligible for. You didn't have to go somewhere else, and you could now access these services regardless of where you lived if you had Medicare. Now Medicaid recipients, they were covered under this public health emergency for telehealth across all 50 states. Once that emergency was declared, every state implemented telehealth resources for anybody who had Medicaid.
Some of the other changes that were implemented because of this emergency declaration was a waiving of certain licensing requirements that many states began to offer what was kind of called, like, an emergency licensing or an ability to see clients across a state line without having a license for that specific state. So, for example, I had a client that traveled to Delaware and was there for an extended period of time. And I was not licensed in Delaware, but when I researched the state's declaration of this public health emergency, they made it so that you were able to still work with a client in that state under this emergency declaration without having to be licensed in that state. So I didn't have to worry about applying to that board. I didn't have to go get any additional kind of licensing or reciprocity, emergency license that just didn't exist. So they just made it a lot easier to be able to see clients across state lines. Now that's not every state, but the but many states did have some kind of waiver that was available under this emergency. There were also some things that got waived around HIPAA when the public health emergency was declared.
What they stated and, again, this kind of came down from the government and from Medicare, but that they were gonna waive any potential HIPAA violation as long as you were practicing in good faith. So if you were using some kind of platform like FaceTime, for example, or another non HIPAA compliant platform and that there was a violation, as long as you could show that you were practicing in good faith. Meaning, you were trying to protect your client, you were trying to, you know, keep their confidentiality that you were not gonna be held responsible. And again, this was a way to try to help make things easier for providers so that they weren't having to just go spend a lot of money or use services or platforms that maybe the client didn't have access to or that the therapist just didn't have time to put into place. So, again, you weren't gonna be held responsible for those violations. And then from the private sector of insurance, a lot of companies waived co pays and even some deductibles if a client was being seen by somebody for telehealth. So if they had a $20 co pay, but they instead of going to an office, whether it was for therapy or a medical appointment, if they had that appointment via telehealth, they didn't have to pay their co pay. And sometimes they even didn't have to pay a deductible.
These were all changes that started when these emergencies were declared. So as we are approaching the end of these declarations, here are some of the changes that we know are gonna be coming. And this is just because this is what's being put out by the government as far as expectations of what we need to prepare for when it comes to telehealth. So remember for Medicare patients prior to COVID, they had to go somewhere specific to have a telehealth appointment or they had to live in that rural area, and that was changed under the declaration. Once the public health emergency goes away in May, for Medicare patients, actually, nothing is going to change. They have decided that they're gonna extend these changes until December of 2024. I actually suspect that if they're extending that until 2024, I have a feeling that that's not like, okay. In December 2024, it's gonna go away.
I have a feeling that they're using that time to look at how do we put a plan in place to continue to have this benefit to exist for Medicare clients beyond 2024. So I think that extension is to give themselves room to say, how do we, now that we're coming out of this emergency declaration, how do we make that change permanent? So there's basically another one and a half years until theoretically this change would go away where, again, Medicare patients would have to live in a rural area. They would have to go to a clinic to be able to have that telehealth appointment. So stay tuned really when it comes to that change because I will again, I'm not a betting person, but I would bet that that change is going to become permanent in some fashion. For Medicaid, again, remember with the pandemic, they made it so that all 50 states had telehealth available to Medicaid recipients. This is something that if you do take Medicaid, if you do work with Medicaid clients, it's dependent on state. Medicaid is a state run resource, and so you're going to need to look at your state or the states you're licensed in to see if either they are extending their emergency because some states may continue to extend that beyond what the federal government is doing in May. They may continue to have that emergency declaration if they had telehealth provisions that were put in place that were just under that emergency declaration.
You wanna just double check. Are these going to be permanent if the emergency declaration in that state is going away? Or is this something that the emergency declaration still exists and it's still available here? So that one you're gonna have to do, a little bit of searching for depending on the states that you're working with Medicaid clients in. Now, again, remember that kind of good faith ability that they that the government was basically extending, saying if you were using a non HIPAA compliant platform, that as long as you were, you know, practicing in that good faith of trying to protect your clients that you would not be held liable. That is absolutely going away in May. So if you have been over the last 3 years using something like a FaceTime or a Skype or even Zoom without having a BAA or a business associates agreement signed that helps to create a, an agreement between you and that platform that makes it HIPAA compliant. If you don't have that set up in place, you're going to need to to find some kind of platform to continue to work with clients that is absolutely HIPAA compliant. They're not going to say, okay, well, we see you were doing your best. If there is a violation as we come out of the emergency declaration.
So now is a good time if you haven't yet to begin looking at what are my options when it comes to, using, you know, a telehealth platform, who is HIPAA compliant, what are the best ones to work with the population that I'm currently working with. Again, if you are not using a HIPAA compliant platform for your telehealth sessions, now is the time to begin putting that into place. We've all been told we need to network in our private practice, but no one actually tells us how to do it or what to say. Enter comprehensive connecting, effective scripts that expand your networking community and actually fill your online practice. This free guide will give you effective scripts to connect with fellow clinicians, medical professionals, and community stakeholders to build strong networking relationships that will help fill your practice. In this guide, you will get tips and tricks for building relationships that will lead to referrals in your practice, real life examples of messages used to connect with referral sources, and customizable plug and send scripts for your specific practice needs. So download your free scripts guide today by going to bit. Ly/compconnecting.
So again, remember I said that during the pandemic, there were a lot of private insurance companies that, you know, were waiving those co pays or deductibles. And actually, a lot of companies started requiring those co pays and deductibles within a year of the pandemic starting. I personally don't know of any insurance companies that are continuing to waive that. If you are with 1, that's awesome. Just prepare yourself that if that has still been going on, that that is going to be most likely ending once that declaration is is over. Regardless of whether a client is seeing you or another provider in person or through telehealth, they're going to have to pay those co pays, those coinsurances, deductibles. Something for you to just double check if you're on an insurance panel that has been waiving those, preparing yourself, and and having that conversation with your clients as may approaches. Now as far as private pay insurance goes, when the pandemic started, so many of us were really freaking out and really concerned about, like, how does this work? Do clients have telehealth coverage? How do I bill for that? Is is this something that they're gonna cover? I highly recommend checking out the Center For Connected Health Policy or CCHP, and I will link their website in the show notes.
They are an organization that does amazing work and really helps to highlight what clients and patients and providers rights are, and they break it down state by state, private versus Medicare versus Medicaid coverage, what all the laws are for each state with each of these insurance plans and telehealth. Remember back at the start of the pandemic, we all were freaking out as as far as is this going to be covered? Is telehealth gonna be covered? The truth is that prior to March 2020, 42 states and Washington DC all had laws that actually required insurance companies to cover telehealth. So these aren't just Medicaid and Medicare, but private pay insurance companies were required by law to cover telehealth services. So where we all were freaking out, unless you live or you don't live in the 8 states that didn't have those laws, you didn't need to be worrying. Again, it was so confusing back then. You know, there was so much going on. Like, how do I even do telehealth? Is this allowed? What the hell is actually happening in the world? But the truth is that despite all of the panicking that we had around telehealth, telehealth has actually been in practice way before the pandemic even started. The first telehealth psychiatry session, it was actually held in 1959.
It was a psychiatrist that was being able to provide services for a client elsewhere in the state using closed circuit TVs. So, like, before 1960, this was happening. And TRICARE, which a lot of times they kind of set the bar with, like, if they're approving something and a lot of other insurance companies will start approving things, they've been covering telehealth since early 2000. I believe 2007 is the exact timeline, but, like, in the early 2000, they've been covering that that long. When we went to grad school, many schools didn't prepare us for telehealth. It was like this kind of questionable thing if it was even brought up. And so while we weren't necessarily prepared for what was happening in the pandemic and it felt like this really new and really scary thing, we didn't need to be panicking quite as much as we were. Telehealth really wasn't anything new.
And so while the official state of emergency and the public health emergencies are gonna be ending, that doesn't mean that telehealth is actually gonna go away or that you need to be scared about what that means for your practice. Many of us were doing online therapy practice prior to the pandemic. Many of us also started our practices during COVID nineteen. If you have been building your practice and starting this during this kind of uncertain time, and you're like, I love working online, but can I continue to do this as this, you know, emergency declaration is ending? Do I still have a sustainable practice? The answer is yes. So during the pandemic, there was a real increased demand for telehealth services. Right? Like, we all were told we need to social distance. It was not safe to necessarily be going in places, especially if you are, you know, immunocompromised or if you lived with somebody who was or if you, you know, had to travel into another building where there was going to be a lot of sick sick people to be able to see your therapist or your doctor, you wanted to opt for being able to do it from home if that was possible. And so for those of us who had not been doing telehealth services prior to 2020, the pandemic moved all of us online and it showed us what having even more time freedom and flexibility in our schedules looks like.
And it really, I think, expanded for many of us and for our families this possibility of a new way of life of being able to have a better work life balance. The other piece is it also showed clients just how accessible therapy can be. Many clients started counseling during the pandemic because we all were experiencing high rates of stress and anxiety and depression. And so telehealth made therapy so much more accessible for people because they didn't have to travel somewhere. So the American Psychiatric Association, they actually did a survey in 2020 and 2021. So it was a couple years ago, but at that time even, 43% of adults said they wanted to continue with telehealth services after the pandemic is over. If you're questioning, are clients going to still want to be able to see somebody via telehealth? I'm gonna say absolutely yes. Clients have now gotten a taste of how easily they can have the support from a therapist from their home, from their car, their office, and they're not gonna wanna stop that easy accessibility.
Just like so many stores started offering, you know, curbside pickup or even home delivery during the pandemic, those services are not gonna be going away. They're not stopping anytime soon. Target didn't build those carports for us to pull up and then put our purchases in our trunk and drive away. They didn't build those whole things if they're gonna stop doing that service anytime soon. Ease and accessibility is something that we began to have so much familiarity with and comfort with during the pandemic. We're going to choose to participate or spend money in organ at organizations or businesses that continue to offer those kinds of things. If you are wanting to continue to have your practice online or even start, maybe you haven't started yet and you're wondering again, like, is this gonna be viable if this is ending? Just know that there is a need. There is still a need for online therapists and that you can build your practice that way.
The need for online therapy is not going away. Now you may get calls from some people who are saying, hey, I'm wanting to see somebody in person or, like, are you offering that? And that's your choice. If you wanna have a hybrid practice where you do see some people in person, but you also offer teletherapy, you can absolutely do that. But there are ways to market yourself so that it is clear from the get go that you do only offer online therapy. So if if that's something that you're wanting and you're like, oh, I don't wanna have that pushback from people encouraging me to see people in person, you don't have to do that. So in the same way that I really do believe that the laws around telehealth aren't going to change for the worse. I believe that we're only going to see them strengthen in the future. And that the fact that Medicare is expanding their laws until 2024, I really will be shocked if they stop that then.
Medicare, a lot of times, sets the bar for many insurance companies or insurance standards. So I'm gonna guess that it's still gonna happen even when those changes come or if they put something into place. What Medicare kind of sets as a standard is going to continue to kind of be what a lot of private insurance companies look to as well. So if you have a completely private paid practice, you're good. You don't have to worry about the insurance coverage or anything like that. If you have been practicing across state lines under the emergency, you may just wanna double check licensure rules. But, again, you're good. Many states already had some kind of rule around telehealth in place.
We just didn't know that until we had to look at it. As long as you have approval or your license, you are good to practice that way. And if you take insurance, just check on what your state laws are regarding that insurance coverage for telehealth. Just make sure that you know, okay, what does the state say that the insurance companies are required to, you know, to cover? Statistically speaking, more likely than not, you are fine. If you do take insurance, you're fine to continue to have that coverage because 43 states already have laws in place that require insurance to cover telehealth. But again, it is always good to verify, but just know you're probably covered. As mental health professionals, we so often overthink and overanalyze and kind of psych ourselves up and out of doing things. So if you're worried about being able to still practice telehealth, you are good.
If you're worried about being able to build an online practice, like, if people are still going to want online therapy, I promise you they do. So if this is something that you want, whether you've already started your practice or you're wanting to build it, don't let this worry hold you back from continuing or pursuing your dream practice. Follow that goal. Follow that dream. I promise you online therapy is here to stay. It's not going anywhere. Thanks so much for hanging out with me today, and I will see you here next week. Thank you so much for listening to the Raise to Empower podcast.
Check the show notes for all links and resources mentioned in the show. If you found today's episode helpful or inspiring, be sure to share it with your therapist friends. And don't forget to subscribe to the show and leave your 5 star rating and review. It truly means so much to me and will help us get our message of empowerment out to other women and mom clinicians. And I'd love to connect with you in our Facebook community. So check out the show notes for the link or head to bit.Ly/raisedtoempower to join us. I'll see you back here next week.