Law Bridges Gap in Mental Healthcare

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Provision allows cross-state PTSD consultations
The recent passage of the National Defense Authorization Act in Congress will make it easier for active-duty personnel and veterans to get mental health care wherever they are, officials said.

A provision of the act, aimed at expanding federal exemptions for behavioral telehealth consultations across state lines, removes the requirement for health care providers to be licensed in the state in which their patients are being treated.

Gen. Peter Chiarelli, the Army vice chief of staff and an advocate for providing behavioral health counseling to soldiers in their homes via telehealth, praised the new law as a “big victory.” “It’s the biggest step forward we’ve seen in two years,” Chiarelli told Army Times. “For me, it is huge. We have just to take advantage of it.” Nearly 20 percent of military personnel returning from Iraq and Afghanistan showed symptoms of post-traumatic stress disorder, according to a Rand Corp. survey.

Patients are plentiful, but the doctors who are needed to treat them are not. Chiarelli acknowledged a shortage of behavioral health specialists in the Army, as well as the challenge of attracting, hiring and retaining them to the rural areas that surround some posts.

“I find when I get closer to large metropolitan areas, I don’t have as many problems,” Chiarelli said. “But when I go to the Fort Stewarts, when I go to the Fort Braggs, when I go to the Fort Hoods, my ability to attract a shortage population in society is difficult. But we’re working very, very hard to get everything we possibly can to hire those folks.” The hope is that connecting patients to care by video teleconference skirts this problem, allowing a provider in Seattle, for example, to speak with a patient across state lines in rural Montana.

Telehealth was touted in a recent Army health study as an effective medium for delivering a wide range of behavioral health therapies targeting PTSD among geographically isolated or dispersed soldiers, particularly members of the National Guard and Reserve.

However, the approach is limited under state laws that require providers to hold licenses in the states where the care is received, said Gary Capistrant, senior director of public policy at the American Telemedicine Association.

“The requirement was for a provider to have multiple licenses, which can take months,” Capistrant said. “It may be you just have one visit with a person in a particular state, and you’re not going to go through that for one person.” Leading the Defense Department’s efforts to provide care to service members and veterans this way is the National Center for Telehealth & Technology in Tacoma, Wash.

The agency has created smartphone applications that help evaluate the symptoms of post-traumatic stress, and it is readying mobile telehealth units where troops can access services from a specially modified bus or shipping container.

There was a previous federal exemption to state licensure requirements which applied to members of the armed forces delivering care between federal facilities, meaning the patient and the specialist each had to be on federal property.

Matt Mishkind, program lead within the agency’s clinical telehealth division, said this was interpreted to include DoD civilians and personal services contractors. The new law explicitly exempts these groups and other credentialed health care professionals working at federal health care institution.

“The law very specifically lays out what had been interpreted before,” Mishkind said.

Moreover, the new law allows care to be provided at “any location,” which Mishkind said may be read as a means to allow practitioners to provide care from a civilian institution, or allow a patient to receive care in their own home.

“If a DoD employee is providing care to this person, it doesn’t matter where they are,” Mishkind said. “That, to me, is one of the more interesting points because it expands where care can be delivered from and to.” The flexibility would make it easier to people who are unwilling to come to a military or federal facility to receive care, due to a perceived stigma associated with mental health issues, or because they live too far away.

It also opens up the possibility of partnerships between civilian hospitals and government institutions.

It may be allowed by law, but at present, the delivery of care via telehealth into service members’ homes is not authorized under Tricare policy, Mishkind said.

“The law is a great step, and we have other efforts underway,” he said, “but until the two truly align, we still have some limitations on where we can deliver the care.”

By Joe Gould    | Published:  February 6, 2012 - Page a29

Original Article:  No longer availible on-line.
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