Objective

To determine the extent of implementation, as of November 15, 2022, of the three recommendations included in our initial audit report, Oversight of Telemental Health Services (Report 2020-S-16).

About the Program

The Office of Mental Health (OMH) is responsible for developing regulations and providing guidance to assist OMH-licensed and -designated providers under Article 31 of the Mental Hygiene Law with the delivery of mental health services, including the use of telemental health (TMH). TMH is a voluntary treatment method that makes use of two-way, real-time interactive audio and video equipment to provide and support mental health services and psychiatric care from a remote location.

In 2015, OMH established a formal set of TMH standards allowing only physicians or psychiatric nurse practitioners to use TMH for assessment and treatment services, followed in 2016 by expanded regulations that allowed delivery of TMH from additional settings. Another expansion in 2019 allowed additional OMH-licensed care providers beyond physicians or psychiatric nurse practitioners to provide TMH services. In March 2020, OMH issued a regulatory waiver related to the COVID-19 disaster emergency that expanded definitions of TMH and TMH practitioners. OMH also issued a blanket attestation for providers to complete that wished to offer TMH during the emergency and outlined the programs and services allowed to offer TMH for the duration of the disaster emergency. Subsequently, OMH streamlined its approval process to ensure providers’ ability to continue to offer TMH beyond the disaster emergency. Without this permanent approval, providers will no longer be able to provide services via TMH after February 1, 2023.

The objective of our initial audit report, which was issued in June 2021 and covered the period from January 2016 through February 2021, was to determine whether OMH was adequately monitoring the delivery and performance of TMH services and ensuring that related TMH activities were conducted in accordance with applicable laws and regulations. During that audit, we found that although OMH had expanded TMH regulations, there were opportunities for it to improve access and oversight in the State. For example, as of December 23, 2020, just 141 of the 448 OMH-licensed, -designated, and/or –funded mental health providers eligible to offer TMH were approved to do so beyond the declared COVID-19 disaster emergency, leaving 307 providers potentially unable to do so. We also found that OMH’s practice of analyzing TMH usage data from only State-operated psychiatric centers, and not private providers, limited its ability to identify both problems and opportunities for improvement on a statewide basis. Finally, we found that OMH’s oversight of providers’ use of TMH was focused on the initial approval and lacked defined procedures or processes to subsequently monitor provider usage.

Key Finding

OMH has made significant progress in addressing the problems we identified in the initial audit and has implemented all three recommendations from that report.