Since the United States COVID-19 pandemic emergency began, telemedicine use has accelerated [1]. Prior to the pandemic, mental health and/or substance use disorder (MH/SUD) care delivered by telemedicine had been increasing but infrequently used—in fewer than 1% of visits [2, 3]. In contrast, in early October 2020, 41% of MH/SUD visits were conducted via telemedicine [4]. The rapid increase in telemedicine during the pandemic was enabled by sweeping temporary changes in federal and state regulations and health plan reimbursement policies that reduced longstanding barriers. These changes included federal relaxation of HIPAA compliance for telemedicine, removal of the requirement for an initial in-person appointment to prescribe buprenorphine (prohibited under the Ryan Haight Act), Medicare coverage for audio-only telephone visits, and an expanded list of services and types of providers who could deliver telemedicine. Other changes included expanding Medicaid telemedicine coverage policies, requiring commercial insurance parity for in-person versus telemedicine visits, and states allowing out-of-state providers to deliver care [1, 5,6,7]. Additionally, some commercial insurers voluntarily expanded telemedicine coverage. While the transition to virtual care occurred quickly [8, 9], it is important to take stock of these recent advances as well as continuing challenges. In this Commentary, we briefly describe our transition to telemedicine at McLean Hospital and elaborate on the national health policy and public health context that should inform our thinking on the role of telemedicine in MH/SUD care post-pandemic.

Similar to our experience, recent research also finds that nationally telemedicine is playing an important role in preserving MH/SUD care during the pandemic; despite that, there have been some disruptions observed in MH/SUD care [4, 8, 10, 11].

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