ADHD Weekly, May 4, 2023

The COVID-19 public health emergency declaration comes to a close on May 11. This means that many people who are receiving healthcare by telemedicine, including care for ADHD and co-occurring conditions, will need to work with their providers to navigate any changes to appointments or how their prescriptions are filled.

It will also put back into effect Drug Enforcement Administration (DEA) rules and restrictions regarding stimulant medications for ADHD, along with other Schedule II medications. These will include requirements that patients have at least one in-office medical visit with their mental health professional or prescriber.

Getting to the medical office is not necessarily an easy trip for many people, especially those in rural areas or who have limitations due to work or transportation. Healthcare providers will also have to put in place HIPAA-compliant messaging software if they are to continue telehealth practice.

“Many providers were doing telehealth for the first time ever during the pandemic, so they really did not have the resources, have equipment, have software, have technologies set up,” says Kathy Wibberly, PhD, director of the Mid-Atlantic Telehealth Resource Center. “They were relying on things like whatever consumer-based video conference we have, whether it’s a smartphone, iPhone, using Zoom, using any number of video conference platforms. Consumers have gotten used to it. It’s easy, right? It’s like whatever’s available on your phone. We don’t need to download any software, we don’t need to use a special link. That is going to come to an end.”

Telemedicine and ADHD care

The pandemic provisions for telemedicine were a huge benefit for many adults and families affected by ADHD. Being able to meet with their health care professional or prescriber on a more flexible schedule and from the privacy of their home enabled many people to begin or continue ADHD treatment.

“My husband is frequently out of town, so I don’t have someone to reliably watch the baby to go to an in-person appointment,” says Cheryl, a mother in Pennsylvania. Her three children were home during the pandemic, and it was difficult to find someone to care for them while she was out.

Having the option to meet with her prescriber online enabled her to continue her treatment while still meeting her responsibilities for work and family during the pandemic

Now, though, her pharmacy will not fill her prescription because it was written by a telehealth provider, and the new rule by the DEA will require her to schedule an in-person visit.

Telehealth appointments and care increased by 38 times the pre-pandemic levels. A significant number of those utilizing telehealth are adults with ADHD or parents of children with an ADHD diagnosis. The changes coming with the end of the public health emergency will play a role in how they manage their ADHD treatment or their children’s treatment.

“Providers and their patients need to know what that treatment is going to look like moving forward and whether, once the public health emergency ends in May, they’re going to need to figure out a way to have a visit in-person before continuing treatment, and that can be a real challenge,” says Jeremy Sherer, who represents telehealth companies. These changes could lead to people having to traveling long distances to receive care for ADHD and other conditions.

For families seeking care from a child development specialist for ADHD, it can mean waiting several months because of the lack of specialists in the United States and the relatively few who practice in more rural locations. Pediatricians and pediatric healthcare medical professionals are often the primary providers of ADHD care for children, but there are many who do not have the required DEA license required to prescribe Schedule II stimulant medications for ADHD, especially in less densely populated areas. For them, connecting a patient with a specialist by telehealth may no longer be an option or they will have to become the go-between with the patient and specialist.

What patients and providers can do

Providers have known these changes to telehealth would be coming, and many have already taken steps to purchase or contract with software that is HIPAA-compliant. Others have been working with their patients or clients to figure out other ways to of providing telehealth services or in-person appointments.

Dr. Wibberly says the telehealth practices that patients and providers are comfortable with will undergo changes if telehealth care is going to continue. Providers will need change how they have been offering care with the end of the public health emergency.

“You can’t just have any consumer-based device,” she says. “You’re going to really need to have some software that has the encryption, you’re going to have to have a business associates agreement with the software vendor. Those vendors are going to need to understand what HIPAA is and… all those great things that come with those regulations.”

One of the unintended consequences, she says, is telehealth visits will become more complicated, at least on the provider’s side of the computer screen.

“You can’t just pick up and just dial using Google Chat or Meet or whatever you happen to have,” Dr. Wibberly says. “It’s not just the video conference, it’s not just encryption. There are many administrative things. People have moved from work sites to home and working from home, they really aren’t thinking about their own routers, their access points, whether their home network is actually secure, whether they’re using a public network, which all would violate HIPAA.”

Networks aren’t the only concern patients and professionals will need to take into account. Privacy in their homes or offices during visits will need to be evaluated. Patients will not be able to attend a telehealth visit from a public location or share a router.

Patients who are able to travel to their provider’s medical or health center will need to do so, at least once—medical practices and state regulations can require more frequent visits. Professionals are still working with the US Department of Health and Human Services to understand if that visit will be required of both new and established patients and clients or just new patients and clients going forward.

Some understand these changes to mean that a patient may be able to be seen locally by a doctor or other healthcare provider who can work with a remote specialist who can then write a prescription. This would benefit the patient, who would not have to travel, and the healthcare provider who could continue to see local patients.

“I would love to just mention, especially for rural providers who don’t have the time, energy, resources, staff, to really think about that hybrid model,” says Dr. Wibberly. “I would really recommend that you actually think about that seriously, like take a step back and do some planning for it.”

If you have not already had a conversation with your ADHD treatment provider, or your child’s provider, now is the time. Most patients who are already receiving care will have between 60 and 90 days to make changes with their provider or to schedule any needed in-person healthcare visits.

Learn more about ADHD and telehealth:

• The Therapist Is Online: Telehealth for ADHD Has Benefits and Drawbacks
• Telemental Health: Benefits and Potential Pitfalls
• New Options for ADHD Treatment During COVID-19
• What Parents Should Know Before Contacting an Online ADHD Provider
• Telehealth for ADHD?
• Telehealth for Teens and Young Adults with ADHD

Join the discussion: Is telehealth for ADHD something you would recommended for another family?