The complex legal and regulatory landscape that plays such an outsized role in the health care industry generally takes on another order of complexity when it comes to behavioral health. Our behavioral health attorneys help providers and health plans of all kinds navigate that landscape, which is still unsettled and fraught with compliance pitfalls.
As the demand for behavioral health services skyrockets—and as access to those services lags woefully behind—our clients depend on us to help them launch their businesses, get reimbursed for their services, and maintain compliance with the intimidating array of behavioral health laws, rules, and regulations.
Behavioral health is an extremely broad regulatory category, quite different from traditional medical services. It covers a wide range of programs whose treatments are open-ended (including mental health care and substance use disorder (SUD) treatment and prevention), and whose outcomes are difficult to quantify. Moreover, the regulatory requirements vary widely, not just from state to state, but also from profession to profession. With behavioral health practices drawing heightened scrutiny from regulators, we help our clients understand their obligations under behavioral health laws and steer clear of the risks and penalties that attend compliance violations.
Grappling with Mental Health Parity
As the industry continues to address the promise, as yet unfulfilled, of the mental health parity laws, plans and providers alike turn to us for guidance. These are not easy laws to comply with, as they have not yet been fully interpreted—correct answers can be elusive. Even so, our clients trust us to provide sophisticated yet practical guidance on delivering mental health services in a compliant manner. In a field brimming with startups, we also help new companies structure their businesses, negotiate their contracts and oversee their compliance issues.
Supporting Substance Use Disorder Stakeholders
The COVID-19 pandemic exacerbated a major mental and behavioral health crisis, putting increased pressure on a strained SUD treatment system. Parties on the front lines of that crisis—SUD providers and treatment facilities, health plans, and associations—look to us for complete legal support for their transactional, regulatory, contracting, reimbursement, and strategic initiatives. With a team that includes attorneys who previously worked at the Substance Abuse and Mental Health Services Administration (SAMHSA), we help clients navigate all applicable federal and state laws, regulations, and guidelines relating to mental health and substance abuse services. We also advise on SUD service coverage and reimbursement issues and work closely with investors interested in the SUD space to evaluate regulatory risks associated with particular investments or acquisitions.
Our Telemental Health Laws App
As the online delivery of behavioral (also known as “telebehavioral” or “telemental”) health services grows exponentially, we continue to update our invaluable app, Telemental Health Laws, a comprehensive collection of state regulatory requirements for all 50 states plus the District of Columbia. This free app, available to anyone, provides users with state-specific content relating to the regulatory requirements for professional practitioners and stakeholders in multiple mental health fields.
- Currently assist multiple startup telebehavioral health entities in starting up their businesses nationally. We advise these entities on corporate, regulatory, provider network, managed care, and reimbursement issues.
- Currently provide advice to a nascent network of a dozen behavioral and medical health care providers (also known as a “Behavioral Health Care Collaborative”) in New York on legally compliant ways to organize a shared infrastructure and integrated care delivery model in order to improve health outcomes, manage costs, and participate in cutting-edge value-based payment arrangements.
- Served as counsel to a national association focused on mental and behavioral health care issues. We tracked recent and significant federal rulemaking efforts related to mental health parity, prepared summaries of the relevant proposed and final rules upon publication, and delivered webinar presentations for the association’s membership discussing key provisions in the proposed and final rules.
- Advised a clinic in Washington, DC, that provides primary care services to Latino residents of the District. The clinic won a $500,000 grant from a large insurer to implement a regional telepsychiatry program. We are currently advising the clinic on a number of regulatory issues regarding the implementation of the telepsychiatry program.
- Advised numerous major telebehavioral companies on regulatory issues concerning telehealth, corporate practice of medicine, reimbursement, the Food and Drug Administration, compliance, and fraud and abuse.
- Reviewed and negotiated managed care agreements for providers with payors involving behavioral health carve-in matters.
- Provided advice and counsel on state-specific requirements related to crisis management in telemental health services, the development of applicable crisis management protocols, and the structure of management and other arrangements with behavioral health practices in compliance with applicable state corporate practice of medicine restrictions.