January 16, 2025
Governor Hochul will present her FY 2025-2026 Executive Budget on Tuesday, January 21st at 1:00 p.m. in the Red Room at the NYS Capitol.
Following the Red Room presentation, NYS Division of Budget Director Blake Washington will Hold a technical briefing at 3:00 p.m. in the Capitol’s Blue Room.
————–
Below please find the NYS Council’s statement regarding New York’s ongoing overdose epidemic and the Governor’s upcoming SFY ’26 executive budget proposal:
“Recent headlines and some government data depict a measurable decrease in the number of overdose deaths both nationally, and here in New York State. While encouraging, New Yorkers who live and work in underserved and often-undervalued communities are living a different reality in which their family members, friends and neighbors continue to die of preventable overdoses and fentanyl poisonings at disproportionate rates.
Conditions of daily life are deeply connected to healthy outcomes, especially when it comes to the treatment of substance use, chronic pain, mental health, and trauma. Every community needs access to culturally-specific providers, peer networks, behavioral health services, drug disposal facilities, Medication Assisted Treatment as well as to naloxone and naloxone training. On-demand prevention, treatment, recovery and harm reduction services that are culturally sensitive and effective must be in place in ALL of New York’s communities if we are to effectively mitigate the overdose crisis for all populations.
New York’s overdose crisis continues to bear down on underserved and communities of color. We have a responsibility to look past the headlines and understand the variables impacting vulnerable New Yorkers. As such, we call on Governor Hochul to include a robust package of investments in the SFY 2026 executive budget that will finally address the health inequities impacting communities that continue to sustain disproportionate rates of overdose, so as to ensure immediate access to appropriate care for every New Yorker requesting assistance.”
The New York State Council represents over 160 mental health and substance use disorder prevention, treatment, recovery and harm reduction community-based organizations across New York. For more information please reach out to us at (518) 461-8200. Visit our Website at www.nyscouncil.org
—————————–
The NYS Council is honored to be a Steering Committee member of the HealthyMinds, HealthyKids Campaign convened by Citizens Committee for Children in NYC. The Campaign has been working together for a number of years. Several years ago we commissioned Health Management Associates (HMA) to develop a rate reform you can read here: https://healthymindshealthykids.org/hmhk-publication/?post_type=data_publications&post_id=17755. The proposal requests some $200M from the state to raise reimbursement rates for providers serving children, youth and families. More recently campaign members drafted a survey and conducted a statewide analysis of waitlists and access to care barriers for these same New Yorkers – all in an effort to drive reform of the OASAS and OMH systems of care for children, youth and families.
Please see the published press statement sharing the Campaign’s reaction to the Governor’s State of the State (SOS) address here, and a new analysis of waitlists and access barriers for New York’s children, youth and families here.
This morning the NYS Council sent a Letter to the Editor to the New York Times in response to an article that appeared in the newspaper yesterday. Here’s the article from the NY Times (directly below). And below the article please find our response:
Online Therapy Boom Has Mainly Benefited Privileged Groups, Studies Find
Digital mental health platforms were supposed to expand access for the neediest patients. Researchers say that hasn’t happened.
Listen to this article · 5:40 min Learn more
By Ellen Barry, NY Times
Jan. 15, 2025
The number of Americans receiving psychotherapy increased by 30 percent during the pandemic, as virtual sessions replaced in-person appointments — but new research dampens the hope that technology will make mental health care more available to the neediest populations.
In fact, the researchers found, the shift to teletherapy has exacerbated existing disparities.
The increase in psychotherapy has occurred among groups that already enjoyed more access: people in higher-income brackets, living in cities, with steady employment and more education, researchers found in a series of studies, the most recent of which was, published Wednesday in The American Journal of Psychiatry.
Among those who have not benefited from the boom, the team found, are children from low-income families, Black children and adolescents, and adults with “serious psychological distress.”
“I think that the whole system of care — and maybe the internet delivery is a piece of this — appears to be pivoting away from those in greatest need,” said Dr. Mark Olfson, a professor of psychiatry at Columbia University Irving Medical Center and the lead author of the studies on access to care.
“We’re seeing that those with the greatest distress are losing ground, in terms of their likelihood of being treated, and that to me is a very important and disconcerting trend,” he added.
It wasn’t supposed to be this way. In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.
“Telehealth did not live up to the hype,” said C. Vaile Wright, senior director of the office of health care innovation at the American Psychological Association. The reasons, she added, are no surprise: Many Americans lack access to reliable broadband, and insurers do not adequately reimburse providers, who, in turn, choose to treat privately paying clients.
“If you can’t afford it, no matter the modality, you just can’t afford it,” Dr. Wright said. It may be, she added, that weekly therapy sessions are simply not scalable to a broad population, and the field should explore light-touch alternatives, like single-session interventions and digital therapeutics.
As telehealth platforms grow, they may be attracting clinicians from community settings with the promise of flexible hours and better conditions, said Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health and Science University who studies the accessibility of mental health services.
Selecting from a large patient pool, they may opt to treat patients with milder conditions and more ability to pay. “It’s certainly something we should know,” Dr. Zhu said. “There should be light around this. Who are these companies serving? And what does this mean for patients who are most in need?”
The percentage of Americans receiving psychotherapy remained relatively steady, at 3 to 4 percent, for decades before beginning a gradual rise, said Dr. Olfson.
Then two factors — the pandemic and the explosion of teletherapy — contributed to a sharp increase, with the number of adults receiving psychotherapy rising to 8.5 percent in 2021 from 6.5 percent in 2018. (By comparison, the annual percentage of adults taking psychotropic medication remained stable, at around 17.5 percent.)
Dr. Olfson said he was surprised by the magnitude of the increase. “We haven’t had something like Covid before, and we haven’t had this technology before,” Dr. Olfson said. “There was a lot of social isolation, a lot of loneliness. And those are things that psychotherapy is designed to address, in a way that medication can’t.”
The findings are based on the Medical Expenditure Panel Survey, which is conducted by the federal government and measures how American civilians use and pay for health care. The survey does not include those in the military, incarcerated or in nursing homes, hospitals or homeless shelters.
Previous studies, based on insurance data, showed that Americans’ mental health spending increased by 54 percent from 2020 to 2022, amid a tenfold increase in the use of teletherapy.
The new studies flesh out which Americans are receiving the care. An analysis of 89,619 adults published in JAMA Psychiatry last month found psychotherapy use grew most among the youngest respondents, among the most educated and among those in the highest two income brackets.
An analysis of the use of telehealth by children and adolescents from 2,445 households reached similar conclusions. The study, published today, found that children from wealthier families, using private insurance, were far more likely to use teletherapy. Children in urban areas were nearly three times as likely to use it as their rural counterparts.
During the years of the pandemic, the use of mental health services by Black children and adolescents decreased, falling to 4 percent in 2021 from 9.2 percent in 2019. In the same period, the use of mental health care among white children rose, to 18.4 percent from 15.1 percent, the team found in another study.
“What we find is that it does appear to be just exacerbating existing disparities,” Dr. Olfson said. “I think there’s a real need to try to address that.”
Ellen Barry is a reporter covering mental health for The Times. More about Ellen Barry
————–
NYS COUNCIL RESPONSE TO THE NYT ARTICLE (DIRECTLY ABOVE) FOR PUBLICATION:
Letter to the Editor
Re: “The Promises and Pitfalls of Teletherapy” (Jan. 15, 2025)
To the Editor:
Your article on teletherapy highlights important benefits and challenges, but it overlooks the crucial role community-based organizations play in ensuring telehealth reaches underserved, low-income populations.
Throughout New York State, community-based organizations have embraced telehealth to expand access to care for those who need it most. For individuals facing barriers such as transportation, childcare, or inflexible work schedules, telehealth has been a lifeline. These organizations, often rooted in trust and local knowledge, are uniquely positioned to bridge the digital divide, helping clients navigate technology and providing devices or internet access when needed.
The New York State Council for Community Behavioral HealthCare represents 165 community-based agencies across New York. We have seen firsthand how telehealth not only addresses immediate needs but also helps to reduce stigma with the promise of services that are available from the privacy of the clients home. By blending telehealth with in-person care, community organizations ensure comprehensive and culturally sensitive services, even for the most vulnerable populations.
To make the promise of teletherapy a reality for everyone, we must continue to support the infrastructure and funding that enable these organizations to thrive. Access to telehealth shouldn’t depend on income, geography, or technical know-how—it should be a standard of care available to all.
Lauri Cole, Executive Director
NYS Council for Community Behavioral Healthcare
518 461-8200 or lauri@nyscouncil.org
———————————————
DEA drug prescribing proposal may change providers’ strategies
Brock E.W. Turner, Modern Healthcare, 1/16/25
Telehealth companies are unsure they’ll feel the impact of the Drug Enforcement Administration’s proposed rule on remote prescribing of controlled substances.
The proposed rule, released Wednesday and scheduled to publish in the federal register on Friday, would establish a special registration process for the remote prescribing of Schedule II-V controlled substances such as Xanax, Vicodin and Adderall. The timing of the proposal, issued in the final days of Biden administration, has led to uncertainty among telehealth companies that aren’t sure if the Trump administration will finalize it.
“It’s hard to tell yet what the business implications may be because some of the aspects of the rule might not look the same at the end of the rulemaking process,” said Jessica Rigsby, vice president at opioid use disorder treatment telehealth company Ophelia.
The DEA also released a final rule on Wednesday for its 2023 proposal that sets up a special registration process for remote prescribing of buprenorphine, a medication used to treat opioid use disorder. The buprenorphine final rule won’t go into effect until Feb. 17, while the proposed rule is pending, which means Trump’s administration will determine the fate of both rules.
Kyle Zebley, executive director of the American Telemedicine Association’s lobbying arm, ATA Action, said it appears the Biden administration is trying to quickly tie up loose ends before he leaves office. The Trump administration could pause the proposal or make adjustments, he said.
The proposed rule for remote prescribing of controlled substances sets up a special registration process for providers based on three tiers. For all eligible providers, the DEA is proposing to require that providers maintain a state-level registration in each state they practice or dispense in.
The agency is also proposing that at least 50% of providers’ prescriptions for Schedule II drugs issued in a given month would need to be issued during in-person appointments. These proposals, if finalized, would be challenging for many telehealth companies, advocates say.
Jeremy Sherer, a healthcare partner at law firm Orrick focusing on digital health and healthcare technology, said in an email the proposal would make it very hard for virtual-only telepsychiatry practices treating conditions like attention deficit hyperactivity disorder to operate in a compliant manner. This is especially true for multi-state telehealth practices regularly treating patients with medications that are classified as Schedule II controlled substances, he said.
The Alliance for Connected Care, an industry group, said in a statement it was “very concerned” with the proposed rule and believed the guardrails set forth by the DEA were not appropriate.
Zebley and the ATA is urging the Trump administration to roll back the proposed rule.
Robert Krayn, CEO and co-founder at virtual mental healthcare company Talkiatry, said he was disappointed that the proposed rule was unable to provide greater access to patients while satisfying the DEA’s diversion efforts. The latest proposal has loopholes that bad actors could exploit, he said.
Talkiatry, which secured $130 million in funding round last June, prescribes Schedule II medications but Krayn declined to disclose a breakdown of how many patients would be affected by the proposal. Despite the potential impact, Krayn is not immediately preparing his company to satisfy the proposed rules.
“The whole reason that something’s proposed is [that] it’s built to be changed and adapted based on feedback,” Krayn said. “So, I think it’ll be premature to make dramatic changes.”
As part of the COVID-19 public health emergency, providers were allowed to remotely prescribe controlled substances regardless of the state they practiced in. As that public health emergency wound down, DEA issued a proposal in February 2023 that removed those flexibilities and reinstated in-person requirements. After receiving industry criticism that called the proposal too restrictive, DEA decided to extend the COVID-19-era flexibilities multiple times, most recently through 2025.
Bridget Early contributed.