COVID-19 Telehealth Policies' Impact on Provision of Alcohol and Substance Use Disorder Services at Federally Qualified Health Centers

ABSTRACT In the United States, alcohol and substance use disorders (AUD and SUD) are highly prevalent and are established causes of mortality, morbidity, individual and societal costs. There is significant unmet need in accessible AUD and SUD treatment options, however telehealth is demonstrated to be an effective solution to addressing barriers to treatment, especially for underserved populations. The COVID-19 pandemic necessitated a rapid pivot to telehealth by adapting available technologies and deregulating telehealth use as a replacement to in-person services. Adoption of telehealth for AUD and SUD treatment may be particularly advantageous for addressing issues of access for medically underserved populations, such as those served by Federally Qualified Health Centers (FQHCs). Results will identify telehealth policies (i.e., Audio-only Telehealth, Provider Type Expansion, Service Type Expansion) that were effective during the pandemic to inform lasting changes to health systems improving access to AUD and SUD services. The central hypothesis is that policies supporting telehealth during COVID-19 will be positively associated with increased AUD and SUD service utilization in underserved populations. Our specific aims are as follows: 1. Conduct legal analysis of state Medicaid COVID- 19 telehealth policies; 2. Evaluate state Medicaid telehealth policies on AUD and SUD service utilization at FQHCs, and 3. Analyze impact of state Medicaid COVID-19 telehealth policies on FQHC special populations. The study will employ the Center for Connected Health Policy's Policy Finder resource for COVID-19 telehealth policy data and FQHC program data for outcome data on patient characteristics (e.g., demographic information) and services provided (e.g., number of visits and number of patients for AUD and SUD services). We will conduct a series of differences-in-differences models and use other analytic methods using longitudinal data to compare categorized telehealth policies developed through legal research on state Medicaid telehealth policies. The aims of the proposed study are inherently innovative as the telehealth policy changes resulting from the COVID-19 pandemic are novel and present a unique opportunity to evaluate the impact of telehealth on AUD and SUD access and utilization, particularly for underserved populations. Identifying policies that improve access to AUD and SUD care and treatment will have lasting and significant implications for health services after the pandemic, such as permanent policy adoption or application to different payors, settings, and populations.