Telehealth in New Hampshire

Telehealth is the delivery of clinical care using communication technology when the provider and client are in different locations. In mental health it usually takes one of three forms: synchronous video (a live, two-way visit), audio-only (a live phone visit, important for people without reliable broadband or a smartphone), and asynchronousor "store-and-forward" care (secure messaging, questionnaires, or recorded information reviewed later).

What was once a niche option became normalized almost overnight during the COVID-19 pandemic, and much of that shift has stuck. For clients, telehealth can remove real barriers — travel, childcare, time off work, the stigma of walking into a clinic, and the distance that defines much of rural New Hampshire.

What the evidence says

Telemental health is not a lesser substitute. A widely cited systematic review by Hilty and colleagues (2013) concluded that telemental health is effective and comparable to in-person care for diagnosis and assessment across many populations and disorders, with generally high satisfaction. Later research on video delivery of depression, anxiety, and PTSD treatments has reinforced this: for a large share of clients, the modality does not blunt the benefit of good therapy.

New Hampshire has built a coverage-parity framework for telehealth. Under RSA 415-J, private health insurers regulated by the state are required to cover telehealth services comparably to the same services provided in person, and cannot deny coverage simply because care was delivered remotely. On the public side, RSA 167:4-d extends telehealth coverage requirements to the New Hampshire Medicaid program.

Notably, NH has moved to support audio-only telehealth for certain services. NH Medicaid reimburses audio-only delivery for specified behavioral health services — a meaningful accommodation for clients in areas with poor broadband or without a video-capable device. The exact list of covered services, codes, and conditions is set by policy and can change.

Because insurance rules and NH policy evolve, treat any billing summary — including this one — as a starting point. Verify current guidance from the New Hampshire Insurance Department and the NH Department of Health and Human Services(DHHS), and check each individual payer's telehealth policy, before relying on it for claims.

The core rule is simple to state and easy to overlook: you must generally be licensed in the state where the client is physically located at the time of the session, not where you sit. A New Hampshire client visiting family in another state, or a college student who has traveled home, can quietly create a licensure problem for an otherwise routine session.

Interstate compacts exist to ease this friction by creating a pathway to practice across member states. New Hampshire participates in several relevant to behavioral health:

• PSYPACT — for psychologists, enabling telepsychology across participating states.
• The Counseling Compact — for licensed professional counselors.
• The Social Work Licensure Compact — for licensed social workers (a newer compact still standing up its operations across member states).
• The Interstate Medical Licensure Compact (IMLC) — an expedited licensure route for physicians, including psychiatrists.

During the public health emergency, federal regulators exercised enforcement discretion that temporarily allowed everyday consumer video apps. That discretion has ended. Telehealth now needs to meet ordinary HIPAA expectations, which means using a platform that is HIPAA-compliant and backed by a Business Associate Agreement (BAA) with the vendor. Consumer-grade tools without a signed BAA are not appropriate for protected health information.

Informed consent for telehealth

Telehealth warrants its own informed consent— separate from, or added to, your general consent. It should cover the benefits and limitations of remote care, privacy and security risks, what happens if the technology fails, how emergencies are handled, and the client's right to switch to in-person care. Document it.

The start-of-session checklist

A brief, repeated ritual at the top of each visit prevents most problems:

• Confirm the client's physical location — the address they are at right now (relevant to licensure and emergencies).
• Confirm an emergency contact and verify it is current.
• Check the setting— a private space where the client can speak freely and won't be overheard.
• Confirm identity and that you are both able to see and hear clearly.

Telehealth is a modality, not a treatment — and like any modality it fits some situations better than others. Matching thoughtfully is part of good care.

Suitability is not fixed. A client who starts on video may need to step up to in-person care if risk rises, if progress stalls, or if the remote setting keeps interfering with the work. Name this possibility early so that a shift to face-to-face care reads as good clinical judgment rather than a failure.

The single biggest difference from in-person care is that you cannot physically intervene. That makes a clear, rehearsed emergency protocol essential — not optional.

• Verify physical location every session. If a crisis unfolds, you need to know exactly where the client is to direct help.
• Keep local resources on hand. Know the emergency services and nearest facilities for the region the client is actually in — which may not be near you.
• Build a safety plan collaboratively for at-risk clients, and keep an emergency contact you can reach.
• Know how to activate crisis services. In New Hampshire, the NH Rapid Response Access Point offers 24/7 mobile crisis support at 1-833-710-6477, and the 988 Suicide & Crisis Lifeline is reachable by call or text.
• Plan the warm handoff.Decide in advance how you'll stay engaged — keeping the client on the line, contacting a support person, or coordinating with local responders — while help is mobilized.

Prescribing controlled substances remotely

Telehealth prescribing of controlled substances is governed by the federal Ryan Haight Act and by DEA telemedicine rules that have been repeatedly extended and revised since the pandemic. The requirements — including whether and when an in-person evaluation is needed — are evolving. Prescribers should verify the current federal DEA rules (and any NH-specific requirements) before prescribing controlled substances via telehealth.

A little preparation makes a video session feel less like a video call and more like therapy. A few things help:

• Find a private spacewhere you can talk freely and won't be overheard — a closed room, a parked car, or headphones if privacy is tight.
• Use headphones or earbuds. They improve sound, keep your side of the conversation more private, and reduce echo.
• Test the technology early. Open the link a few minutes before, check your camera, microphone, and connection, and know who to contact if something breaks.
• Have your details ready.Know the address you'll be at and have an emergency contact handy — your clinician may confirm both at the start.
• Reduce distractions.Silence notifications, close extra tabs, and give the session the same protected time you'd give an in-person appointment.

Meridian's verified directory includes New Hampshire clinicians and community mental health centers, many of whom offer telehealth appointments alongside in-person care.