Congress Looks to Improve Telehealth Access for Mental Health Services Under Medicare

The 116th Congress is trying to make telehealth services for mental health conditions more widely accessible to Medicare beneficiaries, building on recent policy changes made by the Department of Health and Human Services Center for Medicare and Medicaid Services (CMS).

Mental health care represents an area where telehealth is making an enormous difference but there is room for improvement – especially under Medicare, where policy restrictions and lack of reimbursement continue to hamper access and growth. This need for progress is well documented.

A December 2018 CMS report mandated by Congress, titled “Information on Medicare Telehealth”, discusses key barriers and opportunities. Among other findings, CMS reported that telehealth services were primarily used by Medicare Fee-for-Service beneficiaries for mental health needs. Related findings included:

  • Psychotherapy was one of the most common services
  • 4% of all telehealth users (74,547 beneficiaries) had at least one mental health diagnosis

For further analysis on the CMS report findings and recommendations, read the CHQI blog on the topic.

Recognizing this problem, the House introduced two bills this year specifically addressing Medicare access and reimbursement for the use of telehealth for mental health services.

The Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019 (HR 3417) was introduced June 21, 2019 by Reps. Richard Neal (D-MA) and Kevin Brady (R-TX), the chairman and ranking member, respectively, of the House Ways and Means Committee. With primary jurisdiction over the Medicare program, the committee approved by 41-0 an amendment in the nature of a substitute on June 26, 2019.

The legislation makes a number of changes to the Medicare program and is described by the two sponsors as “improving the quality of and access to services for Medicare beneficiaries.” Section 103 of HR 3417 specifically improves access to telehealth for mental health services by expanding the list of allowable originating sites to include the patient’s home. It also eliminates facility fees for the originating facility site.

Further, Section 103 establishes requirements for the patient-provider relationship in order to qualify for Medicare reimbursement. Services would be covered as long as there is an initial in-person meeting within six months before the start of telehealth treatment. In-person reassessments would also be required to be conducted at “pre-determined intervals” to be specified by the Secretary of the Department of Health and Human Services.

Another House bill designed to improve access to telehealth use for mental health services would also allow the patient’s home to be an originating site, in order to qualify for Medicare reimbursement. The Mental Health Telemedicine Expansion Act (HR 1301) introduced by Reps. Suzan DelBene (D-WA) and Tom Reed (R-NY) also requires the patient and provider to meet in person before transitioning to telehealth services.

When the bill was first introduced – in the last Congress – Rep. DelBene noted that Washington state has 158 areas with a shortage of mental health professionals. She added, “Everyone – regardless of where they live – should have access to telemedicine services from the comfort of their home so they can be treated for mental health conditions ranging from anxiety and depression to addiction and suicidal thoughts.”

The provision in both bills that requires the patient and provider to first meet in person before moving to a telehealth platform may “draw scrutiny”, according to mHealthIntelligence. He cites previous debate and litigation in Texas that ultimately resulted in the state dropping the requirement.

Further House action has yet to be scheduled as Congress is in recess at least until September 8, 2019.

Most stakeholders agree there is clear value to improving access to mental health services through telehealth.

Utilizing telehealth for mental health treatment addresses major barriers to care including patient stigma and privacy, provider shortages, caseloads and burnout, and patient resource issues including transportation.

So, while the private sector zooms ahead, Medicare – despite some recent policy flexibility – has room for improvement. The good news is that Congress is working to place access to telehealth services for mental health treatment on the top of the to-do list.

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