Telehealth
Maintain Telemental Health Care Flexibilities in Medicare
Download the Telemental Health Care Flexibilities in Medicare Issue Brief (May 2024)
Background
During the COVID Public Health Emergency, Medicare telehealth flexibilities
provided a critical means for social workers to maintain health care services
for beneficiaries in need. In addition to continuity of care, these flexibilities also
ensured that social workers were able to meet the significant increased
demand for mental health services resulting from the COVID-19 pandemic.
The
Consolidated Appropriations Act of 2023 extended several telehealth
flexibilities implemented during the pandemic through December 31,
2024. One of these flexibilities enables Medicare beneficiaries to seek
mental health services via telehealth without requiring an in-person
visit. Without congressional action, an in-person visit requirement within
six months of accessing mental health services via telehealth will take
effect on January 1, 2025. Given mental health conditions remain the
top telehealth diagnosis since the onset of the pandemic—rising from
34% to 67%—this policy is unduly burdensome for beneficiaries.
Of note, Medicare beneficiaries utilize telehealth for a larger share of
their behavioral health services—43% of beneficiaries for behavioral
health services versus 13% of beneficiaries for office visits (E/M visits).
1
The current policy slated to take effect next year applies this in-person
requirement to all patients with mental health conditions regardless of
whether such a visit is needed or wanted.
The six month in-person requirement is counter to the intent of ensuring
more Americans receive life changing care; and, in fact, could further
exacerbate our nation’s growing mental health crisis. Even in states with
the most access, two in five individuals go without treatment.
2 In order to
maintain and continue the progress we have made in working to ensure
that beneficiaries in need have access to mental health services, it is
essential that Congress act to prevent this burdensome and unnecessary
in-person requirement from taking effect.
Legislative Solutions
The bipartisan, bicameral
Telemental Health Care Access Act (S.
3651/H.R. 3432), led by Sen. Bill Cassidy (R-LA) and Rep. Doris Matsui
(D-CA-07), would remove barriers to care for Medicare beneficiaries by
permanently removing the six month in-person requirement. This bill
would align telemental health care with current policy for individuals
seeking medical services or substance use disorder services, which
have no in-person requirements.
1 U.S. Department of Health and Human Services Office of Inspector General. (2022).
Data brief: Telehealth was critical for providing services to medicare beneficiaries during
the first year of the covid-19 pandemic. Retrieved from
https://oig.hhs.gov/oei/reports/OEI-02-20-00520.pdf
2 Mental Health America. (2021). The State of Mental Health in America 2021 Report.
Retrieved from
https://mhanational.org/issues/state-mental-health-america.