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The Covid-19 pandemic was accompanied by a dramatic increase in demand for mental health services from standard mental health treatment to substance abuse disorder treatment. Contrary to common sense, Medicare recipients were required to see a provider in person within six months of getting telehealth services. See New Medicare Law Requires In-Person Visit for Telehealth Coverage. Enter a bipartisan group of four senators who introduced legislation entitled the “Telemental Health Care Access Act of 2021” on June 15th. The bill amends Section 123 of the Consolidated Appropriations Act to remove the in-person mandate.
Telemental Health Care Access a Timely Issue
Senator Tina Smith, one of four senators sponsoring the legislation, noted that telehealth was key to accessing treatment for Medicare patients during the public emergency: “During the pandemic, telehealth helped eased Americans’ fears by allowing them to avoid the risk of visiting a hospital or clinic. Now we have the opportunity to build on this success, bypassing our bipartisan bill to make sure Medicare patients are able to access telemental health services without additional barriers.”
Other organizations that support telehealthcare in general also praised the legislation: “The Telemental Health Care Access Act is a critical piece of legislation that would repeal the telemental health in-person requirement. Passing this legislation and ensuring this unnecessary requirement is not repeated for other services, along with other pieces of legislation that make the telehealth waivers permanent, could not be a higher priority for the ATA and our members,” said Ann Mond Johnson, CEO of the American Telemedicine Association.
The week before the legislation was introduced, supporters of the legislation CTeL hosted a “Hill Day” to try and convince legislators to move on the matter. After the introduction of the legislation, CTeL lauded the Act as a step forward: “We are thrilled that Congress headed [sic] our advice and are considering this important policy change. Congress must address this burdensome requirement, which undercuts the very important tenants around flexibility and access afforded by telehealth.”
A Step Forward for Breaking Down Barriers to Telemental Health Treatment
The Telemental Health Care Access Act of 2021 is another step in breaking down barriers to telehealth treatment that started with legislation called the SUPPORT for Patients and Communities Act in 2018; that act removed various requirements for substance use disorder telehealth treatment. More recently, a piece of legislation was passed as part of an end-of-year package in 2020 that expanded access for Medicare patients to receive services via telehealth in their homes or at other sites.
Suicide Prevention a Key Impetus for the Act
Suicide and the depression that can lead to it were the major concerns behind the Telemental Health Care Access Act of 2021. Laurel Stine, Senior Vice President of Public Policy of the American Foundation for Suicide Prevention, said, “One of the leading causes of suicide among older adults is depression, and early identification and effective treatment is paramount in saving lives.”
“Telehealth has been essential for maintaining and expanding access to healthcare services during the COVID19 pandemic.,” said Senator Ben Cardin, another of the four senators sponsoring the Act, “This is especially true for those seeking mental health counseling and medical management, as we have seen spikes in anxiety, depression, substance abuse, domestic violence and suicide resulting from social isolation.” See New Act to Allow Counselors Medicare Telehealth Reimbursement.
More information is available in the press release from Senator Bill Cassidy here.
Why Are Changes in Medicare Telehealth Important for Telehealth Professionals?
As Telehealth.org has recently reported, professionals and organizations seeking to grow their telehealth services in the future would do well to consider specializing in medicare telehealth if they wish to have their services reimbursed. In fact, the future is particularly promising for those professionals who develop specializations in co-morbid chronic illness and behavioral health. These include cancer, cardiology, diabetes, chronic obstructive pulmonary disease, and psychiatry. By developing one’s skills for working with clients and patients with these particular medical challenges who are medicare beneficiaries, behavioral professionals will truly be in a prime position for telehealth expansion in the coming years. For details, see Future of Telehealth Reimbursement: Offering Medicare Telehealth Services?
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Increase your telehealth revenue. Industry leaders explain how, when, and why to use telehealth CPT codes and modifiers.
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When will this bill be voted on?
We don’t get that kind of information here at telehealth.org but I have made your question public so that perhaps someone else will respond.
It makes me feel hopeful that telehealth for Medicare patients is likely to continue. For one thing, patients with movement disorders, such as Parkinson’s will not be worried about their fall safety, transportation and/or need for assistance in getting to and from appointments. The other item is the difficulty discerning when older patients with all sorts of underlying medical issues will and can feel comfortable in practice offices where it is challenging to maintain the appropriate distance from others, including the practitioner.
Telehealth has its pros and cons. Our counseling and psychiatric offices probably see about 1000 people a month. During Covid we had to do mostly telehealth. Majority of clients feel in person is more superior care. Telehealth is more for their convenience. Many clients were doing telehealth while yelling at the kids, cooking dinner, or being distracted by other things. It’s very difficult to get clients to be able to stay focused at times and to have them understand importance of privacy during therapy. For others they opened up more because they seem to prefer the safety of the interaction. We had several instances of clients in crisis who were engaging in acting out behaviors and it was rather frightening as it was difficult to be able to effectively do an intervention as no one around on their end. We had parents of a child underreport how young child doing only to have us have to hospitalize her on a feeding tube once we could get her on screen. She wouldn’t sit still on a screen and parents in denial. Frankly the liability was concerning for me.
Anne, Thank you for posting. The problems with telehealth that you have described can largely be attributed not only to working with people from home, but also due to lack of training of the practitioners. Asking traditionally trained clinicians to practice telehealth without formal telehealth training is much like asking someone has been driving a car for 125 years to suddently start drivingf an 18-wheeler over night. While it may seem doable, there are many hidden problems that can surface and leave the driver at a loss for how to manage the session. Without formal training in how to identify, anticipate and deal with problems in telehealth, it can be chaotic and unnerving to everyone involved. Unfortnately, that was the case last year, when everyone was forced to start delivering telehealth, only to experience the list of frustrations and complexities that you outlined. Although we have a very learge mailing list and much recognition in the field, many professionals did not know if the training was available. I encourage you to look at our course cataloge to see which training might be of use to your group: https://blog.telehealth.org/trainingcatalog/
Employers seem to like telehealth. Less time off for transit to and from an appointment. Now appointments can be done over lunch break which is ZERO time off.
Advantages for children & youth include the reality that they are more comfortable communicating with all significant people in their lives through online media, so therapy appointments are actually more comfortable than sitting in a clinician’s (rather sterile) office setting. From my experience it includes many of the advantages of being able to make a home visit, seeing their rooms, pets, toys, and home environment. Also, I had a session with a child in the back seat of a car, and the parent forgot that I was able to hear what was going on, as the child had a headset with earphones for confidentiality, resulting in a more realistic picture of how the parent spoke than ever would have happened in my office!
Telehealth is particularly important for patients living with brain injury (PLWBI). Here in New Mexico, particularly, many are in isolated villages around the state. Risk of attempted suicide is significantly higher among PLWBI than in the general population.
“The relative risk of attempted suicide is three to four times higher in patients with severe TBI compared with the general population.17 Clinical evidence also indicates that both severe and mild TBI are associated with increased suicidal tendencies.31 Brenner et al 32 reported that compared with those without TBI, death by suicide was 1.34-fold higher in military veterans with a history of severe TBI, while veterans with a history of relative mild TBI, that is, fracture or contusion, had a 1.98 times higher risk of attempted suicide. Pain may have contributed to the increased risk of suicide in the mild TBI group. In comparison, increased suicide risk by severity of TBI in our study revealed that patients with mild, moderate and severe TBI had 2.22-fold, 2.23-fold and 2.32-fold, respectively, higher risks of attempted suicide compared with patients without TBI (table 4).” Wu et al, 2021. https://pmj.bmj.com/content/96/1142/747 Please see citations under link.
I think it’s important to have both options supported by insurance. Some clients prefer telehealth because of the commute and others really want the in person interaction.
Teletherapy has been a godsend during the Pandemic, but also for my mobility impaired clients. That is why it needs to continue.
My current clients prefer telehealth as it is can one less ride in the car that parents have to make! Kids prefer it because they can jump right back into what they were doing before the appointment. It ought to stay as is.