Congress to Try Again on Medicare Coverage for Telemental Health

Congress will once again mull a bill aimed at reimbursing healthcare providers who use telehealth or telemedicine to provide mental health services to Medicare recipients at home.

By Eric Wicklund

March 07, 2019 - Congress is taking another stab at legislation that would expand telehealth access for Medicare beneficiaries seeking mental health services at home.

The Mental Health Telemedicine Expansion Act (HR 1301), reintroduced last month by Reps. Suzan DelBene (D-WA) and Tom Reed (R-NY), would include the patient’s home in the list of originating sites for telehealth, thus enabling providers to be reimbursed through the Centers for Medicare & Medicaid Services for home-based telemental health.

The bill, which failed to make it through Congress last year, does include one caveat: It requires that the provider and patient have an in-person meeting before using telehealth.

“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,” DelBene said in a press release issued with Reed when the bill was first introduced in 2018. “This bill is an important step in the right direction for those in need.”

“In Washington state, there are 158 areas with a shortage of mental health professionals, but many patients still face challenges accessing care even when they don’t live in health professional shortage areas,” the press release added. “More than 3.6 million people each year miss or delay care due to lack of transportation to their physician. Telemedicine allows those patients to take off less time from work and spend less time sitting in traffic.”

The bill is the latest in a national effort to increase access to mental health services via telehealth and telemedicine. Several states, including Massachusetts, Maryland and Washington, are considering or have enacted new guidelines aimed to boost coverage and access.

Telemental health was also on the minds of analysts at Epstein Becker & Green. The national law firm released a report in December 2018 that took note of state efforts to expand telehealth coverage for mental health services while also bemoaning a lack of reimbursement options for providers.

“Despite Medicaid’s fewer restrictions on telehealth coverage as compared to its Medicare counterpart, there is limited federal guidance or information regarding the implementation of telehealth services in state Medicaid programs or coverage parameters for states choosing to offer such services,” the attorneys noted in a press release. “Healthcare practitioners who treat Medicaid populations are at risk for steep penalties for noncompliance, including fines and the potential loss of their professional licenses.”

“(P)ublic recognition of the benefits of utilizing telehealth technology to provide greater access to healthcare services has significantly increased,” they pointed out in an overview of the report. “While the shortage of behavioral health providers has long been acknowledged, the growing use of telehealth technologies as a strategy to increase access to psychiatrists, psychologists, counselors, therapists and other behavioral health professionals continues to gain attention and validation as an alternative model of care delivery.”

The bill’s reliance on an in-person consult to establish the doctor-patient relationship could draw scrutiny. That requirement was at the center of a years-long battle between the Texas Medical Boards and telehealth vendor Teladoc one that made its way through the courts before Texas lawmakers amended state laws to loosen the reins on telehealth.

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