Please support Telehealth.org’s ability to deliver helpful news, opinions, and analyses by turning off your ad blocker. Telehealth.org: Q & A #20
Telehealth.org is continuing its Q&A series to address questions that it frequently receives. This week’s installment concerns a recently published blog post about a controversial reimbursement requirement for telemental health telehealth after the end of the public health emergency (PHE). Entitled Reimbursement Repercussions of April 2023, End of Public Health Emergency, the article raised several questions from readers who voiced concern over the mental health telehealth in-person visit requirement. Controversial since its announcement in 2020, the requirement was codified as part of the 2023 Physician’s Fee Schedule.
In February of 2022, Telehealth.org alerted the professional community that expanding Medicare reimbursement for telehealth from the Centers for Medicare & Medicaid Services (CMS) for video and audio services included an unpopular requirement for in-person meetings for telebehavioral health. The Senate Finance Committee at the time had been working on removing the in-person mandate. Their draft discussion document suggested that the Medicare requirement for in-person consultations would be removed and that audio-only mental health reimbursement would be permanent. The Committee was cited as stating that these changes are essential, calling them part of a “Bill of Rights.” See New Medicare Law Requires In-Person Visit for Telehealth Coverage for more information.
Current Medicare Mental Health Telehealth In-Person Visit Requirement
To the dismay of many telebehavioral health supporters, the requirement was officially codified in the 2023 Physician Fee Schedule – but it is not scheduled to be enacted for two years. Given the delay, it is unlikely to sustain the required two-year waiting period. As detailed in last week’s blog post, the current Physician’s Fee Schedule includes the following list of Medicare reimbursement approvals (note the in-person requirement’s date of enforcement):
- Medicare reimbursement for eligible telehealth services, including telebehavioral health, when the patient is located in a geographically rural area AND in an eligible originating site
- Medicare reimbursement for mental health telehealth services (including audio-only services in some cases)
- For behavioral health, an in-person visit is required within the first six months of an initial telehealth visit and every 12 months thereafter, with certain exceptions, starting January 1, 2025.
Reasons to Avoid Panicking about the New Medicare In-Person Visit Requirement
- The law only applies to Medicare. It was passed in the final hours as part of the much larger law in 2020 without discussion. In other words, it was not given adequate time for the involved parties to voice a concern.
- A considerable amount of disfavor for the law already exists at the legislative level.
- The considerable time delay before enforcement is a notable sign that Medicare is likely buying time to review the thousands of articles published about telehealth across healthcare since the start of COVID.
- We at Telehealth.org are unaware of evidence supporting the need for in-person visits for the majority of mental health telehealth clients or patients. We encourage anyone with information supporting this in-person visit requirement to paste the details below.
- With an added two years before the Medicare in-person requirement takes effect for telebehavioral health, providers are encouraged to let Medicare do its work. CMS often imposes timelines in the distant future to allow adequate time to review all sides.
- Changes will likely be made in the 2024 or 2025 Physician Fee Schedule, which is Medicare’s annual publication of reimbursement requirements.
Now Is the Time for Advocacy
Readers with opinions on Medicare’s in-person visit requirements are strongly encouraged to write to their elected officials to voice their concerns in a 1-page letter. Such letters are most effective when they:
- Clearly state the original concern
- Briefly outline how a client or patient is likely to suffer negative consequences, and
- Offer a succinct suggestion for corrective action.
Elected officials do pay attention to their constituents. Write your letter today and let us know what you said in the comment box below!
Additional Resources
- For more information about the Omnibus Government Spending Package, see CCHP’s summary and full text of the bill. For detailed behavioral policies that went into effect on January 1, 2023, as part of the 2023 Physician Fee Schedule, see Telehealth.org’s summary for behavioral professionals.
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