Medicare requirements, Medicare mental health coverage, CMS telehealth, Medicare telehealth

Proposed Changes to Medicare Requirements for Telehealth, Including In-Person Visits


June 15, 2022 | Reading Time: 2 Minutes

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In 2020, in response to COVID-19 restrictions, the Centers for Medicare & Medicaid Services (CMS) expanded the scope of CMS telehealth services. Under the new telehealth policy, Medicare telehealth reimbursement became available for video and audio services, but an unpopular Medicare requirement for in-person meetings has continued for telebehavioral health services. The Senate Finance Committee hopes to build these flexibilities into future Medicare mental health coverage and remove the in-person requirement. The draft discussion document suggests that the Medicare requirement for in-person consultations will be removed and that audio-only mental health coverage will be permanent. The Committee regards this work as essential, calling it the “bill of rights.” See New Medicare Law Requires In-Person Visit for Telehealth Coverage to see’s previous outline of these Medicare telehealth reimbursement issues. 

Recommendation from Committee to Improve CMS Telehealth Services

The Committee is led by Chairman Ron Wyden, who has expressed his hope that the new telehealth policy will help strengthen access, awareness, and support for telehealth. To this end, the Committee plans to enhance communication about benefits. The suggested policy ensures that people with Medicare know when and how to use telehealth for mental health services. The policy also establishes benefit transparency. 

The Committee requests the cooperation of Medicare and Medicaid to encourage and support providers to use virtual care and Children’s Health Insurance Program (CHIP) programs to address school behavioral health needs. Other telehealth policies in the draft require Medicare to publish the rights of beneficiaries to receive mental healthcare via an online platform. They also want to ensure Medicare mental health coverage transparency regarding cost-sharing issues. The Committee has recommended that Medicare guide providers on improving the accessibility of virtual mental health care for those with language barriers and sensory impairments.

Without Legislation, Flexible Medicare Regulations May End 

The flexible Medicare regulations experienced since March 2020 will fall away 151 days after COVID-19 is no longer deemed a Public Health Emergency (PHE). Each PHE period lasts for 90 days. The current period will end on July 15, 2022. It is expected that authorities will extend the PHE for another two quarters to the end of the year. Congress needs to approve the CMS telehealth policy for it to be permanent. Committee member, Senator Ben Cardin, said that telehealth had become a vital part of healthcare, particularly in underserved sectors of the community.

The changes in Medicare mental health coverage come at a crucial time. A recent CVS Survey indicated that 59% of Americans are worried about their mental health or that of a close family member. 56% of those surveyed said they believed Americans were more comfortable speaking about their mental health issues since the pandemic. 63% said they would be more comfortable using telehealth for therapy, and 58% felt they would use digital tools to seek assistance and improve mental health issues.

Medicare Mental Health Coverage is Here to Stay

It seems that Medicare mental health coverage is here to stay, which is a definite improvement in telehealth policy, as shown by a survey published in early January 2021. More people use telehealth services for mental health and behavioral issues than physical conditions. In the long run, it is becoming more evident that telehealth will prevail since it is less expensive, easier to access, more secure, and offers higher quality care.

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