CMS Expands Coverage for Telehealth in Mental Health Care – HealthLeaders Media

Analysis  |  By Eric Wicklund  
   November 05, 2021

The Centers for Medicare & Medicaid Services is making it easier for healthcare providers to use telehealth – including the telephone – to deliver mental health and substance abuse care to patients in their homes.

The Centers for Medicare & Medicaid Services is expanding coverage for the use of telehealth technology in underserved areas and for the delivery of mental health services.

In its final rule for the 2022 Physician Fee Schedule, released this week, the agency has amended its rules to allow beneficiaries to receive care in their homes “for the purposes of diagnosis, evaluation, or treatment of a mental health disorder.” This ends the long-debated practice of excluding a patient’s home from the list of originating sites for telehealth services, and gives providers the opportunity to craft telehealth programs that reach patient where they live.

The Centers for Medicare & Medicaid Services is expanding coverage for the use of telehealth technology in underserved areas and for the delivery of mental health services.

In its final rule for the 2022 Physician Fee Schedule, released this week, the agency has amended its rules to allow beneficiaries to receive care in their homes “for the purposes of diagnosis, evaluation, or treatment of a mental health disorder.” This ends the long-debated practice of excluding a patient’s home from the list of originating sites for telehealth services, and gives providers the opportunity to craft telehealth programs that reach patient where they live.

As part of that service, CMS is mandating that the provider and patient must meet in person at least six months prior to adopting virtual visits, and that an in-person exam be conducted at least once every 12 months thereafter, with some exception allowed due to “beneficiary circumstances.”

The agency is also changing its definition of telehealth to include audio-only platforms, the most common of which is the telephone, for these home-based telehealth visit for mental health services. The move reflects a surge in telephone use during the pandemic, when providers were replacing in-person care with telehealth visits and patients were looking for easier ways to access care—especially in dealing with stress, depression, anxiety and substance abuse.

“The COVID-19 pandemic has highlighted the gaps in our current healthcare system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

CMS officials emphasized that coverage for audio-only telehealth services is limited to mental healthcare services furnished by providers who use two-way audio-visual telehealth platforms (often called video visits), but whose patients either can’t or don’t want to use that platform. The agency is also clarifying that mental health services can include treatment for substance use disorders (SUD).

The agency is making permanent several measures enacted during the ongoing public health emergency (PHE) caused by the pandemic to expand telehealth access and coverage. And the moves come as both federal and state lawmakers look to establish long-term policies that combine in-person care with technology platforms that improve access to care, including telehealth and remote patient monitoring.

The efforts address a surge in mental health and substance abuse issues tied to the pandemic, and the reluctance of many healthcare providers to embrace telehealth without reimbursement, especially in treating underserved populations who rely on Medicare and Medicaid.

In this vein, CMS is also establishing permanent coverage for mental health services delivered via telehealth through federally qualified health centers (FQHC) and rural health clinics (RHC), two types of care providers that have traditionally targeted underserved populations, but which haven’t been reimbursed for telehealth services.

On a related note, the agency is extending dozens of telehealth services allowed during the PHE through the end of 2023. Coverage for those services would have expired at the end of 2021, but CMS has said it wants more time to study how these services have impacted care delivery and clinical outcomes. The move gives providers more time to gather data on the effectiveness of their telehealth services, which could be used to convince CMS to make coverage permanent.

The agency is also changing its definition of telehealth to include audio-only platforms, the most common of which is the telephone, for these home-based telehealth visit for mental health services. The move reflects a surge in telephone use during the pandemic, when providers were replacing in-person care with telehealth visits and patients were looking for easier ways to access care—especially in dealing with stress, depression, anxiety and substance abuse.

“The COVID-19 pandemic has highlighted the gaps in our current healthcare system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

CMS officials emphasized that coverage for audio-only telehealth services is limited to mental healthcare services furnished by providers who use two-way audio-visual telehealth platforms (often called video visits), but whose patients either can’t or don’t want to use that platform. The agency is also clarifying that mental health services can include treatment for substance use disorders (SUD).

The agency is making permanent several measures enacted during the ongoing public health emergency (PHE) caused by the pandemic to expand telehealth access and coverage. And the moves come as both federal and state lawmakers look to establish long-term policies that combine in-person care with technology platforms that improve access to care, including telehealth and remote patient monitoring.

The efforts address a surge in mental health and substance abuse issues tied to the pandemic, and the reluctance of many healthcare providers to embrace telehealth without reimbursement, especially in treating underserved populations who rely on Medicare and Medicaid.

In this vein, CMS is also establishing permanent coverage for mental health services delivered via telehealth through federally qualified health centers (FQHC) and rural health clinics (RHC), two types of care providers that have traditionally targeted underserved populations, but which haven’t been reimbursed for telehealth services.

On a related note, the agency is extending dozens of telehealth services allowed during the PHE through the end of 2023. Coverage for those services would have expired at the end of 2021, but CMS has said it wants more time to study how these services have impacted care delivery and clinical outcomes. The move gives providers more time to gather data on the effectiveness of their telehealth services, which could be used to convince CMS to make coverage permanent.

Eric Wicklund is the Technology Editor for HealthLeaders.


Eric Wicklund is the Technology Editor for HealthLeaders.
CMS is permanently expanding coverage for telehealth services, including audio-only (telephone) services, used in the treatment of mental health and substance abuse issues. The changes are part of the 2022 Physician Fee Schedule, and will include allowing federally qualified health centers and rural health clinics to use telehealth for mental health and substance abuse care and allowing patients to receive care in their own homes.
Telehealth use soared during the pandemic, as providers sought to reduce in-person care and shift as many services as they could onto virtual platforms. In making these changes, CMS is acknowledging that telehealth should be covered more extensively from here on for certain services.
The moves also highlight the alarming increase in mental health and substance abuse issues as a result of the pandemic, and give providers more opportunities to deliver care through telehealth — and to be reimbursed by Medicare and Medicaid for those services.
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