Telehealth on hold: What about mental health care?

Telemental health has a different set of rules for telehealth services because Congress has made permanent some flexibilities for coverage under Medicare fee-for-service. But the situation is not ideal, said Kyle Zebley, senior vice president, public policy of the American Telemedicine Association, and executive director of ATA Action, its advocacy affiliate. Here he explains the distinctions involving mental health treatments, telemedicine, and the “tangled web of issues” around mental health care via telecommunication.

Medical Economics: As I understand it, there may be some key differences right now in using telemedicine visits for mental health care versus using it for physical health care. Can you explain what those are, and should they be treated the same way?

Kyle Zebley:A couple of things in response there. At the end of the 2020 the Congress did come together and they made permanent telemental health as a permanent part of the Medicare program, regardless of an extension of flexibilities. We do have permanency for this important suite of services. That's good. The bad news is that comes encumbered with a clinically inappropriate, mandatory barrier to care in the form of in-person requirements. And what that means is, you've got to find, if we were in a period of time where the flexibilities are no longer persisting as we are now, you've got to find this unicorn of a telemental health provider that will see you periodically in person and then continue to deliver that care virtually. That doesn't make sense, doesn't allow for the full advantage of telehealth. It needs to be repealed. It needs to be precedent never to be repeated. And one of the things that our extensions have done is forestall the implementation of this in-person requirement. The Centers for Medicare & Medicaid Services, to their great credit, have said, if you already have an established relationship via telehealth, even post expiration, theoretical expiration of these flexibilities that have become all too real, you can continue to receive care from that previously established relationship. However, their hands are tied for new relationships moving forward during this period of the lapse, and again, that makes it significantly more complicated. So again, it's a bit of a tangled web of issues that are important to highlight. Now in terms of whether or not that was the right thing to do, or telemental health should be treated differently than other areas of care, we are of the belief that we are wanting to empower all health care providers to apply the standard of care consistent with the terms of their state-based license for their profession, to determine for themselves what can and can't be done appropriately via telehealth. And that's held us in great stead. It's about empowering our health care professionals to make the right determination on behalf of their patients as to what can and can't be done via telehealth. All areas of appropriate care should be covered and reimbursed by payers such as Medicare. At minimum, what we should never be in a position of, is in this day and age where there are too few mental health providers to have in person requirements only for telemental health services as we look towards permanency, rather than for other services. That is a gross distortion of fairness. It's not clinically necessary, as I keep hammering. And and we should be in a situation where all these services have a level playing field and are appropriately covered and getting reimbursed.