Senators Reintroduce Bill to Ease Telemental Healthcare Access

A group of bipartisan senators have reintroduced a bill to expand access to virtual mental healthcare services for Medicare beneficiaries.

The Telemental Health Care Access Act aims to remove the statutory requirement that Medicare beneficiaries be seen in person within six months before receiving mental healthcare services through telehealth.

United States Senators Ben Cardin (D-MD), Bill Cassidy, MD (R-LA), Tina Smith (D-MN), and John Thune (R-SD) reintroduced the bill on January 24. According to Cardin, experts have highlighted the benefits of telehealth access for adults covered by Medicare.

“Earlier this Congress, I held a hearing in the Senate Finance Health Care Subcommittee where experts detailed the value of telehealth services being covered by Medicare,” he said in a press release. “The experts agreed with the goals of this legislation and reiterated the importance of providing telehealth permanency to continue treating those who would otherwise struggle to get the care they need. Our legislation also provides another opportunity to address the issue of access to care and health disparities.”

The legislation was initially introduced by the same group of senators in 2021. It targets the in-person requirement for telemental health service utilization noted in the Consolidated Appropriations Act of 2020. According to the senators, the bill aligns with Medicare coverage for substance use disorder (SUD) telehealth services as detailed in the SUPPORT for Patients and Communities Act in 2018. The act eliminated certain requirements so patients could access SUD treatment services through telehealth.

“Since the pandemic, we have seen how telehealth expanded health care access for those with substance use disorders, physical ailments, and mental health conditions. It has been an important lifeline for rural communities,” said Cassidy in the press release. “This bill removes barriers to allow Medicare patients to receive the telemental health services they deserve.”

The reintroduced bill has support from numerous organizations, including the American Nurses Association, the American Psychiatric Association, The Trevor Project, the Maternal Mental Health Leadership Alliance, the National Association for Behavioral Health, the Alliance for Connected Care, and the American Telemedicine Association (ATA).

“This is a big step towards achieving our goal – to permanently remove the telemental health in-person requirement, allowing patients to receive care where and when they need it, especially when they are most vulnerable,” said Kyle Zebley, senior vice president of ATA and executive director of ATA Action, the association’s advocacy arm.

Telehealth use reached unprecedented heights during the COVID-19 pandemic. And while utilization has dropped overall, it remains high in the mental healthcare sphere.

Telehealth has decreased by nearly 25 percentage points from 31.2 percent in the second quarter (Q2) of 2020 to 5.8 percent in the third quarter (Q3) of 2023, according to an analysis by Epic Research.

Researchers examined data for 475 million telehealth and in-person visits between Q2 2019 and Q3 2023 gathered from the Cosmos database, a collaboration of 222 health systems using Epic EHRs.

The research also shows that in Q2 2020, the specialties with the highest telehealth use rates were mental health (65.5 percent), endocrinology (55.5 percent), and geriatrics (55.2 percent). In Q3 2023, mental health continued to dominate, with 37 percent of mental health visits occurring virtually.

Research has also shown that Medicare beneficiaries with serious mental illnesses, like schizophrenia or bipolar I disorder, had more mental health visits if they received care at a medical practice with high telehealth use.

Published in JAMA Health Forum, the study included 247,707 Medicare beneficiaries who received care at 11,170 practices, of which 3,180 had low telehealth use (0 percent to 49 percent), and 4,197 had high telehealth use (90 percent to 100 percent).

Researchers found that patients who received care at the highest telehealth use practices had 1.94 more visits per year than those who received care at practices with the lowest telehealth use. This represents a 13 percent jump in mental health visits per year for the patients at the highest telehealth use practices compared to patients at the lowest telehealth use practices.