Lawmakers Ask CMS to Expand mHealth Coverage for Mental Health Services

A group of lawmakers is urging the Centers for Medicare & Medicaid Services to expand mHealth access to mental health services by allowing people to connect by phone.

In a letter to Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma, the group of Congressmen asked that “audio-only telehealth services” for mental health be included in Medicare coverage during the Coronavirus pandemic.

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“Currently, Medicare only reimburses recipients for services conducted with audio and video equipment, excluding coverage of mental healthcare services provided over the phone,” U.S. Rep. John Katko (R-NY) said in a press release. “With telehealth services being the only way millions of Americans have access to mental health services during the COVID-19 pandemic, it is imperative that CMS immediately acts to expand coverage to audio-only telehealth services, ensuring all Medicare recipients have access to mental healthcare.”

Among the flurry of emergency actions handed down by federal and state officials was a directive from CMS to allow Medicare coverage of audio-only phone calls for initial consults, giving providers the chance to asses by phone whether a patient could stay at home or come to the hospital or office for further treatment.

That exception isn’t included for mental health treatment, which experts say could be part of the next wave as both patients and providers deals with the stress of the pandemic.

The letter calls on CMs to allow audio-only communications to provide psychotherapy services and psychotherapy with evaluation and management (E/M) services covered by Medicare under CPT codes 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90853, 90845, 90839, 90840, 90846, 90847, 90849 and 90875.

In addition, the lawmakers are asking for the same coverage for health behavior assessment and intervention services that help Medicare patients cope with or manage physical health conditions. Those services are covered by Medicare under CPT codes 96156, 96158, 96159, 96164, 96165, 96167, 96178, 96170 and 96171, while medical evaluation and management for inpatient and outpatient services in a variety of facilities are covered under 99212-99214, 99231-99233, 99307-99310 and 99334-99337.

“It is our understanding that Sec. 3703 of the recently passed Coronavirus Aid, Relief, and Economic Security Act does provide authority for the Secretary of the US Department of Health & Human Services to waive this requirement during a public health emergency,” the letter adds. “As Members of the Mental Health Caucus, we strongly urge you to waive this requirement.”

Katko noted the pandemic is hitting seniors especially hard.

“According to a 2020 National Academies of Sciences, Engineering and Medicine report, 43 percent of adults age 60 or older in the United States reported feeling lonely,” he said in his press release. “With new measures in Central New York and across country now in place to keep people at home in an effort to stop the spread of COVID-19, these numbers are sure to rise. Now more than ever, it is imperative we expand telehealth services to ensure those struggling with mental health and substance use disorders have access to quality care.”

Kasko and US Rep Grace Napolitano (D-CA) co-wrote the letter, with support from Reps. Brian Fitzpatrick (R-PA), David Trone (D-MD), Terri A. Sewell (D-AL), Chris Pappas (D-NH), Dave Loebsack (D-IA), Joseph P. Kennedy III (D-MA) and Kendra S. Horn (D-OK).