Providing Telemental Health Services in a Post-Public Health Emergency World

The Current Landscape of Mental Health

According to a 2022 Mental Health America (MHA) report entitled The State of Mental Health in America, mental health-related diagnoses in the United States are at dire levels, with nearly 50 million American adults experiencing a mental illness in 2019. That same year, over 27 million Americans suffering from mental illnesses did not receive adequate treatment due to a lack of insurance coverage, limited access to providers, and the stigma associated with seeking treatment for mental illnesses. MHA’s findings revealed that over 2.5 million children in the United States are reported to suffer from severe depression, over 60 percent of which go without receiving any kind of mental health treatment.[1] In 2021, the Substance Abuse and Mental Health Services Administration’s (SAHMSA) data revealed that the number of adults experiencing mental illness was over 47 million and nearly 14 percent of youth aged 12-17 suffered from at least one major depressive episode.[2] Despite these persisting trends, access to mental health services in the United States has increased throughout recent years in large part due to telehealth flexibilities authorized by the Biden Administration during the ongoing PHE.

What Could Mental Health Services Look Like Moving Out of the Pandemic?

Understanding the increased demand for medical services and the need to adopt creative means to deliver care to patients during the pandemic, the federal government implemented a number of temporary regulatory flexibilities throughout the PHE that made it easier to provide telehealth services. These flexibilities increase access to telehealth by allowing providers to offer services across state lines; authorizing the use of household technologies like Apple’s FaceTime, WhatsApp, and Zoom; and granting COVID-19 waivers to allow telehealth providers to connect with Medicare and Medicaid beneficiaries. While these measures have led to improved health outcomes for Medicare and Medicaid beneficiaries, many of these flexibilities are only temporary and likely to unwind after the PHE declaration expires.[3]

Demand for mental health and behavioral services remains high and the 117^th Congress has devoted greater attention to ensuring parity in the access and affordability of mental and behavioral health services. Despite these factors, access to mental health services made available through the expanded uses of telehealth services are destined to lapse at the end of the PHE, which is currently set to expire on July 15, 2022. However, the Consolidated Appropriations Act of 2022 allows a 151-day transition period before numerous telehealth flexibilities and other PHE-related policies formally expire. The law makes several flexibilities permanent, including allowing Medicare patients’ access to some telehealth services, such as audio-only consultations for behavioral and mental health services.[4] Additionally, the Calendar Year (CY) 2022 Telehealth Update Medicare Physical Fee Schedule codified continued coverage of video-based mental health services in Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC).[5] At the end of the 151-day transition period, the following policies are set to end:

• Medicare reimbursement for mental health telehealth services that do not require a bi-annual in-person visit;
• Medicare reimbursement for telehealth visits furnished by physical therapists, occupational therapists, speech language pathologists, and audiologists;
• Medicare coverage of audio-only visits for physical health issues;
• Flexibility regarding where patients receive Medicare telehealth services; and
• Medicare and Medicaid reimbursement of FQHCs and RHCs as distant site telehealth providers for non-mental health services.[6]

The wind-down of these flexibilities may prove challenging for insurers, providers, and most notably, for Medicare and Medicaid beneficiaries. There may also be significant implications for telehealth-only providers and the telehealth industry at large. Issues related to patient access to services, both behavioral and physical, are bound to persist as the Kaiser Family Foundation estimates that between 5.3 million and 12.3 million Americans could lose Medicaid eligibility due to the end of the PHE’s continuous enrollment requirement.[7] It’s currently unclear what percentage of individuals who lose Medicaid eligibility will qualify for commercial or employer-sponsored health plans. For a detailed outlook on post-PHE implications and for support on this issue, contact Sonja Nesbit, Managing Director in the Healthcare & Life Sciences group.

References

[1]https://mhanational.org/sites/default/files/2022%20State%20of%20Mental%20Health%20in%20America.pdf?eType=ActivityDefinitionInstance&eId=a7a571c8-7fac-4660-b06d-ff88af5c2bec

[2]https://www.mhanational.org/issues/2021/mental-health-america-prevalence-data#:~:text=19.00%25%20of%20adults%20are%20experiencing,Jersey%20to%2025.25%25%20in%20Utah.

[3]https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/

[4]https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-117HR2471SA-RCP-117-35.pdf

[5]https://www.cms.gov/files/document/se22001-mental-health-visits-telecommunications-rural-health-clinics-federally-qualified-health.pdf

[6]https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency/

[7]https://www.kff.org/medicaid/press-release/kff-analysts-find-that-between-5-3-million-and-14-2-million-people-could-lose-medicaid-coverage-following-the-end-of-the-public-health-emergency-and-continuous-enrollment-requirement-with-an-unknown/