Federal Bill Aims to Expand Medicare Reimbursement for Mental Health Telehealth Services

In late December 2018 US Senator Kamala Harris’ office announced through a press release that she would be introducing two bills aimed at increasing access to mental health services, one of which would expand Medicare reimbursement for mental health services provided through telemedicine.  The bill, introduced in the 115th Congress (2017-2018 Legislative Session) as S. 3797 and is titled the “Mental Health Telemedicine Expansion Act”, would define mental health telehealth services as those covered by CPT codes 90834 and 90837, both of which describe individual psychotherapy. These services are already covered by Medicare when delivered via live video, but are currently subject to Medicare’s originating site and geographic restrictions.

The Mental Health Telemedicine Expansion Act would require CMS cover these codes, and stipulate that the requirement that an originating site be located in a rural health professional shortage area or non-metropolitan statistical area not apply in the case of CPT codes 90834 and 90837.  It would also allow the home to qualify as an originating site that is not subject to the geographic requirement when using these two codes as well.  Originating sites that would not qualify for reimbursement under CMS’ normal telehealth originating site and geographic restrictions, would not be eligible for a facility fee under this proposed language.  Other restrictions in Medicare on telehealth, such as the modality and provider type limitations would still apply.

The bill does also place some additional requirements around payment for mental health telehealth services (CPT Codes 90834 and 90837), requiring an in-person assessment of the needs of the individual prior to the provision of mental health telehealth services as well as a reassessment of the individual’s needs by a physician or practitioner at a frequency specified by the Secretary.

Because S. 3797 was introduced so late in the 2018 legislative session, there is a good chance that it will be reintroduced in the new 2019-2020 Legislative Session (116th Congress).