CMS Expands Telehealth for Behavioral Health in Final Rule

The Centers for Medicare and Medicaid Services issued a final rule that it says promotes wider use of telehealth in the behavioral health industry.

On Tuesday, the federal health care regulator announced its final rule on the Physician Fee Schedule for Medicare payments for the calendar year 2022. In it, CMS eliminates restrictions on where Medicare beneficiaries — those ages 65 and older — can be when they seek mental health care via telehealth.

During the COVID-19 public health emergency, the federal government temporarily added certain telehealth services to the Physician Fee Schedule.


“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

Under the new final rule, Medicare would allow for mental health telehealth visits to originate from within a patient’s home. Further, it eliminates geographic restrictions for mental health services offered via telehealth.

The directive to eliminate the location-based restrictions on telehealth in mental health care comes from the Consolidated Appropriations Act, which was passed earlier in the year. The same bill also directs $825 million to be invested in federally designated community mental health centers.


However, the CAA requires that the telehealth visit must come within six months of an in-person visit. The act gave the U.S. Health and Human Services Department leeway to establish how often a patient must be seen in person. The new final rule says providers must conduct in-person services at least every 12 months.

The new final rule also allows for providers to do audio-only communications to diagnose and treat mental health disorders with established patients in their homes under certain circumstances.

The new rule limits the use of audio-only telehealth to circumstances where a mental health provider could do a two-way video chat but the patient cannot use or refuses to consent to use the video chat system. The rule would require providers to note that they were able to do an audio-only call but the patient wasn’t able to or didn’t want to use a video call.

The new final rule also clarifies that mental health services include treatment for substance use disorder.

The new final rule also allows Medicare to pay rural health clinics and federally qualified health centers for mental health services furnished via telehealth regardless of the public health emergency. Similar rules about having patients come to an in-person appointment at least every 12 months apply to these entities as well.

The new final rule also makes changes in the realms of diabetes prevention programming, access to medical nutrition therapy services, vaccinations, pulmonary care, quality and value payments, clinical labor rates and physician assistant services.

“Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS,” said CMS Administrator Chiquita Brooks-LaSure. “The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future.”

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