US Senators Move to Eliminate In-Person Rule for Behavioral Health Telehealth Services

Lawmakers have reintroduced a bipartisan bill to make behavioral health delivered by telehealth more available to those on Medicare into Congress.

Four sponsors have reintroduced the Telemental Health Care Access Act. The legislation would eliminate the in-person exam mandate to receive mental health services via telehealth. It undoes 2020 legislation that expanded telehealth access for Medicare beneficiaries but added the requirement that patients have been seen in person within six months of starting telehealth services. It also brings mental health services in line with how addiction treatment is covered, according to a news release.

Supporters of telehealth access frequently criticize in-person exam mandates. A parallel law, the Ryan Haight Act, has been the subject of intense debate because it requires in-person health care involving controlled substances.


The coronavirus pandemic has led to an explosion in telehealth use. Once something of a tchotchke for most of the health system, the pandemic led companies and governments to provide services over the internet or not provide them at all. As a result, telehealth visits among Medicare beneficiaries increased 62 times and 43 times compared to 2020 and 2021, respectively, compared to 2019, according to a federal government report

Thirty-five percent of behavioral health visits were conducted via telehealth in 2021, according to the same report, the highest among specialties examined.

“We fought to expand telehealth access during the pandemic and the results demonstrated how critical a tool it is for countless Americans, especially for mental health services,” U.S. Senator Ben Cardin (D-Md.) said in the release.


He and other bill sponsors called telehealth a lifeline for rural patients and others who may struggle to access services.

The other bill sponsors include U.S. Sens. Dr. Bill Cassidy (R-La.), Tina Smith (D-Minn.), and John Thune (R-S.D.). Smith is a founding member of the Senate Mental Health Caucus, which was launched in October

Addressing systemic issues in federal behavioral health regulation has been a go-to for bipartisan wins in Congress. In November, the Senate Finance Committee approved the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.

One of the most significant behavioral health funding reforms also carried along a rare round of gun regulation via the Bipartisan Safer Communities Act, passed in the wake of the massacre at Robb Elementary School in Uvalde, Texas.

Behavioral health providers should expect more change into 2024 and beyond. Both leading presidential candidates have made notable changes to regulation in response to the opioid overdose death epidemic. Industry leaders expect continued support for behavioral health.

Medicare is increasingly getting attention from newcomers and incumbents to the behavioral health space. Regulation changes such as this may be helping that movement. Brightside Health announced in October that it would expand into both Medicare and Medicaid. The move would double is potential patient population.

“Medicare beneficiaries and providers have come to rely on telemedicine to ensure access to high-quality mental healthcare for seniors,” Brad Kittredge, CEO of the virtual mental health startup Brightside Health. “Among commercial insurance populations, telemedicine accounts for about 60% of all encounters, making it the preferred way people want to get mental healthcare. Perpetuating access among the Medicare population should be a no brainer.”

Talkspace Inc. (Nasdaq: TALK), one of the early movers on tech-focused virtual mental health services, especially text therapy, announced this month it would be launching in Medicare and Medicare Advantage.

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