HHS’ Becerra: We Can’t Allow Behavioral Health Telehealth Flexibilities to Expire

The Biden administration sees continued behavioral health-telehealth flexibilities as vital to improving access to services.

Testifying on Biden’s proposed fiscal year 2025 budget, U.S. Health and Human Services Secretary (HHS) Xavier Becerra touted the federal government’s approach to telehealth and behavioral health during the coronavirus pandemic response as a win.

“We can’t allow those flexibilities to expire,” Becerra told the U.S. House Ways and Means Committee on Wednesday. “When the pandemic hit, a lot of folks thought it wouldn’t work on the mental health side, but it’s actually one of the areas where we had the greatest success. The last thing we need to do is allow them to expire.”


The Consolidated Appropriations Act of 2023, signed by President Joe Biden on Dec. 29, 2022, extended telehealth flexibilities established during the public health emergency declared by the Trump administration until the end of 2024.

Several behavioral health-related telehealth flexibilities have been made permanent within Medicare. Some include allowing telehealth visits to originate in beneficiaries’ homes, allowing audio-only communication and removing geographic restrictions for telehealth visits.

One vital flexibility that remains temporary is the removal of a mandatory in-person visit within six months of starting telehealth services and annually after that, according to HHS.


Becerra and several representatives on the committee point to telehealth generally as a tool to increase access to health care for vulnerable populations, especially older adults and those who live in rural areas.

“For a lot of these seniors … they might have to drive an hour or two hours in a day to get where they got to go and this would be a lot better for them, maybe not on the initial visit but after a couple of visits,” Rep. Vern Buchanan (R-Fla.) said during the hearing, adding he represents one of the most senior districts in the U.S.

Beccera also highlighted the need for states to harmonize telehealth policies.

“Much of the flexibility that comes from telehealth [comes from] being able to go over state lines,” Beccera said. “Right now, because states decide who gets licensed to do care, we have to have the cooperation of the states so care can go beyond its own state borders.”

Informally, how the federal government sets up policies in Medicare sets up basic parameters that the private insurance market tends to follow. And Medicare has seen a lot of changes related to behavioral health.

In November, the Biden administration released final rules that allow mental health clinicians to participate in the Medicare program. These and other changes are making the Medicare program more attractive to private behavioral health providers to work with. Still, challenges remain, potentially leaving seniors with limited options for care.

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