Two years after the outbreak of COVID-19, healthcare continues to re-imagine new methods to deliver service to patients. Legislators across the nation are beginning to take notice by actively working to pass legislation to provide more care at a lower cost for various patients.
On May 26, the Senate Finance Committee introduced a discussion draft addressing new mental healthcare initiative policies. Notably, a new feature includes a “Bill of Rights” that focuses on mental health service delivery. In addition, the draft’s Bill of Rights seeks to address the requirement of an in-person visit before telehealth services may begin for Medicare patients. However, the law has been temporarily halted due to COVID-19.
Committee Chairman Ron Wyden (D-OR) said telehealth has been a “game changer” during the pandemic, “particularly so Americans can get mental healthcare when they need it.”
According to the National Alliance on Mental Illness, 21% of adults experienced mental illness in 2020, and 5.6% of adults experienced severe mental illness in 2020.
“These policies will help strengthen access, awareness, and support for telehealth, including by creating a ‘Bill of Rights’ for information on the availability of telehealth for mental healthcare,” Wyden said.
Arielle Kane of the Progressive Policy Institute is glad to see the Senate getting ahead of changes for telehealth services.
“It’s wise to codify things before the public health emergency expires so [the Centers for Medicare and Medicaid Services] can adapt to and formalize new policies,” Kane said. “Specifically, it’s important to provide the option of audio-only services for Medicare patients and remove the in-person visit requirements. This policy change will make a real impact on people’s lives, especially for those in low-serviced areas.”
She added, “Ideally, everyone would have good enough internet access for video-based care, but we need to accommodate those who don’t have these flexibilities.”
A joint report from PPI and Americans for Prosperity examined the availability and use of telehealth. For seven of the 10 observed conditions, the total appointment average was the same or fewer for people use used telehealth compared to those who did not.
“The biggest concern with telehealth was that it would increase unnecessary utilization, but it hasn’t come to fruition. Of course, it makes sense to establish checks and balances, but the data has shown no unnecessary growth in services as previously feared,” Kane added.
The only instances when utilization was higher were anxiety disorders, mood disorders, and infectious diseases. The study, conducted early in the pandemic, did not examine Medicare fee-for-service data.
In February, the Office of the Assistant Secretary for Planning and Evaluation released a report examining the disparities in telehealth utilization. The analysis discovered that low-income people were more likely than other groups to use telehealth services during the pandemic but found people earning less than $25,000 annually were more likely to use audio-only services. In contrast, those with little software literacy and English proficiency were least likely.
The draft shared its first attempt to console these disparities, requiring Medicare to offer suggestions to health providers on improving telehealth for patients whose primary language is not English and who have hearing or visual impairments.
“This action is in direct response to the ASPE report. Video-based telehealth was lowest for those without a high school diploma, adults 65 and over, and Latino individuals,” Kane said.
“Lower-income people tend to use the internet from their phone, so how is that affecting telehealthcare delivery?” she asked. “Why are these platforms confusing and bureaucratic? It’s essential to think out these scenarios to ensure proper adaptation.”
Brian Blase, president of Paragon Health Institute, said telehealth is a promising way to address mental health provider shortages and improve the patient experience but that there are risks that should be fully understood before Congress acts further.
“Most Medicare Advantage enrollees already have access to telehealth benefits, and Congress has already significantly expanded telehealth mental health services for all Medicare beneficiaries,” Blase said. “While people should have the right to spend their own money on any types of health services, telehealth can lead to significant waste, fraud, abuse, and misspending in Medicare given its fee-for-service nature, lack of utilization controls, and minimal program integrity components.”
He added: “Both the Medicare Payment Advisory Commission and the Department of Health and Human Services Office of the Inspector General, among others, are gathering information about the risks of further expanding telehealth. These risks should be fully understood before Congress acts so as to not add to Medicare’s financial crisis, to avoid imposing greater burden on taxpayers, and to preserve the future availability of Medicare benefits.”
Paragon’s health reform book Don’t Wait for Washington: How States Can Reform Health Care Today includes proposals for how states can ease telehealth restrictions to make healthcare more accessible for patients.
Policies outlined in the discussion draft include:
- Eliminating Medicare’s requirement for an in-person visit before virtual mental health services
- Codifying policy to reimburse providers for audio-based mental health services
- Mandates that Medicare and Medicaid promote and support provider use of telehealth
This year, the committee has four other focus areas for mental health improvement, including workforce, care integration, mental health parity, and youth. Other discussion drafts may be introduced prior to the committee’s consideration.
