APA to CMS: Some Telehealth Changes Made During COVID-19 Should Become Permanent

APA CEO and Medical Director Saul Levin, M.D., M.P.A., sent a letter on Monday to Seema Varma, the administrator of the Centers for Medicare and Medicaid Services (CMS), commending the agency for the steps taken to reduce barriers to telehealth services for people with mental and substance use disorders during the COVID-19 pandemic and urging the agency to make permanent many of the regulatory changes that have helped expand telehealth services.

“The days, weeks, and months ahead are at best uncertain and for many crippling. … As some areas of the country begin to explore what the new normal will be and are lifting shelter-in-place restrictions and allowing nonessential businesses to resume in-person operations, there will continue to be an increased need for mental and behavioral health care services,” Levin wrote.

To ensure continuity of care and continued improved access to mental health and substance use care, the letter calls on the agency to make the following changes permanent:

• Remove limitations around originating site and geographical restrictions for mental health services.
• Include all services on the expanded Medicare-approved telehealth list, including group psychotherapy.
• Maintain coverage of and increased payment for telephone evaluation and management (E/M) services (99441-99443) that matches reimbursement for traditional outpatient E/M services that may be provided in person or via telehealth. Additionally, Levin requested the removal of the frequency limitations that are imposed under those codes to allow those patients who receive all their care via the telephone alone (and not in person or via telehealth) as often as is medically necessary, which could be more frequently than once every seven days.
• Allow for the use of audio-only (telephone) communications for E/M and behavioral health services, including care for opioid use disorders, when it is in the patient’s best interest. In addition, reimbursement for audio-only care should be no less than what was established during the emergency.
• Remove frequency limitations for existing telehealth services in inpatient settings and nursing facilities.
• Allow teaching physicians to provide direct supervision of medical residents remotely through telehealth.

“These changes would ensure a smooth transition to in-person care and increase access via telehealth and telephone to necessary care. It is especially important for mental health and substance use care, where the ability to establish and maintain a strong, uninterrupted therapeutic alliance with patients is crucial to effective interventions,” Levin stated.

Levin also recommended that after the COVID-19 pandemic ends, CMS should resume regulations “that require general supervision of nurse practitioners and physician assistants by a physician and implement policies to advance the use of physician-led, team-based care, such as evidence-based integrated care models and telehealth, to improve access to quality care.”

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