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Talkspace Expands Tele-Mental Health to Medicare

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But the waivers that allow for coverage of tele-health expire at the end the year. Several bills have been put forth to extend coverage.

Talkspace has begun providing its online behavioral health program to traditional Medicare beneficiaries in 11 states, reaching about 13 members. By the end of this year, Talkspace plans to be available to all 33 million traditional Medicare members, along with several Medicare Advantage plans, across all 50 states.

Jon Cohen, M.D.

Jon Cohen, M.D.

Primary care physicians will be able to refer patients who need behavioral health support, Jon Cohen, M.D., Talkspace CEO said in a news release. “The mental health crisis is generation-neutral, but loneliness and social isolation, which impact older adults more significantly, greatly impact their overall well-being and, in turn, raise their overall total medical costs,” he said.

There is a need for behavioral health providers in many counties in the United States that serve Medicare and Medicaid enrollees, found a recent report by the HHS Office of Inspector General (OIG). There has been increase in demand for mental health services since the beginning of the COVID-19 public health crisis, with 40% of adult reporting symptoms of anxiety and depression compared with 11% before the pandemic.

But less than 55% of U.S. psychiatrists accept traditional Medicare, according to a report last year from the Commonwealth Fund. The Commonwealth Fund found that one in four of Medicare beneficiaries live with mental health issues, including depression, anxiety, schizophrenia and bipolar disorder. However, only between 40% and 50% of these receive treatment.

Medicare spends more than $27 billion annually on behavioral health services. In 2023, 51% of Medicare enrollees were in a Medicare Advantage plan. The remainder were enrolled in traditional Medicare. Medicare covers outpatient and inpatient services for mental health and substance use disorders. Outpatient services include individual and group psychotherapy, psychiatric evaluation, and medications.

Medicare Advantage plans are required to ensure that 90% of enrollees have access to a psychiatrist within 10 miles of their home. In 2024, this was expanded to include clinical psychologists and clinical social workers. The OIG report found that during the pandemic, beneficiaries had trouble accessing services. In 2021, there were fewer than five active behavioral health providers per 1,000 Medicare Advantage enrollees is the counties selected for review. In traditional Medicare, the number was less than three providers.

Of those that did receive behavioral health care, the OIG report found that 47% of those in traditional Medicare and 40% in Medicare Advantages saw their provider at least some of the time through telehealth programs.

A study published in December 2023 in the Journal of Medical Internet Research that telehealth services for depression and anxiety resulted in improvements in symptoms and improved access to care. This was a real-world retrospective data analysis of patients using a telepsychiatry platform led to average reductions of 45.7% for anxiety symptoms and 45.1% for depressive symptoms.

During the COVID-19 pandemic, HHS allowed for expansion of telehealth services. Although the public health emergency ended in May 2023, the Consolidated Appropriations Act, 2023 extended many of these telehealth flexibilities through Dec. 31, 2024.

Additionally, on Nov. 2, 2023, CMS issued a final rule that announced policy changes for Medicare payments under the Physician Fee Schedule (PFS). Effective Jan. 1, 2024, telehealth services furnished to people in their homes would be paid at the non-facility PFS rate.

And although some changes allowing for telehealth services were made permanent, especially for non-mental health services, others were extended with waivers only through Dec. 31, 2024. One requirement of coverage of mental health services, however, is that patients have an in-person visit within six months of an initial behavioral/mental telehealth visit.

Several bills have been introduced in Congress to extend tele-health services. The most recent one was introduced into the U.S. House by John James (R.-Mich.), Don Davis (D.-N.C.) and David Schweikert (R.-Ariz). The Telehealth Enhancement for Mental Health Act was introduced in April 2024.

This follows a bill that was introduced in March 2024 called the Telehealth Modernization Act of 2024 to permanently extend telehealth flexibilities for Medicare beneficiaries. It was introduced by Carl L. “Buddy” Carter (R.-Ga.), Lisa Blunt Rochester (D.-Dela.), Greg Steube (R.-Fla.), Terri Sewell (D.-Ala.), Mariannette Miller-Meeks (R.-Iowa), Jefferson Van Drew (R.-N.J.), and Joe Morelle (D.-N.Y.).

Additionally, a bill introduced in January 2024 by Sens. Bill Cassidy, (R-La.), Tina Smith, D-Minn., John Thune, R-S.D., and Ben Cardin, D-Md., which would remove requirements that tele-mental health patients see an in-person provider within six months.

Energy & Commerce Health Subcommittee Chair Brett Guthrie (R.Ky.)

Energy & Commerce Health Subcommittee Chair Brett Guthrie (R.Ky.)

In April 2024, a hearing of Energy & Commerce Health Subcommittee addressed expanding telehealth services in Medicare. Subcommittee Chair Brett Guthrie (R.-Ky.) explained that during opening remarks how CMS removed to telehealth services during the COVID-19 pandemic.

“Congress, under the leadership of those on this committee, again took action to extend these valuable telehealth flexibilities beyond the pandemic through December 31 of this year,” Guthrie said. “The looming deadline gives us the chance to examine long-term telehealth solutions that can drive innovation in health care through greater care delivery.”

Guthrie said the Telehealth Enhancement for Mental Health Act will “help us improve Medicare’s delivery of critical tele-behavioral healthcare services, which played a significant role throughout the pandemic to help seniors cope with social isolation and substance use disorder.” 

This story was updated to include additional information from CMS.

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