Advocates Press CMS to Make Permanent Rural Tele-behavioral Health Services

The letter notes that 20% of rural Americans experience mental illness, and that rural America is disproportionally adversely affected by the opioid epidemic.

Twenty advocacy groups have called upon the Centers for Medicare & Medicaid Services to extend and make permanent billing for tele-behavioral health outpatient service after the COVID-19 Public Health Emergency expires.

In a letter to CMS Administrator Chiquita Brooks-LaSure, the stakeholders lauded CMS's efforts to bolster telehealth in its CY 2022 Medicare Physician Fee Schedule, which extends through the end of 2023 some of the temporary telehealth regulations that were imposed at the start of the pandemic.

"Given the enormity of the challenge ahead of us, we must leverage our entire rural safety net to address these surging behavioral health needs," the letter said. "We strongly believe that CMS should ensure critical access hospitals, rural health clinics, federally qualified health centers, and other providers are all equipped to fully leverage telehealth and that they are able to bill for clinically equivalent services the same way they would an in-person service."

The letter signers include the American Physciatric Association, Gundersen Health System, the National Association for Rural Mental Health, and the National Rural Health Association.

Among the provisions of the CY2020 fee schedule, it would allow for RHCs and FQHCs to bill and get paid for tele-behavioral mental health visits, including audio-only visits, the same as in-person

"We agree that telehealth payment should be addressed for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and also believe outpatient behavioral therapy services offered by Critical Access Hospitals (CAHs) are a key component of a comprehensive rural behavioral health strategy," the letter stated. "Without action to ensure these hospitals can bill tele-behavioral health as they do in-person services, access to CAH-provided outpatient will be lost for thousands of Americans in rural areas."

The letter notes that 20% of rural Americans experience mental illness, and that rural America is disproportionally adversely affected by the opioid epidemic. In addition, suicide rates are 40% higher in rural areas than in large urban areas (and are increasing at a faster rate).

"This is only made worse by the fact that there is a severe shortage of mental health professionals in rural areas. Over 80% of rural counties do not have a psychiatrist, compared to 27% of counties in metropolitan areas," the letter said, adding that the challenges "are particularly acute for Medicare beneficiaries."

"Approximately 33% of widowers become depressed – and while elderly adults represent only 13% of the population, they represent approximately 20% of all suicide deaths. At the same time, approximately 68% of elderly adults have little awareness about how to recognize and be treated for depression."

"These are exactly the issues that Congress intended CAHs to address when designating them providers of essential services in rural communities," they wrote. "As you know COVID has only exacerbated these challenges."