Telehealth Reimbursement Allows Access to Mental Health Care During COVID-19.

Dear Editor,

Older adults belong to the cohort most at risk for serious illness reactions to COVID-19, for whom shelter in place is most strongly recommended. In order to make remote services more accessible, the Center for Medicare and Medicaid Services (CMS) announced nonenforcement of some telehealth policies, e.g., those limiting the patient's location to approved rural facilities, or requiring HIPAA compliance of audio-visual platforms used for telehealth. While these measures increased access to care to Medicare subscribers with IT fluency, they failed to address access to care for Medicare subscribers who lack IT fluency. Around 93% of people over the age of 70 and 98% of people over the age of 80 (an average of 95.5% of people over the age of 70) do not use the internet to communicate with health care providers, and instead rely entirely on face-to-face or telephone interactions with health care providers.

The American Psychological Association has made repeated appeals to CMS to allow reimbursement for the use of telephonic psychotherapy services during shelter in place. On April 30, 2020, CMS responded by allowing reimbursement for telephonic contact with patients using CPT codes for routine psychotherapy. This important change in Medicare policy makes health care temporarily accessible to 95.5% of Medicare subscribers over the age of 70. However, the change is only temporary and will expire when the COVID-19 crisis has been resolved.

Valid and reliable instruments are available for assessing the media people use for accessing health care. Such instruments might be employed with older adults, in order to determine the most effective means through which they can access health care. Hospitals, community health clinics, government-funded health agencies and private practices might gather additional data that a) inform health care providers about the most effective media for communicating with older adult patients, and b) provide a more broad-based sample to contribute to the existing data demonstrating patterns of IT use by older adults for communicating with health care providers, as well as accessing social contact, financial management, and other business functions.

CMS's decision to reimburse telephonic psychotherapy is an important acknowledgement of the potential barriers to health care IT represents for older adults. Reimbursing providers for telephonic delivery of ongoing psychotherapy and other services make health care accessible to an average of 95.5% of Medicare subscribers over the age of 70. Although the duration of shelter in place and the future trajectory of COVID-19 remain uncertain, the data suggest that substantial and permanent CMS policy changes allowing reimbursement for telephonic access to health care for older adults will be increasingly important in the near future.

Author Contribution

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