Life before telehealth is a dim memory. You may have given up your office during the pandemic, saw all your clients virtually and now prefer to keep it that way. Or you have a hybrid practice of in-person and virtual services. So, like me, you may have panicked when you heard that Medicare providers will no longer be able to see clients virtually starting March 31, 2025.
Don’t panic! According to Health and Human Services (HHS), telehealth for behavioral health services is permanent under the current law. Psychotherapists can continue to see clients virtually.
Here’s what HHS currently states:
- “FQHCs (Federally Qualified Health Centers) and RHCs (Rural Health Communities) can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services.
- Medicare patients can permanently receive telehealth services for behavioral/mental health care in their home. (Italics are mine.)
- There are no geographic restrictions for originating site for Medicare behavioral/mental telehealth services on a permanent basis.
- Behavioral/mental telehealth services in Medicare can permanently be delivered using audio-only communication platforms.
- Marriage and family therapists and mental health counselors can permanently serve as Medicare distant site providers.”
The confusion may be the result of the following Medicare requirement:
“An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required through March 31, 2025.” In other words, starting April 1, 2025, an annual in-person visit will be required.
EXEMPTIONS
In some cases there is an exception for the yearly in-person visits but not the first six-month visit. There are additional exceptions and more than one might expect that will likely apply to many of your clients. As stated in the CMS Physician Fee Schedule final 2022 rule in 2022:
“Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period.
For example, situations in which the risks and burdens associated with an in-person service may outweigh the benefit could include, but are not limited to, instances when an in-person service is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition(s).
The risks and burdens associated with an in-person service could also outweigh the benefit if a patient is in partial or full remission and only requires a maintenance level of care.
Other examples of such instances may include the clinician’s professional judgment that the patient is clinically stable and/or that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family, or if it is determined that the patient is at risk for disengagement with care that has been effective in managing the illness.
Practitioners must also document that the patient has the ability to obtain any needed point of care testing, including vital sign monitoring and laboratory studies. Practitioners must note the exception for any applicable 12-month interval.”
All that said, Congress has routinely waved the yearly in-person mandate, like they did in December 2024, and they may do it again. The APA and NASW are advocating to eliminate this requirement permanently. You can add your voice by contacting your Senators and Representatives.
In the meantime it’s wise to take these three actions:
- Plan on the initial visit in the first six months and then the yearly in-person visit unless and until the law is waved.
- Document the in-person visit.
- If you do not meet in person, document the reasons for the exception so it’s clear you’re complying with the law.
If clinical documentation is something you struggle with, consider Documentation Wizard’s yearly LIVE webinar, Misery or Mastery®: Essential Documentation for Psychotherapists on Friday, April 11. You’ll learn how to turn your skill and intuition into effective and efficient documentation that passes audits, protects you in board complaints, and gives you peace of mind.
Beth Rontal, LICSW, a private practice therapist and the Documentation Wizard® is a nationally recognized consultant on mental health documentation. Her Misery and Mastery® trainings and accompanying forms are developed to meet strict Medicare requirements. Beth’s Documentation Wizard training program helps clinicians turn their clinical skill and intuition into a systematic review of treatment that helps to pass audits, protect income, maintain professional standards of care, reduce documentation anxiety and increase self-confidence. Beth’s forms have been approved by 2 attorneys, a bioethicist, and a billing expert and have been used all over the world. She mastered her teaching skills with thousands of hours supervising and training both seasoned professionals and interns when supervising at an agency for 11 years. Her newest initiative, Membership Circle, is designed to empower psychotherapists to master documentation with expert guidance, efficient strategies, and a supportive community.
Thank you, Beth, for this authoritative and reassuring information. You are a bright light in a dim time.
Richard, you’re welcome. We all do what we can to provide support during these tough times. I’m glad this blog helped provide some reassurance, at least for now.