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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.
      Center for Disease Control and Prevention
      Coronavirus Disease 2019 (COVID-19): People Who Are at Higher Risk for Severe Illness.
      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.
      Center for Medicare and Medicaid Services
      Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised.
      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.
      • Lepkowsky C.M.
      • Arndt S.
      The internet: barrier to health care for older adults?.
      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.
      American Psychological Association Services, Inc.
      Phone Only Telehealth Services for Medicare during COVID-19.
      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.
      • Lepkowsky C.M.
      • Arndt S.A.
      Functional Assessment of Currently Employed Technology Scale (FACETS): reliability and validity.
      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
      American Psychological Association Services, Inc.
      Phone Only Telehealth Services for Medicare during COVID-19.
      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.
      • Lepkowsky C.M.
      • Arndt S.
      The internet: barrier to health care for older adults?.
      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

      The author warrants that he has reviewed and approved the manuscript prior to its submission, and assumes responsibility for the contents of the manuscript.

      Disclosure

      The author declares no conflicts of interest in the manuscript, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest. The author also declares no sources of funding for the manuscript.

      References

        • Center for Disease Control and Prevention
        Coronavirus Disease 2019 (COVID-19): People Who Are at Higher Risk for Severe Illness.
        2020 (Accessed April 17, 2020. Available at:)
        • Center for Medicare and Medicaid Services
        Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised.
        2020 (Accessed April 17, 2020. Available at:)
        • Lepkowsky C.M.
        • Arndt S.
        The internet: barrier to health care for older adults?.
        Pract Innov. 2019; 4: 124-132
        • American Psychological Association Services, Inc.
        Phone Only Telehealth Services for Medicare during COVID-19.
        2020 (Accessed April 17, 2020. Available at:)
        • Lepkowsky C.M.
        • Arndt S.A.
        Functional Assessment of Currently Employed Technology Scale (FACETS): reliability and validity.
        Int J Med Sci Clin Invent. 2018; 5: 4064-4068