Telehealth services are gaining ground as a means to expand reach and keep health costs down.
But what about telemental health? On one hand, it could be a boon for older adults who may be isolated or otherwise unable to visit a mental health practitioner in person. However, as the American Telehealth Association notes, “the service must be provided to an eligible Medicare beneficiary in an eligible facility (originating site) located outside of a Metropolitan Statistical Area” or in a health professional shortage area (HPSA).” There are exceptions for providers and hospitals participating in demonstration programs. But the criteria often mean some older people can’t access regular mental health care.
Medicare covers telehealth services that mimic normal face-to-face interactions between beneficiaries and their health care providers. But American Psychological Association points out that these payers now only cover “face-to-face,” interactive video encounters, which means the patient must be at eligible originating site with the psychologist or another provider at a distant site. That can be a tough requirement for a senior with limited transportation options.
The covered services themselves also are limited by Medicare’s own admission:
- Medicare reimbursement for services is limited to one depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic able to provide follow-up treatment and referrals.
- Individual and group psychotherapy with doctors or certain other licensed professionals is allowed by the state where the patient get the services.
- Family counseling is covered if the main purpose is to help with the patient’s treatment.
- Testing to find out if the patient is getting the needed services and the current treatment is helping.
- Psychiatric evaluation.
Cost is another barrier to obtaining needed mental health care. Medicare beneficiaries pay 20 percent coinsurance, plus the Part B deductible. For many older adults. paying out of pocket for mental health care may be considered an unaffordable luxury.
In a new AHCJ tip sheet about telemental health and older adults, journalist Phyllis Hanlon points out that in addition to cost, the uneven adoption of health technology poses some real challenges for those who could benefit from tele-mental health but are reluctant to use the services. The good news is that the Veteran’s Administration, long a proponent of telehealth, is making significant strides in using remote mental health services.