Bill Overview
Title: To amend title XVIII of the Social Security Act to remove in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
Description: This bill permanently removes in-person evaluation requirements for mental health telehealth services under Medicare.
Sponsors: Rep. Hern, Kevin [R-OK-1]
Target Audience
Population: People enrolled in Medicare seeking mental health services through telehealth
Estimated Size: 65000000
- The bill targets individuals who use Medicare as their source of health insurance coverage.
- Approximately 65 million people are enrolled in Medicare as of recent data, including age 65 or older individuals and those under 65 with disabilities.
- Mental health services are an essential part of healthcare, and telehealth access has become increasingly important, especially for those who may have mobility issues or live in remote areas.
- Telehealth provides essential benefits of accessibility and convenience that encourage individuals to seek necessary mental health care.
Reasoning
- The simulated population includes various demographics that are differentially impacted by the removal of in-person evaluation requirements for telehealth mental health services under Medicare.
- The policy primarily affects older adults and younger individuals with disabilities, who might have limited mobility or access to mental health facilities.
- Given the budget constraints, the policy is likely to prioritize high-impact and high-need individuals within the Medicare population, focusing on those for whom telehealth represents a significant improvement in service access and continuity.
- The simulated interviews reflect a mix of high, medium, low, and no impact scenarios, recognizing that not everyone will experience the change in the same way.
Simulated Interviews
retired farmer (rural Iowa)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I find it hard to get to the doctor, especially in winter. Telehealth makes it so much easier for me to get counseling.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 5 |
semi-retired mechanic (urban Ohio)
Age: 66 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- Telehealth lets me talk to my therapist without the hassle of finding a ride. It's important for my treatment.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
disabled, former teacher (New York City)
Age: 43 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- Telehealth has made my life easier, removing the need to travel which can be very taxing on me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
retired engineer (suburban Florida)
Age: 78 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 12/20
Statement of Opinion:
- I'm glad this change makes it easier to see my psychiatrist. It's a big help for managing my condition.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
unemployed (California)
Age: 59 | Gender: other
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- This might be the only way I can stay in therapy; getting out is tough because of my condition.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
retired homemaker (Texas)
Age: 80 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- I'm not very tech-savvy, but my daughter helps me use telehealth, which is useful for my check-ins.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
retired postal worker (Alaska)
Age: 69 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- Without telehealth, I wouldn't talk to my therapist at all, the trips are too long and expensive.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 8 | 4 |
retired nurse (Tennessee)
Age: 61 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- Telehealth helps me keep my appointments more regular without the strain of travel.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
retired teacher (Ohio)
Age: 82 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- This is a blessing, I don't have to navigate public transport or depend on others to make my appointments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 5 |
part-time librarian (New Mexico)
Age: 45 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- Getting out is hard, so telehealth has been great. Being able to continue this is crucial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $5000000000 (Low: $4000000000, High: $6000000000)
Year 2: $5500000000 (Low: $4500000000, High: $6500000000)
Year 3: $6000000000 (Low: $5000000000, High: $7000000000)
Year 5: $7000000000 (Low: $6000000000, High: $8000000000)
Year 10: $9000000000 (Low: $7500000000, High: $10000000000)
Year 100: $15000000000 (Low: $12000000000, High: $18000000000)
Key Considerations
- Gradual uptake of telehealth services by older populations may affect initial costs and projections.
- If telehealth consultations are shorter, requiring more frequent visits, costs might be higher than anticipated.
- There is potential for fraud and increased administrative costs in the management of telehealth services.
- Wider access to mental health services may yield societal benefits that could offset some costs over time.