Bill Overview
Title: A bill 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: Sen. Sullivan, Dan [R-AK]
Target Audience
Population: people with mental health conditions
Estimated Size: 60000000
- Medicare is a federal program in the United States that primarily provides health insurance to individuals aged 65 and older, although it also covers some younger individuals with disabilities and specific diseases.
- Mental health services are a critical component of healthcare that benefits individuals with mental health conditions, which can affect people of various demographics globally.
- Because the bill amends a program specific to the United States (Medicare), the direct impact will largely pertain to the U.S. population.
Reasoning
- Medicare primarily serves U.S. residents aged 65 and older or younger individuals with specific disabilities. The policy will therefore predominantly affect these demographics.
- The bill's objective is to enhance access to mental health care by removing physical barriers to receiving care. Thus, individuals with mobility issues, lack of transportation, or those residing in rural areas may see positive impacts.
- The budget constraints necessitate careful consideration of scale, expecting that not every Medicare beneficiary will utilize the service, but those with mental health conditions and barriers to in-person care may benefit significantly.
- The current Cantril wellbeing scores and possible changes reflect expected improvements due to increased access to mental health services.
- It's important to consider not only immediate benefits but also long-term impacts as people may develop more consistent care habits.
Simulated Interviews
retired teacher (rural Montana)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- Finally, it will be easier for me to manage my depression without all the travel.
- Having counseling sessions from home will save me energy and reduce stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 9 | 5 |
retired engineer (suburban Florida)
Age: 85 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Telehealth will ease my anxiety about missing appointments because of transportation issues.
- I'm still comfortable visiting my doctor in person when needed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 6 |
part-time artist (urban New York City)
Age: 65 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- This could help reduce the number of appointments I miss due to feeling unwell.
- I'm hopeful this makes therapy a more consistent and reliable part of my life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 5 |
farmer (rural Kansas)
Age: 73 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- This update makes it easier to attend therapy without leaving the farm, which can be hard at my age.
- I'm concerned about the technology complexity but excited about the convenience.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 7 | 6 |
retired nurse (suburban California)
Age: 68 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- This could relieve some of the burden of finding alternative care for my husband while I attend appointments.
- Proximity to care can lessen my stress and anxiety.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
retired police officer (urban Chicago)
Age: 62 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- Receiving care without needing to commute could lower my stress levels on appointment days.
- I'm comfortable with this digital-focused change in accessing mental health care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
retired homemaker (rural Alabama)
Age: 80 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- The idea is good, but with poor internet maybe I'll face challenges actually using this service.
- It might encourage me to tackle my internet access issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
retired architect (urban Houston)
Age: 69 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I live close enough to get in-person care easily, but telehealth offers added convenience.
- Still, I'm fine with either option.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
retired administrative assistant (urban Atlanta)
Age: 78 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Telehealth will reduce my stress about leaving the house for appointments.
- I already rely on family for support, so this will lessen dependency.
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 | 7 | 5 |
retired professor (urban Boston)
Age: 73 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 4/20
Statement of Opinion:
- Telehealth is convenient but not essential as I have easy access to services.
- It might offer more flexibility for scheduling.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $525000000 (Low: $420000000, High: $630000000)
Year 3: $550000000 (Low: $440000000, High: $660000000)
Year 5: $600000000 (Low: $480000000, High: $720000000)
Year 10: $650000000 (Low: $520000000, High: $780000000)
Year 100: $750000000 (Low: $600000000, High: $900000000)
Key Considerations
- The policy is expected to increase access to necessary mental health services, potentially improving outcomes for individuals with limited access to in-person care.
- Telehealth deliveries may also benefit system efficiencies, especially in rural and underserved areas.
- The cost implications largely depend on changes in service utilization patterns and potential savings from avoided acute care interventions later.