Instructions
Please copy the draft letter texts of your choosing from the options below, then go to the action tool and paste them in the comment field. Once pasted, please feel free to personalize the text to reflect how the proposed rule would affect you, your patients, and/or the community where you live, serve, or work. Please note that the first option listed below brings you to a page where you can copy a complete letter with all the topics combined. If you wish to comment only on the topics that most reflect your and your community's experiences, we have share single-topic draft letters in subsequent rows. If you wish to return to the action center from this page, click here.
Deadline to Comment: September 13, 2021
| Topic | Draft Letter Texts |
| Complete Draft Letter | Please click here to access a draft letter which combines all the messages listed below. To meet character limits within the action tool, we have slightly abbreviated the individual components within the complete letter. |
| Health Equity | CMS should continue its efforts to close gaps in access to mental and behavioral health services. Many of the provisions in this Proposed Rule on telehealth, for example, would continue to allow patients from underserved communities—such as rural areas and communities of color—to access these services, often for the first time. For many patients seeking mental and behavioral health services, the availability of tele-mental and tele-behavioral health increases their ability to participate in treatment; for example, many people with disabilities either cannot drive and lack services to transport them to in-person appointments, or experience heightened anxiety during in-person appointments and require the familiarity of their own homes to fully engage in treatment. The availability of audio-only telehealth is particularly beneficial to many older patients who may lack the familiarity with the technology necessary for an audio/video telehealth appointment. |
| Telehealth Flexibilities | I want to thank CMS for the flexibility extended during the pandemic, such as making the home an originating site, enabling coverage of more services via telehealth, and allowing patients to use audio-only devices. |
| Audio-Only Services | I strongly support the proposal by CMS to allow patients to receive audio-only mental health services in their homes on a permanent basis. Audio-only coverage should also be expanded to include behavioral health services. Like psychotherapy, Health Behavior Assessment and Intervention (HBAI) services (codes 96156-96171) do not require patient visualization, making them suitable for telehealth visits, including audio-only, to patients in their homes. Feedback sessions for psychological and neuropsychological testing evaluation (96130 – 96133) and the neurobehavioral status exam (96116, 96121) should also be available as audio-only services. An in-person visit is not needed to successfully provide mental and behavioral health services through telehealth, including audio-only. If CMS is forced to establish an interval for subsequent in-person visits for patients being treated through telehealth, the interval should be at least 12 months. |
| Supporting Research- and Evidence-based Practice | I applaud CMS for recognizing the more than 20 years of psychological research demonstrating that psychotherapy delivered via audio-only (phone) is as effective as the care delivered in person and I strongly support the proposal by CMS to allow patients to receive audio-only mental health services in their homes on a permanent basis. Audio-only coverage should also be expanded to include behavioral health services (HBAI services, codes 96156-96171) as there is psychological research to support this service. |
| Psychological and Neuropsychological Testing | I support CMS’ proposal to allow Psychological and Neuropsychological Testing furnished via telehealth to remain covered until the end of 2023, allowing time to address CMS’ concerns. This will also allow psychological researchers to continue to add to the growing empirical evidence for the validity of psychological and neuropsychological testing by telehealth and protect beneficiaries from suddenly losing access to critical services when the PHE ends. |
| Developmental Testing, Adaptive Behavior Services, Multiple Family Group Psychotherapy | CMS should place Developmental Testing services (96112 & 96113) and Adaptive Behavior & Treatment (97151, 97152, 0362T, 97153, 97154, 97155, 97156, 97157, 97158 and 0373T) on the interim telehealth services list until the end of 2023. This will allow stakeholders more time to demonstrate why these services should remain available through telehealth. In 2020, APA asked that the code for multiple family group psychotherapy (90849) be added to Medicare’s permanent telehealth list. CMS turned down this request because the code has non-payment status in Medicare. Because many private payers base their coverage decisions on Medicare policies, adding code 90849 to the telehealth list will enable psychologists to be reimbursed when furnishing these critically important services to patients who are not Medicare beneficiaries. |
| Rural Health Centers / Federally Qualified Health Centers (RHCs/FQHCs) | I support the proposal by CMS to continue coverage of telehealth and audio-only services in RHCs and FQHCs. Medicare beneficiaries receiving services through these facilities should have the same access to mental and behavioral health services as those treated by providers practicing independently. |
| Reimbursement for Telehealth and Audio-only Services | All telehealth services, including audio-only, must be reimbursed at the same rate as if the service was furnished in-person. For Medicare this means reimbursing the service at the non-facility rate. Paying less for telehealth services will discourage their use by providers and threaten beneficiary access to needed services. |
| Remote Therapeutic Monitoring | CMS should adopt codes 989x1-989x5 for remote therapeutic monitoring (RTM). Psychologists are among the health care professionals who provide non-physiologic services through RTM and must be allowed to bill Medicare under these codes. Reimbursement for services under the new RTM codes should be the same as the reimbursement for the remote physiological monitoring (RPM) codes that the RTM series was designed to resemble. |
| Chronic Pain Management | I appreciate CMS’s consideration of new reimbursement policies for chronic pain management services. CMS should take steps to increase Medicare patient access to psychological pain management services, including by making psychologists independently reimbursable for pain management assessments, care planning and consultation, and patient services. |
| Conversion Factor Reduction | CMS should work with Congress to avoid the losses clinicians will incur if budget neutrality requirements must be met in 2022. Subtracting 3.75% from next year’s conversion factor will be a significant loss for many providers. The projected 3.89% loss for 2022 follows a 3.3% reduction in 2021 for budget neutrality reasons. With this newest reduction in the conversion factor Medicare providers will have lost almost 7% in payment from 2020 to 2022. Having payments cut by so much will put beneficiary access to critical services in jeopardy. |