clinical social work association

Update on Medicare Coverage of Telemental Health

December 3, 2024

Laura Groshong, LICSW, Director of Policy and Practice

Thanks to the many CSWA members who have written their members of Congress about the need for legislative action to extend or make permanent coverage of virtual videoconferencing for telemental health treatment.

Also, thanks to the members who have sent messages about the CMS rule that may allow LCSWs to continue to receive coverage for videoconferencing treatment in 2025. The reason Medicare rules are so important is that they usually influence the coverage allowed by commercial insurers.

There is some confusion about whether this rule has to be confirmed by Congress or not. I am working to determine whether this rule can stand on its own or requires Congressional approval. Three members of Congress have responded to our message that they are working on passing a bill. The bills that would extend telemental health coverage are HE 6534 (Home-Based Telemental Health Care Act); S. 1077 (Home-Based Telemental Health Care Act); S. 3651 (Telemental Health Care Act of 2024); S. 2016 (CONNECT for Health Act), which you can mention in your messages.

I encourage CSWA members to continue to send messages to members of Congress on this issue. Some staff for Medicare have confirmed the rule to guarantee coverage in 2025, some staff have not. These mixed messages are frustrating and difficult for LCSWs.

To help resolve this problem, please contact your regional MAC office at https://www.hhs.gov/guidance/document/cms-regional-offices to find out what the rule will be in your state/jurisdiction. Additionally, prudent LCSWs should contact any commercial insurers they are paneled with and ask whether they intend to change their coverage of telemental health treatment. Let me know what results you have, if any.

As for audio only treatment, coverage should continue as it is now. Be sure to document that the patient is 1) uncomfortable with videoconferencing; 2) not able to use computer technology; or 3) unwilling to consent to using videoconferencing.

CSWA hopes to provide clarity on this issue shortly.

Laura Groshong, LICSW, Director, Policy and Practice  
Clinical Social Work Association  
lwgroshong@clinicalsocialworkassociation.org