September 29, 2025

By Laura Groshong, LICSW, Director of Policy and Practice

The post on telemental health that went out last week prompted many questions which I will try to answer here:

1. Are clients who are currently being seen virtually need to be seen in person once a year? If the patient has not been seen in-person prior to 10/1/25, they will need to be seen once a year in-person. If the patient has been seen virtually prior to 10/1/25, they will likely be exempt from the in-person requirement. (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 10)

2. Where are the citations for the in-person requirement? The citation in #1 and the following citation, both from CMS, are the information I am using. (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 6)

3. Do we know if this same restriction will apply to psychiatrists and psych NPs? We do not have an answer to this as it is outside of our scope.

4. Won’t the predicted continuing resolution (CR) again extend COVID era telehealth variances? For context, during the COVID-19 pandemic, Congress and federal agencies gave temporary flexibility for telehealth. Each time Congress has passed a CR, they’ve often tacked on an extension to include those flexibilities.

The continuing resolution to maintain funding for the Federal budget is by no means definite to avoid a government shutdown. A CR must occur by Tuesday, 9/30/25 or government funding for most functions will stop. Healthcare cuts are one of the ways that this administration planned to fund the huge bill passed this summer.

5. How do we define existing patient? An existing patient is someone who has been seen virtually prior to 10/1/25.

6. How will commercial insurers respond to the in-person requirement? There is no clear message from commercial insurers yet. They are probably waiting to see whether the in-person requirement is delayed or not.

7. Could you advise us members whom to contact to protest this? Contact your members of Congress at https://www.congress.gov/contact-us.

8. Will we be able to have a new Medicare client who is a no-show covered, including for the initial appointment? There are a few plans, mainly ERISA, i.e., self-insured, that cover no-shows, but Medicare is not one of them. There is no plan at this time for that to change for the in-person requirement.

9. Do patients who become Medicare-eligible while we are seeing them using different insurance coverage have to be seen in person when they switch to Medicare coverage? That is likely, but I would check with your Medicare Administrative Contractor to find out for sure.

I will continue to answer questions about telemental health as they come in and as information is provided by Congress and CMS.

Contact: Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org.