The Biden administration is signaling a strong commitment to preserving and expanding behavioral health telehealth flexibilities as a critical strategy to improve access to mental health services for millions of Americans. Speaking before the U.S. House Ways and Means Committee during a hearing on the proposed fiscal year 2025 budget, U.S. Health and Human Services (HHS) Secretary Xavier Becerra praised the federal government’s approach to telehealth during the coronavirus pandemic response, calling it “one of the areas where we had the greatest success.”
“We can’t allow those behavioral health telehealth flexibilities to expire,” Becerra emphasized. “When the pandemic hit, a lot of folks thought it wouldn’t work on the mental health side, but it’s actually one of the areas where we had the greatest success. The last thing we need to do is allow them to expire.”
The Evolution of Behavioral Health Telehealth Flexibilities During and After the Pandemic
During the early days of the COVID-19 pandemic, rapid changes in federal telehealth policies allowed behavioral health providers to reach patients remotely in ways that were previously restricted. Many feared telehealth would not be effective for mental health treatment, but the experience proved otherwise, showing that virtual visits could deliver timely, effective care while reducing risks related to in-person contact.
In response to this success, the Consolidated Appropriations Act of 2023 — signed by President Joe Biden at the end of 2022 — extended many of the behavioral health telehealth flexibilities through the end of 2024. These included waivers allowing telehealth visits to originate from patients’ homes, permitting audio-only telehealth sessions, and eliminating geographic restrictions that limited telehealth use to rural or underserved areas.
Several of these behavioral health telehealth flexibilities have been permanently adopted within the Medicare program, including allowing telehealth visits from beneficiaries’ homes and removing geographic limits.
Why Behavioral Health Telehealth Flexibilities Matter for Vulnerable Populations
One of the key reasons for preserving telehealth flexibilities is the potential to expand access for traditionally underserved and vulnerable populations. Many seniors, rural residents, and people with disabilities face significant logistical challenges in accessing in-person behavioral health care. Telehealth reduces these barriers by allowing care to be delivered remotely.
Rep. Vern Buchanan (R-Fla.) emphasized this point during the hearing, noting that many seniors in his district must travel long distances for appointments. “This would be a lot better for them,” Buchanan said, referring to telehealth, “maybe not on the initial visit but after a couple of visits.”
Overcoming Regulatory Challenges to Maximize Behavioral Health Telehealth Flexibilities
Despite the clear benefits, state licensure laws continue to pose challenges to fully utilizing behavioral health telehealth flexibilities. Each state controls healthcare provider licensing, which limits the ability to provide care across state lines.
Secretary Becerra stressed the need for states to cooperate and harmonize policies. “Much of the flexibility that comes from telehealth [comes from] being able to go over state lines,” he explained. “Right now, because states decide who gets licensed to do care, we have to have the cooperation of the states so care can go beyond its own state borders.”
Medicare’s Role in Shaping Behavioral Health Telehealth Flexibilities
Medicare policies often set the foundation for private insurance coverage, and the Biden administration has taken important steps to encourage behavioral health providers to participate in Medicare. Expanding access to behavioral health clinicians in the program and supporting telehealth services are key components.
These Medicare reforms, combined with maintaining telehealth flexibilities, are designed to improve access for seniors, many of whom face limited behavioral health care options due to provider shortages and regulatory barriers.
Looking Ahead: Sustaining Telehealth Flexibilities for the Future
As the public health emergency that triggered many telehealth changes approaches expiration, the Biden administration is pushing Congress and states to make behavioral health telehealth flexibilities permanent. Reversing these policies risks disrupting care for millions who rely on telehealth for mental health services.
To ensure continued progress, policymakers must focus on:
- Permanently removing mandatory in-person visit requirements
- Encouraging interstate licensure cooperation
- Investing in broadband and digital access to reduce technology gaps
- Aligning private insurance policies with Medicare’s telehealth standards
Conclusion
The Biden administration’s strong advocacy for telehealth flexibilities reflects a commitment to expanding mental health care access and improving outcomes for vulnerable populations. Telehealth has proven to be an effective, convenient, and vital way to deliver behavioral health services — not just a temporary fix during the pandemic, but a lasting improvement to America’s health care system. Maintaining and building upon these flexibilities will be essential to meeting the growing behavioral health needs of the nation.
