Stakeholders Push Congress To Permanently Expand Telehealth Care Options

Inside Health Policy

January 10, 2022 7:24 pm

Telehealth stakeholders are gearing up for an extended push to cement telehealth’s role in American health care in the year ahead. Last year brought dramatic expansions of telehealth’s breadth and depth, and with pending bipartisan legislation including the Telehealth Extension Act — and a defined end to the COVID-19 public health emergency still uncertain — stakeholders agree the upcoming year promises to be similarly active.

Telehealth stakeholders are pushing for a significant extension of the PHE, which in turn would extend current telehealth regulatory flexibilities, particularly as an increasing number of telehealth studies conducted during the pandemic demonstrate providers’ success at providing remote care. While the conclusion of the PHE will eliminate waivers and undo current Medicare telehealth reimbursement rates, both Congress and CMS have expressed interest in continuing broad access to telehealth.

Extending the public health emergency would allow providers to continue utilizing the telehealth infrastructure implemented throughout the pandemic and would also give stakeholders time to push Congress to pass legislation allowing telehealth care on a more permanent basis, said Krista Drobac, executive director for the Alliance for Connected Care.

Drobac said several studies from the HHS Office of Inspector General documenting telehealth’s successes prove that most concerns with telehealth are unfounded. One study found that telehealth patient-provider relationships have largely remained the same; 84% of Medicare beneficiaries participating in telehealth care have received care from providers with which they had an established relationship prior to the pandemic.

“As demonstrated, beneficiaries and the community do not need arbitrary guardrails like established relationships and in-person requirements to ensure beneficiaries are getting the care they deserve,” Drobac said in an email. “Patients are maintaining their own providers when possible and appropriate. We believe this will continue but as telehealth models evolve, patients should have the choice to see other providers with whom they do not have a previous relationship.”

An additional HHS OIG study found there are still areas of telehealth that could permanently benefit from congressional input.

Statutory barriers including originating site limits and geographic boundaries have been temporarily waived as part of the PHE, meaning many beneficiaries were able to receive care from their homes. The study said that Congress would need to take steps to permanently revise originating site restrictions. It recommended instituting a licensure reciprocity system among providers, which OIG said would help streamline problem-solving.

“CMS plays an important role in facilitating the exchange of information among States to improve the use of telehealth for behavioral health services. Sharing information among States will help ensure that States realize the benefits of telehealth and make informed decisions about how to address challenges with using telehealth,” the study said.

OIG’s study is supported by a recent report from McDermott Will & Emery, which found that telemental treatment flourished during the PHE, particularly as a result of the Consolidated Appropriations Act, which eliminated geographic care restrictions for mental health care. Post-PHE, however, CAA states telemental care must be accompanied by an in-person visit within six months before patients’ first telehealth appointment, a point of significant criticism from both providers and patients.

Stakeholders including the Healthcare Leadership Council and the American Medical Association said they will look to Congress to permanently expand eligibility — including removing geographic and site restrictions and in-person visit requirements — before the public health emergency ends.

“Fortunately, there is overwhelming bipartisan support on Capitol Hill to allow Medicare patients to maintain this benefit, although the potentially significant budget impact of the policy change is raising concerns,” Jack Deutsch, a spokesperson for AMA, said in an email. “Nevertheless, prospects are good for positive action on at least a temporary extension of the expanded benefit this year.”

Likewise, CMS has the capacity to cement certain new telehealth services by including them in HHS’ current statutory definition of telehealth services. Currently, CMS’ fee schedule includes provisions for over 100 new telehealth services, which were added as temporary items on the Medicare Telehealth List, through the end of 2023.

Some stakeholders say expanding telehealth may be the solution to ongoing workforce issues on the provider side. Kyle Zebley, vice president of public policy at the American Telemedicine Association, said many beneficiaries have moved from in-person to remote care for care needs that do not require in-person treatment. Zebley said this could be a mid-term or even long-term solution to an ongoing workforce shortage that is overwhelming existing providers.

“You’re not going to efficiently make use of a limited health care workforce — keep in mind, there’s a tremendous lag time, we’re talking about 15 years from now, if we wanted to expand our crop of doctors — you can’t solve the restraints of the system without telehealth,” Zebley said.

While bipartisan support for expanding telehealth remains strong among legislators, some stakeholders believe telehealth expansion will not be formalized unless provisions are included in larger “must-pass” packages. ATA hopes telehealth will be included in President Joe Biden’s budget for fiscal year 2023, which will be released in February, Zebley said.

Zebley said federal legislators must also be presented with a hard deadline to act; recurring deadlines like the 90-day PHE reauthorization process will not be enough to galvanize legislators into action, Zebley said.

“[Stakeholders] need to apply pressure to their Members of Congress, and other policymakers at the federal level, to make sure there’s no backsliding, to make sure they still have access to care where and when they need it,” Zebley said.

At the state level, however, Zebley said steps to expand telehealth are moving significantly more quickly. He said ATA is tracking more than 35 bills that have been introduced since the beginning of the year. He said this is a positive start to the new year, especially after 2021, a year where Zebley said 10 years of progress were made in one — “the most successful year in the history of telehealth,” he said.