‘Telehealth Cliff’ Threatens Medicare Patients, Advocates Say


July 26, 2021 9:07 am

Hundreds of health and technology groups urge Congress to extend telehealth flexibility for Medicare beneficiaries past the end of the Covid-19 pandemic.

Last year’s CARES Act let the Centers for Medicare & Medicaid Services temporarily waive certain restrictions on how providers can deliver remote care.

A Biden administration proposed rule (RIN 0938–AU42) would extend temporary Medicare coverage of some telehealth services through Dec. 31, 2023, but the 430 groups said in a letter to congressional leaders that they don’t think the proposal goes far enough. They want telehealth to become a permanent fixture of the health-care system.

The groups that signed the letter included the American Medical Association, the American Board of Telehealth, the Alliance for Connected Care, the Federation of American Hospitals, AmazonGoogle, and Zoom Videoconferencing.

“Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth,” according to the groups’ letter.

“This would have a chilling effect on access to care across the entire U.S. health system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health,” the letter stated.

Telehealth use has increased dramatically during the pandemic because many patients have been unwilling or unable to see doctors in person. Telehealth represented 0.22% of private health plan medical claims in December 2019, booming to 6.51% in December 2020, according to data from FAIR Health.

Virtual visits have been especially helpful to mental health providers who are having a hard time meeting the demand of an ever-growing population of patients seeking care.

Beneficiaries like telehealth too, with 75% of Americans showing “a strong interest in using telehealth moving forward,” according to a telehealth study from the COVID-19 Healthcare Coalition.

Congressional Barrier

The CMS can’t permanently expand telehealth without changes to the Social Security Act, which limits the telehealth services Medicare can and can’t pay for. Before Covid-19, Medicare would only cover visits for beneficiaries in certain rural locations that originated in qualifying sites.

Given these restrictions, “Congress must act to ensure that the Secretary has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services,” the letter said, referring to Department of Health and Human Services Secretary Xavier Becerra.

The groups asked Congress to remove the geographic restrictions on patients and providers. The pandemic has demonstrated the importance of telehealth services “in rural and urban areas alike,” they said.

The groups want Congress to ensure flexibility in which services are eligible for telehealth and how they are delivered. Audio-only services should be permitted for reimbursement by the CMS “when clinically appropriate,” they said.

They want to remove a new restriction that would require mental health patients to have an in-person visit every six months. “Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities,” they said.

Future Legislation

Several telehealth bills are moving through Congress, which range from directing the HHS to extend Covid-19 flexibility (S. 368) to a widely supported bill that would amend the Social Security Act to expand telehealth access (S. 1512). Lawmakers are also pushing for legislation that addresses the in-person requirement for mental health services (S. 2061).

While these bills would improve access, the Alliance for Connected Care signed the letter because “we wanted to keep the pressure on,” Executive Director Krista Drobac said. “We need Congress to take action.”

“Congress not only has the opportunity to bring the U.S. health care system into the 21st century, but the responsibility to ensure that the billions in taxpayer funded COVID investments made during the pandemic are not simply wasted but used to accelerate the transformation of care delivery, ensuring access to high quality virtual care for all Americans,” the groups said in their letter.