As Congress asks for more transparency from the agency, another 62 telehealth projects are approved for funding, bringing the total to $128.23 million for 367 programs in 45 states and Washington DC
– The Federal Communications Commission has approved another 62 applications from healthcare providers for funding from the COVID-19 Telehealth Program.
With its 11th set of applications, the FCC has awarded $128.23 million from the $200 million program to 367 connected health programs in 45 states and Washington DC.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
In a letter to FCC Chairman Ajit Pai last week, US Reps Frank Pallone Jr (D-NJ) and Michael Doyle Jr. (D-PA) called for the agency to provide weekly updates, beginning this week, on the number of applications received for funding from the $200 million program, as well as those approved for funding, those not approved for funding and the amount of money dispersed to healthcare providers.
“While the FCC has posted weekly updates of funding awards, we are troubled by the lack of transparency regarding the health care providers who have applied but have not yet received an award,” Pallone, chair of the Commerce and Energy Committee, and Doyle, chair of the Subcommittee on Communications and Technology, wrote. “We have heard reports that many health care providers are facing issues obtaining funds, particularly those serving tribal lands.”
“Similarly, health care providers report they have been unable to receive funding for some important telehealth equipment that we believe should be covered under the law,” they added.
The latest group of approved applications, as usual, includes a mix of large and small providers, from clinics and programs to hospitals and health systems, all looking for support to expand telemedicine and mHealth technology platforms to meet the demand caused by the coronavirus pandemic.
This list includes Miami’s Baptist Hospital, Florida’s Citrus Health Network, the Hearts for Hearing Foundation in Oklahoma City, Detroit’s Henry Ford Health System, the Hospital for Special Surgery in New York City, Maimonides Medical Center in Brooklyn, Marshfield Medical Center in Wisconsin, Cleveland’s Metrohealth System, the Oregon Health and Science University in Portland, the Providence St. Joseph Health Consortium in Washington, Thomas Jefferson University Hospitals in Philadelphia, University of Colorado Health, here hospitals in the UPMC network and the West Virginia United Health System.
The task force is a who’s who of telehealth’s top advocates, including representatives of Intermountain, Stanford and UPMC, as well as American Well, Teladoc and MDLive.
A group of 30 senators from both sides of the aisle on Monday urged leadership to make permanent the expansion of telehealth services that has been undertaken during the coronavirus pandemic.
The letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.) calls for provisions from the CONNECT for Health Act included in previous COVID-19 legislation be extended after the public health emergency is over.
“Americans have benefited significantly from this expansion of telehealth and have come to rely on its availability,” said the lawmakers led by Sens. Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.). “Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic.”
Telehealth has grown in popularity during the coronavirus pandemic as a safer alternative to in-person visits.
The services help doctors work with patients diagnosed with COVID-19 without putting themselves at risk.
It also helps providers care for high-risk patients who might contract the disease if forced to leave their homes for medical visits.
Advocates say enhanced telehealth capabilities could result in improved service with lower fees even beyond the pandemic.
“Doing so would assure patients that their care will not be interrupted when the pandemic ends,” the senators wrote. “It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.”
Convinced that telemedicine, which exploded during Covid-19 shelter-in-place orders, is here to stay, insurers are moving to expand networks and provide virtual primary care plans at lower premiums and less cost-sharing for patients.
Telehealth lets patients meet with health-care providers electronically, via computers or telephones, instead of in person. Patients can receive services at home from providers outside their areas, including monitoring for such chronic conditions at diabetes.
When Covid-19 hit, telehealth, typically available in health plans but not robustly used, took off, with many insurers waiving out-of-pocket costs so consumers could get care without exposing themselves or their providers to the risk of coronavirus infection. The federal government and many states issued regulations or enacted emergency laws to raise reimbursement rates for providers and ease restrictions, such as licensing requirements, to expand telehealth access.
Now, that shift may be here to stay. More insurers, spurred by telemedicine’s lower costs and greater efficiencies, are setting up networks beyond their geographic areas, potentially boosting competition among providers. But telehealth has limits, and it’s also unclear if the savings long associated with virtual medicine will be undermined by the higher rates that insurers and the federal government paid to help expand the sector in the first place.
Virus Opened Door
Telehealth services have been available for years, primarily for people in rural areas or those who lack access to specialized services, but use has been anemic.
More than 70% of people with health insurance have access to telehealth through their plans, and many insurers have partnerships with telehealth providers, Sam Glick, a leader of the Oliver Wyman Health Innovation Center, an initiative of the management consulting firm, said. Still, the pandemic led many consumers to telehealth for the first time.
“Before Covid, fewer than 10% had ever used it,” Glick said. “Now with Covid, a lot more people have tried it.”
The cost savings can be substantial. Visits with medical providers using telehealth services such as Teladoc Health Inc., a U.S.-based multinational telemedicine and virtual health-care company, can be as low as $75 for cash payments and even less if covered by insurance, compared with a typical charge of $150 to $300 for an in-person visit, he said.
Increased use of telehealth may also help drive down costs by expanding health plans’ networks of doctors and other providers and creating greater competition, Glick said.
While individual doctors have to be licensed in the state where their patient is located, many physicians have licenses in more than one state and, more importantly, companies such as Teladoc or Amwell set up systems so patients can be matched with appropriately licensed medical practitioners, Glick said.
That makes them national competitors, “which is very different than what a local medical group with all of its doctors in one place can do.”
Virtual Primary Care
Three months into the pandemic, some health insurers are creating primary care networks based on telehealth, offering reduced or no-costing sharing for members who enroll and lower premiums.
Louisville, Ky.-based Humana Inc. June 1 expanded its On Hand primary care plan, first started in 2019, from two to 13 states. On Hand uses telehealth service Doctor on Demand and is being offered to companies with 100 or more employees where, previously, it was available only to smaller companies.
“We wanted to take it another level” and create entirely virtual primary care plans instead of just embedding basic telehealth options in traditional plans, Caleb Gallifant, Humana’s vice president of product development and partnerships, said. Telehealth previously was used mostly for urgent care, he said.
Humana, with 1.3 million members in employer-sponsored plans, wouldn’t divulge the number of people enrolled in On Hand, but Gallifant said it has gotten more requests as it has expanded its market.
“I think there’s some pent-up demand,” he said.
On Hand makes it easier for geographically dispersed companies with remote workers to offer broader networks, and most companies who buy the plan have never offered health benefits before, Gallifant said.
Premiums are cheaper—20% to 50% less than traditional plans; there are no copays for telemedicine primary care visits; and enrollees receive thermometers and blood pressure monitoring devices at home, he said.
Comfort Level
Familiarity with telehealth grew so quickly in the pandemic that Mountlake Terrace, Wash.-based Premera Blue Cross fast-tracked the creation of its virtual primary care plan, Premera NOW, which came out in mid-May in time for open enrollment season, said Rick Abbott, vice president of product and market solutions.
“We’ve seen a progression of almost a decade in terms of experience and comfort with things like telehealth just in the past 90 days,” Abbott said.
Premera, which operates primarily in the Pacific Northwest, has more than 2.2 million members, including some with large employers such as Microsoft Corp. and Amazon.com Inc.
Premera NOW uses telehealth primary care clinic 98point6. Patients who use telehealth for a substantial portion of their primary care needs receive “unlimited access for free” and are charged a copay for specialist office visits when referred by a virtual primary care doctor, Abbott said.
Premiums for Premera NOW run about 10% less than traditional employer-offered plans, and Premera is looking at offering a similar type of virtual primary care plan in the individual market, he said.
Cost and Care
The U.S. Department of Health and Human Services, as well as private insurers in many cases, raised telehealth rates to match in-person visits, providing incentives to providers to participate in telehealth during the pandemic, Danielle Showalter, a principal with consulting firm Avalere Health, said.
Higher rates, though, call into question whether cost savings long associated with telehealth will be lost. Premera decided “for the near term” to equalize payments for local providers to help them “make it through this pandemic whether you were in telehealth or in-person,” Abbott said.
But the company hasn’t decided what to do about future rates.
Abbott said telemedicine probably warrants “a lower price point” than in-person health care because it’s delivered in a way that uses fewer resources, “but that’s a discussion our network team is having with our local providers and our insurance commissioner as well.”
Telehealth isn’t suited for all medical scenarios, but health plan administrators expect it to play a bigger role in some areas, such as monitoring chronic conditions.
Devices that track blood sugar, blood pressure, and other health metrics will increasingly be used in telehealth plans, Glen Tullman, executive chairman and founder of Livongo Health, a digital health company aimed at helping people manage chronic diseases, said. That will cut down on unnecessary visits for people who are doing well and flag those in need of extra help, he said.
Glick agreed telehealth would play a bigger role in monitoring chronic illnesses, a shift that could have implications for the structure of health insurance by pushing it toward monthly provider payments for continuous care rather than paying for individual claims or visits.
Others say telehealth may continue to play a greater role in mental and behavioral health services, two areas that were a “real focal point area of expansion” during the pandemic—and where providers are lacking in some regions, said Showalter. Or it could be used for tasks that have, so far, been less explored, like emergency room triage.
“There are just a lot of uses for telehealth that haven’t previously been tapped as much, really across all of the markets, that have that kind of opportunity now that we’ve been put in a nice little test bubble thanks to the coronavirus,” Showalter said.
To contact the reporter on this story: Sara Hansard in Washington at [email protected]
Congress took steps to quickly expand access to telehealth during the COVID-19 pandemic .
Now 30 senators are calling for those changes to become permanent.
Senator Brian Schatz, D-Hawaii, wrote a letter (PDF) urging Senate majority leader Mitch McConnell, R-Kentucky, and minority leader Charles Schumer, D-New York, to support expanding access to telehealth services on a permanent basis so that it remains an option for Medicare beneficiaries both now and after the pandemic.
“Doing so would assure patients that their care will not be interrupted when the pandemic ends. It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment,” Schatz wrote in the letter, which was co-signed by a bipartisan group of senators including Commerce Chair Roger Wicker, R-Mississippi; Mark Warner, D-Virginia; Kyrsten Sinema, D-Arizona; Lisa Murkowski, R-Alaska; Lindsey Graham, R-South Carolina; and Amy Klobuchar, D-Minnesota.
Virtual care has proven to be a lifeline for patients during the COVID-19 pandemic and the use of telehealth services has skyrocketed in the past three months.
The number of Medicare beneficiaries using telehealth services during the pandemic increased 11,718% in just a month-and-a-half, according to Schatz.
Two of the measures Congress took up this spring—the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020 and the Coronavirus Aid Relief and Economic Security Act (CARES Act)—enabled temporary policies during the COVID-19 emergency, such as allowing the Secretary of Health and Human Services the authority to waive telehealth requirements.
Because of these new authorities provided by Congress, Medicare has expanded coverage of telehealth services for the duration of the pandemic to include all areas of the country—as well as allowing a patient’s home to serve as an originating site for telehealth. In addition, more types of health care providers—including federally qualified health centers and rural health clinics that provide primary care in rural and underserved areas—can furnish and bill Medicare for telehealth services, the senators wrote in the letter.
“Americans have benefited significantly from this expansion of telehealth and have come to rely on its availability,” Schatz wrote.
Many of the temporary policies were adopted from the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, which Schatz introduced in October. The bipartisan legislation aims to expand Medicare coverage for telehealth services.
The healthcare industry is speculating about the future of telehealth changes after increased use during the pandemic. Health providers and medical groups have been pushing Congress and CMS to make these short-term policy changes permanent as many believe virtual care is here to stay.
The College of Healthcare Information Management Executives (CHIME) wrote in a recent letter to CMS Administrator Seema Verma that healthcare CIOs view telehealth and the ability for patients to access care at a distance as “critical to fighting this disease.”
Providers are starting to look at what life without a public health emergency and COVID-19 will look like, CHIME president and CEO Russell Branzell wrote.
“The increased use of telehealth has moved the country further into 21st Century medicine. The flexibilities are reducing burdens on providers and patients alike and reverting to pre-COVID telehealth policies will be seen as a step backward,” Branzell wrote.
Given the recent flexibilities provided by both Congress and the Centers for Medicare & Medicaid Services, steps should be taken to measure the impact of telehealth on Medicare, the senators wrote.
The senators are calling for the federal government to collect and analyze data on the impact of telehealth on utilization, quality, health outcomes, and spending during the COVID-19 pandemic.
“There is currently a scarcity of data available regarding the impact of telehealth on the Medicare program. This data would assist Congress in crafting additional policies to improve health outcomes and use resources more effectively,” Schatz wrote.
Last week, Senators Martha McSally, R-Arizona, and Doug Jones, D-Alabama, introduced bipartisan legislation to make $50 million available for a Virtual Health Pilot administered to support remote patient monitoring programs in community health centers rural health clinics during the pandemic.
Those funds would be administered by the Health Resources and Services Administration, according to the legislation.
The Health Innovation Alliance cheered the legislation, saying it provides a “vital step forward to ensuring telehealth can deliver for those who need it the most.”
“Telehealth continues to meet the challenge during this pandemic to help reduce the spread of COVID-19 while giving patients access to health care services they need. Congress needs to take action to permanently eliminate the outdated barriers to telehealth services that have been waived by the Administration,” the organization said.
A bill introduced this week in the House would ensure Medicare coverage for telehealth services provided by FQHCs and RHCs and eliminate originating site facility and location requirements for distant site telehealth services.
– A bill introduced in Congress this week aims to improve telehealth coverage for federally qualified health centers (FQHCs) and rural health clinics (RHCs).
Introduced by US Reps. Glenn Thompson (R-PA) and George Butterfield (D-NC), the Helping to Ensure Access to Local TeleHealth (HEALTH) Act of 2020 would, if approved, mandate Medicare coverage for telehealth services at these clinics and remove originating site facility and location requirements for distant site telehealth services delivered by them.
The bill would make permanent connected health coverage included in the CARES Act, which only lasts as long as the COVID-19 emergency, and bring into the spotlight one of the most troubling barriers to widespread telehealth adoption.
As defined by the Centers for Medicare & Medicaid Services, there are roughly 1,400 FQHCs and another 4,300 RHCs in the US, many of them serving predominantly underserved populations and communities. Because they’re haven’t been considered a distant site for telehealth by CMS, opportunities for reimbursement are few and far between, and many rely on grants and donations to offer telehealth services.
With the coronavirus pandemic sharply curtailing in-person care and putting both patients and providers at risk of catching the virus, many clinics have turned to telehealth and mHealth to keep the virtual doors open.
But the telehealth freedoms enabled by the CARES Act last only as long as the emergency. In addition, many experts note that the nation’s current economic troubles and soaring unemployment rate will leave millions without health insurance and push them toward these clinics for care.
Some states – notably Colorado and California – made moves prior to the pandemic to extend telehealth coverage for FQHCs and RHCs. In addition, the Creating Opportunities for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, introduced for a third time by a large group of Senators in October 2019, proposes to remove geographic restrictions on originating sites for FQHCs and other locations and allow them to qualify as distant sites for telehealth reimbursement.
“The HEALTH Act recognizes the new normal that community health centers and our patients are living in,” Chris Shank, CEO and president of the North Carolina Community Health center Association, said in a press release issued by Thompson and Butterfield. “The pandemic has led community health centers nationwide to adopt innovations like telehealth in order to protect the safety of patients and the medically underserved communities we serve. Through the temporary telehealth changes thus far, community health center patients have been able to access primary care and behavioral health services while physically distancing to limit spread of coronavirus.”
“Patients and providers alike will benefit from permanent telehealth access even once the virus is under control,” he added. “Allowing patients to connect virtually to their health care provider removes significant barriers like transportation, which disproportionately affects patients with lower incomes and those living in rural communities. The HEALTH Act will reduce longstanding barriers to health care access by reducing red tape and providing sustainable reimbursement for telehealth services provided by community health centers.”
The coronavirus pandemic sparked the growth of telehealth across the healthcare industry. This growth will continue after the pandemic, industry experts said at the Value-Based Care Summit | Telehealth20: Virtual Series.
– The healthcare industry saw an unprecedented rise in telehealth amidst the coronavirus pandemic. This trend will continue, according to industry leaders at the Value-Based Care Summit | Telehealth20: Virtual Series.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
Various panels at the event highlight strategies and best practices across the industry. And attendees weighed in on their organization’s strategies to combat COVID-19 and plans to move forward in a post-coronavirus world.
Speakers from the Center for Telehealth and Connected Care at Dartmouth-Hitchock Medical Center, Boise State University, and St. John’s Health discussed how to reduce care disparities in rural populations using telehealth.
Meanwhile, representatives from Memorial Hermann Health System, SR Health by Solutionreach, and CHRISTUS Good Sheperd Health System walked through designing an effective business plan for telehealth solutions.
And UnitedHealthcare and Moonshot Health Consulting highlighted strategies for developing stronger payer/provider relationships for telehealth solutions after COVID-19.
A key element of all discussions was the important role telehealth have played, and continue to play, across the industry.
Stay-at-home orders meant many patients were not seeking care on-site. So organizations needed to adjust their practices if patients were going to continue receiving care safely. Telehealth was the obvious solution.
Unsurprisingly, 91 percent of conference attendees said the role of telehealth had increased at their organization since March 2020. And over two-thirds (68 percent) were explicitly motivated to participate in telehealth programs because of the coronavirus.
Now, as stay-at-home orders are lifting and hospitals and health systems are resuming elective care, organizations need to think about what telehealth programs will look like moving forward.
An overwhelming majority (96 percent) of attendees believe that telehealth’s role will continue to grow in the industry. Only 4 percent of respondents believe that telehealth’s role will stay the same.
Organizations will continue building their telehealth programs to support success. Sixty-eight percent said they planned to further invest in telehealth following the public health emergency. Another 44 percent said they plan to invest in IT infrastructure and capabilities, which support telehealth solutions. Robust IT capabilities allow telehealth programs to thrive.
Many organizations have gotten a handle on the coronavirus as case numbers begin to decline in some states. As these organizations come up for air, they can begin expanding these programs that helped them successfully respond to the pandemic.
There is some evidence organizations will get support in these pursuits. Telehealth is here to stay, Centers for Medicare and Medicaid Services (CMS) Administrator, Seema Verma, has admitted.
“CMS’ rapid changes to telehealth care a godsend to patients and providers and [allow] people to be treated in the safety of their home,” she said in an earlier press release. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”
Moving forward, telehealth’s role will only become more integral as organizations resume normal services and start to understand how the new normal of care delivery looks.
The Center for Connected Health Policy (CCHP) has developed a new tool on its website to track the emergency actions and legislation directly resulting from the COVID-19 pandemic. Since state Governors declared states of emergency in mid-March, Medicaid programs have released a multitude of documents pertaining to waivers and easing of restrictions related to telehealth. Common temporary allowances found in the Medicaid documents include:
Allowing the home to be an originating site for telehealth
Expanding the types of providers allowed to be distant site providers during a telehealth interaction
Providing reimbursement for additional types of services when delivered via telehealth
Allowing the telephone as a mode of service delivery
In addition to the above, most state Departments of Insurance have released either guidance or provided temporary requirements for health plans in their state to cover telehealth delivered services sometimes mandating payment parity with in-person services. Medical Boards have also in some cases eased cross-state licensing, consent and prescribing requirements for telehealth delivered services on a temporary basis during the state of emergency. CCHP has identified in its tool which documents address each of the above described topic areas, along with their corresponding expiration date, if available.
The sources used to gather the list of state actions include each state’s Office of the Governor (which often includes executive orders), Medicaid Program, Medical Board and/or Department of Insurance. CCHP plans to update this tool on a regular basis so that the current telehealth waivers and guidance documents are all in one place and can be tracked as they are either extended in duration, altered, expire or made permanent. If you have additional information on state actions that are not included in CCHP’s state action tool, please submit your information to [email protected] and we will be sure to include it in future updates.
A new bill before Congress aims to create an annual $10 million grant program to help providers extend telemental health programs into rural areas focused on the farming, forestry and fishing industries.
– Lawmakers are looking to extend telehealth into rural parts of America to improve access for people in need of mental health services.
A group of Senators last week introduced the Home-Based Telemental Health Care Act of 2020 (S.3917), which would create a grant program to help providers to extend their connected health platforms into rural areas focused on the farming, fishing and forestry industries.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
“Now, especially as our nation continues dealing with a pandemic, we need to help rural America overcome the unique obstacles that small towns and rural communities face in providing mental health,” Senator Tina Smith (D-MN), who sponsored the bill with Senator Mike Rounds (R-SD), said in a press release. “Our bipartisan bill will help health providers in rural areas expand telemental health care services for farmers, ranchers and foresters, and many others in local communities who are experiencing stress and burnout caused by the pandemic, difficult weather, low commodity prices and more. It’s important that they get the services they need during this uncertain time.”
According to the Senators, the bill would create a $10 million loan program, to be renewed each fiscal year through 2025. The Health and Human Services Secretary, through the Health Resources and Services Administration’s Office of the Advancement of Telehealth and the rural health liaison at the Department of Agriculture, would administer the grants.
While lawmakers have cited the stress caused by the current COVID-19 crisis, the farming, forestry and fishing industries have been hard hit by behavioral health issues long before the pandemic – and care providers have sought to use telemedicine and mHealth to help them.
The bill is one of several introduced recently that aims to expand telehealth services and coverage at least through the coronavirus pandemic, if not indefinitely. Advocates are hoping that some might get swept up into the next coronavirus relief bill.
Joining Smith and Rounds as co-sponsors of the bill are Senators Kevin Cramer ((R-ND), John Boozman (R-AR), Susan Collins (R-ME), Ed Markey (D-MA), Cindy Hyde-Smith (R-MS) and Michael Bennet (D-CO).
Congress and CMS are being inundated with requests to make permanent telehealth guidelines enacted to expand coverage during the coronavirus pandemic. Here’s a rundown of what they’re requesting.
– The ongoing coronavirus pandemic has pushed telehealth and mHealth to center stage as healthcare providers of all sizes look to provide care on virtual platforms. But the emergency – and the legislative and policy measures enacted to deal with it – won’t last forever.
So what happens to telehealth then? What does this impending “new normal” hold for connected health?
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
With telehealth adoption at record levels and both providers and patients calling for continued coverage, federal and state governments are under pressure to make those emergency measures permanent. Congress is under particular pressure to pass laws expanding telehealth coverage, and the Centers for Medicare & Medicaid Services has signaled a willingness to review and likely revise its guidelines for Medicare and Medicaid coverage.
This Wednesday, the Senate Committee on Health, Education, Labor and Pensions (HELP) is conducting a hearing on telehealth lessons learned during the pandemic. The committee is scheduled to hear from Joseph Kvedar, president of the American Telemedicine Association (ATA) and a digital health expert with Boston’s Partners HealthCare Network; Karen S. Rheuban, director of the Karen S. Rheuban Center for Telehealth at the University of Virginia and a past ATA president; Andrea Willis, senior vice president and chief medical officer with BlueCross BlueShield of Tennessee, one of the first payers in the nation to make telehealth coverage permanent; and Sanjeev Arora, founder and director of the Project ECHO Institute at the University of New Mexico Health Sciences Center.
In addition, 29 Senators sent a letter to Congressional leadership this week asking that telehealth provisions in the CONNECT for Health Act and included in recent COVID-19 emergency measures be made permanent.
“Americans have benefited significantly from this expansion of telehealth and have come to rely on its availability,” the letter, dated June 15, reads. “Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic. Doing so would assure patients that their care will not be interrupted when the pandemic ends. It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.”
Here’s what a few of the experts and advocates are saying about specific connected health measures that should be extended.
“Before the pandemic, Medicare fee-for-service coverage of telehealth services was extremely restrictive, with limitations for rural locations, originating sites, eligible practitioners and services, and qualifying technology,” says Thomas J. Ferrante, senior counsel at the Foley & Lardner law firm. “The CARES Act allowed CMS to temporarily remove these requirements under broad waivers.”
Ferrante says both CMS and Congress will need to act.
“For example, removing the requirement that the patient be located in a qualifying originating site will require Congress to pass legislation amending the current statutory requirement,” he says. “Conversely, the amount of payment for telehealth services, and the specific CPT codes that will be paid by Medicare, can be adjusted by CMS without the Legislature’s approval.”
Ferrante notes that telehealth coverage has long faced an uphill battle, particularly with Medicare, because there hasn’t been enough evidence to prove the utilization improves clinical outcomes and drives down costs. Advocates are hoping to see that proof in how telehealth has been used during the pandemic, and US Rep. Robin Kelly has sponsored a bill calling for such a study – but that study wouldn’t be due back to Congress until the end of 2024, likely well after the bloom has faded and the momentum has waned.
“Notwithstanding, such opponents’ arguments, telehealth has become popular enough, and enough information may be gleaned from this pandemic experiment to garner the requisite bipartisan support,” Ferrante says. “Healthcare industry stakeholders should write and lobby members of Congress to make some telehealth waivers permanent through the next round of major coronavirus legislation under consideration. Similarly, stakeholders should provide their comments during the next release of proposed rulemaking by CMS.”
Nadia de la Houssaye, a partner with the Jones Walker law firm, says Congressional action on CMS’ telehealth coverage is “long overdue and critically important.” In particular, she’s looking at CMS guidelines that limit telehealth to rural areas and don’t allow coverage for telehealth in clinics, health centers or the patient’s home.
“Telehealth reimbursement should not be limited to a patient’s geographical location,” she notes. “CMS’ prompt action to lift originating site barriers played a significant role in provider adoption and usage of telehealth in the midst of COVID-19. …. All Medicare beneficiaries should have equal access to covered healthcare benefits, regardless of where and how care is delivered. Permanent removal of CMS’ pre-pandemic geographic and reimbursement barriers will ensure better and more affordable care to our nation’s most vulnerable population – the elderly and disabled.”
Four other topics are on de la Houssaye’s radar as well:
State licensure barriers: “State licensure laws have long been one of the greatest barriers to interstate telehealth expansion,” she says. “Not only is the licensure process expensive, timely and onerous, (but) regulations and policies vary across state lines. Post-COVID-19, re-evaluation at the state and federal level must occur to eliminate state licensure barriers.”
Options include have a state waive its licensure requirement if a provider has a license in another state, creating cross-border licensure waivers with neighboring and/or rural states or making the Interstate Medical Licensure Compact nation-wide—though joining the compact expedites licensure but doesn’t eliminate all barriers.
At the federal level, de la Houssaye suggests legislation designating the provider’s location as the location in which care takes place for the purposes of licensure and payment. “Though states will likely resist such federal legislation, state licensing boards will nevertheless maintain control over issuing provider licenses located in the state, while allowing providers to treat patients remotely in other states,” she says. “Additionally, Congress could re-visit the TELE-MED Act of 2015, which would permit Medicare providers who are licensed in one state to provide telehealth services to Medicare patients across state lines and without the need for additional state licenses. Though removal of state licensure barriers will not happen overnight, it is essential to the future of telehealth.”
Broadband internet access: “Without fast and reliable access to high-speed broadband, telehealth is limited,” de la Houssaye points out. “To deliver on telehealth’s potential, adequate bandwidth must be available throughout the continuum of care. Congress and the FCC have accelerated efforts to address this infrastructure barrier through significant grant funding initiatives, including the COVID-19 Telehealth Program and the three-year Connected Care Pilot program. This federal funding not only recognizes the essential role telehealth will play post-pandemic, but more importantly the critical need for an infrastructure that will support its use.”
HIPAA, data security and privacy: “To protect patient privacy, it is important that HIPAA and data security measures return to post-pandemic levels and that emerging new technology platforms abide by these established regulations and standards,” de la Houssaye says. “Not only must platforms contain the requisite security measures, providers must be reminded that it is unacceptable to engage in a telehealth encounters in public or with family members in the same room.”
De la Houssaye has the anecdotes to back up those concerns. She says she’s seen a physician conducting a virtual visit while shopping at Target, and talked on the phone with a woman who had to speak softly to avoid disrupting her physician-husband’s telemedicine session in the living room.
Private payer reimbursement: de la Houssaye notes that states have enacted vastly different guidelines for private payer coverage. “State and federal action is needed to incentivize providers to continue telehealth usage post-pandemic,” she says. “While the federal government can promote telehealth by setting minimum coverage and reimbursement standards for Medicaid, state insurance regulators, Medicaid agencies and medical boards can all change rules for practice, coverage and reimbursement to promote greater use of telehealth services for those not insured through federal programs.”
Additionally, post-COVID-19 is a good time to evaluate alternative payment models that reward value in the remote delivery of services, rather than traditional fixed fee reimbursement,” she concluded.
Carrie Nixon, a healthcare innovation attorney and managing partner of the Nixon Law Group, sees two potential courses of action:
Incentivize provider adoption and implementation of telehealth and remote patient monitoring programs through a two-pronged approach. First, she says, Congress should pass legislation establishing a pool of funds available to providers across the entire spectrum of care, public and private, for exactly this purpose (similar to the HITECH Act). Second, CMS should use the carrot-and-stick approach under MACRA’s Quality Payment Program, making implementation of a virtual care program a high-weighted “Improvement Activity” metric for providers in the MIPS track, and a requirement for all participants in the Advanced Alternative Payment Model track.
Finalize proposed changes to the fraud and abuse landscape to allow telehealth, RPM and other digital health companies to enter into previously prohibited business arrangements with providers to facilitate the transition to a true value/outcomes based model of delivery and reimbursement. For example, Nixon says, the proposed Patient Engagement and Support safe harbor should be finalized, allowing RPM companies to provide incentives to patients for adhering to their RPM program by taking a certain number of readings per month. And the proposed Care Coordination Arrangements safe harbor should be finalized to allow “in-kind remuneration” like sharing of staff between a provider and a vendor for RPM monitoring, allowing a vendor to provide devices to be used in conjunction with its telehealth platform for free to providers and others.
Also weighing in are government agencies like the Federal Trade Commission, which sent a letter in May to CMS listing six telehealth directives that should be extended beyond the pandemic.
“Telehealth can potentially increase the supply of accessible practitioners and thereby enhance price and non-price competition, reduce transportation expenditures, and improve access to and choice of quality care,” the letter stated. “Many experts consider reducing restrictions on Medicare reimbursement of telehealth services especially important for fulfilling telehealth’s potential, not only because Medicare places substantial limitations on using telehealth services, but also because Medicare influences the reimbursement policies of state Medicaid programs and private payers.”
In addition, the ATA sent a letter to Congressional leadership in May outlining funding and policy changes that should be part of the next coronavirus relief package, with the goal of extending telehealth freedoms long past the current crisis.
The ATA’s letter listed nine recommendations:
Expand the Federal Communications Commission’s $200 million COVID-19 Telehealth Program to include for-profit hospitals and health systems and others not included in the pool, and add another $300 million to the pot.
Expand the FCC’s Health Care Connect Fund Program to include public, non-profit entities.
Increase funding for the Health and Human Services Department’s Public Health and Social Services Emergency Fund.
Provide a payroll tax credit for COVID-19 hospital facility expenditures, which often include the purchase of telemedicine equipment and additional telehealth training.
Amend Medicare Part B cost sharing to increase flexibility for telehealth use.
Have HHS forge an agreement with at least one eligible organization to collect, analyze and report on telehealth, digital health and remote patient monitoring metrics. That group should partner with stakeholders to analyze utilization, cost, access, experience data and identified structural and policy barriers to care.
Incorporate telehealth and RPM platforms into the National Health Security Strategy.
Prioritize telehealth policy and elevate the Office for the Advancement of Telehealth, which is currently categorized under the Office of Rural Health Policy in the Health Resources and Services Administration.
Address outdated 1834(m) restrictions on telehealth, perhaps by enacting the CONNECT Act for Health (S.2741 and HR.4932).
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
By 
By 