July 21, 2021

7 min read

Future of Telehealth: 6 Pieces of Federal Legislation We're Watching

There are currently dozens of telehealth bills in Congress. As is the case with most pieces of federal legislation, a majority of these bills will go nowhere. However, some have the potential to become law and significantly reshape or at least affect the rules concerning the delivery and coverage of telehealth services.

In no particular order, here is background information on six pieces of pending federal telehealth legislation that we're watching closely because of the momentum building for them.

1. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021

Reintroduced: April 29, 2021 (originally introduced 2016)

Primary sponsor: Brian Schatz (D-HI)

Number of cosponsors: 59 (including 49 original) as of June 21, 2021

Summary: This bill would expand access to telehealth services on a permanent basis, support healthcare providers and beneficiaries in utilizing telehealth, enhance telehealth oversight, and gather more data on the impact of telehealth. As mHealth Intelligence summarizes, it would:

  • Permanently remove all geographic restrictions on telehealth
  • Expand the list of originating sites to include the home and other sites
  • Allow federally qualified health centers (FQHCs) and rural health clinics (RHCs) to provide telehealth services beyond the pandemic
  • Give the HHS Secretary the authority to waive telehealth restrictions
  • Mandate studies of how telehealth has been used during the pandemic and the effectiveness of telehealth waivers
  • Encourage the Centers for Medicare & Medicaid Services (CMS) Innovation Center to test more payment models that include telehealth

Key Takeaways for Providers: This bill would essentially continue many of the telehealth waivers and allowances that were implemented for the COVID-19 health emergency while giving HHS the ability to regulate and determine federal coverage for telehealth going forward. Providers could continue to provide Medicare audio/visual telehealth visits with coverage similar to the coverage under the COVID-19 waiver.

2. Protecting Access to Post-COVID–19 Telehealth Act of 2021

Reintroduced: Jan. 19, 2021 (originally introduced 2020)

Primary Sponsor: Mike Thompson (D-CA)

Number of co-sponsors: 42 (including five original) as of June 21, 2021

Summary: This bill would make permanent several telehealth flexibilities that were initially authorized during the COVID-19 public health emergency, particularly with respect to Medicare coverage of telehealth services. This would include the following:

  • Allow FQHCs and RHCs to serve as the distant site for telehealth services under Medicare
  • Authorize payment in the same manner as for non-telehealth services rather than in accordance with a separate methodology determined by CMS
  • Allow beneficiaries to receive Medicare telehealth services at any site, regardless of type or location

The American Telemedicine Association (ATA) is one of the organizations that has come out in support of the legislation. Ann Mond Johnson, ATA CEO, stated, "This legislation is an important step towards breaking down discriminatory geographic restrictions and adding a flexibility for the HHS Secretary to include additional originating sites. Effectively and permanently addressing health disparities is urgently needed — and telehealth can bridge existing gaps to provide care to patients in rural and underserved communities, when and where they need it."

Key Takeaways for Providers: This bill would continue a smaller subset of the telehealth waivers as compared to other bills under consideration, which may explain its greater support. It focuses on telemedicine (audio/visual provider visits) and removes the restrictions imposed in the law so that HHS can regulate coverage requirements.

3. KEEP Telehealth Options Act of 2021

Reintroduced: March 9 and March 15, 2021 (originally introduced in 2020)

Primary sponsors: Troy Balderson (R-OH) in the House, Deb Fischer (R-NE) in the Senate

Number of cosponsors: 11 (including 8 original) in the House and 1 cosponsor (original) as of June 21, 2021

Summary: The bill would require HHS, Medicare Payment Advisory Commission (MedPAC), and Medicaid and CHIP Payment and Access Commission (MACPAC) to study the expansion and usage of telehealth services during the pandemic and issue a report to Congress with recommendations for enhancing the quality of and access to these services.

As Rep. Balderson noted in a news release, "For many rural and low-income Ohioans, this shift to telehealth has been beneficial, breaking down previous barriers for them to access quality care. By permanently expanding telehealth services, we can level the healthcare playing field for years to come."

Key Takeaways for Providers: This bill would mandate the development of a report to show the efficacy (or lack thereof) of the COVID-19 telehealth waivers to help Congress consider expansion in the future.

4. Telehealth Modernization Act

Reintroduced: February 23 and 25, 2021 (originally introduced in 2013)

Primary sponsors: Tim Scott (R-SC) in the Senate, Earl Carter (R-GA) in the House

Number of cosponsors: 11 (including 6 original) in the Senate and 55 (including 7 original) in the House as of June 21, 2021

Summary: This bill would modify the requirements for Medicare coverage of telehealth. More specifically, it would extend select flexibilities initially authorized during the pandemic, including permitting FQHCs and RHCs to serve as the distant site, the home of a beneficiary to serve as the originating site for all services, and all practitioner types of to furnish telehealth services, as determined by CMS.

The ATA was again one of the organizations supporting the legislation, with Mond Johnson stating, "Even under the most extraordinary circumstances of the COVID-19 public health emergency, telehealth services have proven to consistently deliver high-quality, safe, and effective care to rural and underserved communities and our most vulnerable patients. … Access to telehealth is no longer an option in today's society, it is an essential component of care delivery."

Key Takeaways for Providers: This bill also focuses on the geographic restrictions for audio/visual telemedicine visits under Medicare versus telehealth in general. It would allow providers to furnish telemedicine visits from FQHCs and RHCs, but not necessarily most doctors' offices or clinics.

5. Expanded Telehealth Access Act 

Reintroduced: March 23, 2021 (originally introduced in 2020)

Primary sponsor: Mikie Sherrill (D-NJ)

Number of cosponsors: 35 (including 15 original) as of June 21, 2021

Summary: This bill would permanently expand the list of the providers eligible for Medicare telehealth reimbursement. During the pandemic, CMS has expanded the types of healthcare providers who receive Medicare reimbursement for telehealth services. The legislation would make permanent reimbursement eligibility for physical therapists, audiologists, occupational therapists, and speech language pathologists while also permitted the HHS Secretary to further expand the list.

Rep. Sherrill said in a news release, "The use of telehealth services during this crisis has demonstrated the critical role technology can play in improving health equity. No one should have to go without care when a video or phone conversation with a healthcare provider could mean quicker, safer medical attention."

Key Takeaways for Providers: This bill focuses on who can provide telemedicine visits and telehealth services. It would keep physical therapists, speech language pathologists, and other non-physician providers of medical services on the list of those who can provide their services over audio/visual technology.

6. Protecting Rural Telehealth Access Act

Reintroduced: June 9, 2021

Primary sponsor: Joe Manchin (D-WV)

Number of cosponsors: At least 2 (original) as of June 21, 2021

Summary: This bill would make some current telehealth flexibilities permanent and is intended to better ensure rural and underserved community healthcare providers can continue offering telehealth services after the current pandemic public health emergency ends. A press release on the bill summarizes its most significant changes as follows:

  • Allow payment-parity for audio-only health services for clinically appropriate appointments. Note: This is important as many rural Americans still lack reliable, affordable broadband access.
  • Permanently waive the geographic restriction allowing patients to be treated from their homes
  • Permanently allow FQHCs and RHCs to serve as distance sites for providing telehealth services
  • Lift the restrictions on "store-and-forward" technologies for telehealth. Note: This is currently only permitted in Hawaii and Alaska.
  • Allow critical access hospitals (CAHs) to directly bill for telehealth services

As Rep. Manchin states in the release, "When we began to see the light at the end of the tunnel for the COVID-19 pandemic, we immediately recognized the importance of making these telehealth flexibilities permanent. Our bill ensures that rural telehealth providers can give rural Americans the quality care they deserve by eliminating restrictions on the use of telehealth options and ensuring doctors can be reimbursed for services they provide to patients from the comfort of their homes."

Key Takeaways for Providers: This bill is similar to the others above that eliminate the geographic restrictions of where providers and patients must be in order for telemedicine visits to be reimbursable, but it goes one step further in allowing audio-only (i.e., over-the-phone) telemedicine visits following the conclusion of the health emergency.

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