Right before Christmas, the U.S. Congress approved the Consolidated Appropriations Act of 2023. Within this $1.7 trillion omnibus appropriations bill are a few significant developments affecting telehealth.
Here are three things to know about the telehealth-related laws included in the bill.
1. Medicare flexibilities extended for two years
Most significantly, the new law extends those Medicare telehealth provisions in place since the COVID-19 public health emergency (PHE) was declared in 2020 for two calendar years through 2024. This extension is independent of whether the HHS continues to renew the PHE (which it most recently did on January 11, 2023).
As McDermott Will & Emery notes, the extended provisions include the following:
- Waiving the geographic restrictions and originating site requirements
- Expanding the list of practitioners eligible to furnish telehealth services
- Allowing telehealth services for rural health clinics (RHCs) and federally qualified health centers (FQHCs)
- Allowing for telehealth services through audio-only telecommunications
HealthLeaders notes that the inclusion of the extension on audio-only telecommunications services came as a "nice surprise for telehealth advocates," with the publication going on to state, "Federal and state regulators have long mandated that telehealth services be audio-visual, and have severely restricted any use of the telephone or an audio-only telemedicine platform for care delivery. But during the pandemic the telephone became a popular tool in regions where access to either telemedicine equipment or reliable broadband is limited."
Medicare reaffirmed in the 2023 Medicare Physician Fee Schedule (PFS) rule that, without an act of Congress, it would need to discontinue reimbursement of audio-only evaluation and management (E/M) services after the PHE. That act of Congress came through within the omnibus bill, delaying this discontinuation by at least two years.
2. Safe Harbor for HDHPs to cover telehealth/remote services extended
Also receiving a two-year extension through Dec. 31, 2024, is the safe harbor allowing health savings account (HSA)-qualifying high-deductible health plans (HDHPs) to cover telehealth and remote care services on a pre-deductible basis. Mercer goes on to note, "In addition, an otherwise HSA-eligible individual can receive pre-deductible coverage for telehealth and other remote care services from a standalone vendor outside of the HDHP. In both cases, the pre-deductible telehealth coverage won't jeopardize an individual's eligibility to make or receive HSA contributions."
3. Telehealth to be studied
A new law that could have long-term implications requires HHS to study how telehealth has affected Medicare beneficiaries' health outcomes. In addition, this study will examine whether there are geographic differences in utilization of telehealth. HHS is expected to produce its final report on telehealth outcomes and utilization near the end of 2024.
A Big Year for Telehealth and Remote Care Management
The signing of the omnibus bill capped a significant year for telehealth. The bill itself was largely lauded by telehealth associations, with the American Telemedicine Association's Kyle Zebley saying, "We can think of no greater vote of confidence for telehealth, nor greater reassurance to our beleaguered healthcare providers and the American people, than to have the unwavering bicameral, bipartisan support of Congress and the administration, confirming continued assess to virtual care services through 2024," and the Alliance for Connected Care stating, "Overall, a big win for America’s patients and caregivers. Bravo Congress."
However, these associations also recognize that there is still uncertainty concerning the future of telehealth, with Zebley saying, "…hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the telehealth cliff," according to Healthcare IT News.
One month prior to the passing of the omnibus bill, the Centers for Medicare & Medicaid Services (CMS) issued its 2023 Physician Fee Schedule (PFS) final rule that included its own noteworthy telehealth and remote care rule changes in areas including remote therapeutic monitoring, remote patient monitoring in home health, and chronic pain management. You can learn about these developments in this Medical Economics column and Prevounce on-demand webinar.