Congress Seeks Legislative Fix to Medicare Telehealth Restrictions

| Brittany McCullough
graphic representing the many different aspects of digital health

Now that the public health emergency (PHE) related to COVID-19 has been extended for another 90 days, health plans, providers and patients alike can breathe a small sigh of relief about transitioning back to pre-COVID times. You may recall that CMS has granted additional flexibilities related to telehealth for the duration of the PHE as I’ve previously discussed. However, for these flexibilities to last, Congress has to remove some of the longstanding statutory restrictions that prevent telehealth from being used more broadly in Medicare.

Well, the Congressional Telehealth Caucus has responded to the outcry from the public for Congress to act by recently introducing a bill entitled “Protecting Access to Post-Covid-19 Telehealth Act” (HR 7663).  Some of the language might look familiar because it resembles the CONNECT for Health Act, another bill largely developed by the Telehealth Caucus, that was introduced in both 2016 and 2017.

According to the press release for this latest measure, HR 7663 is a bipartisan bill and is meant to “continue the expanded use of telehealth beyond the Coronavirus pandemic by eliminating restrictions on the use in Medicare.”

Here are some key provisions in the bill:

  • Permits HHS Secretary to waive or modify telehealth requirements under §1834(m)(1) of the Social Security Act (SSA) during an emergency declaration by the President or PHE declaration by the Secretary
  • Authorizes CMS to continue to reimburse for telehealth services 90 days past the conclusion of a PHE
  • Eliminates most originating and geographic site restrictions
  • Requires the CMS Administrator to submit a report to Congress regarding any waiver or modification of telehealth requirements and detail the following:
    • Number of eligible individuals to receive telehealth services and utilization data broken out by racial/ethnic background
    • Number of practitioners that furnished telehealth services and accompanying frequency
    • Amounts payable for telehealth services
    • An assessment of benefits to eligible individuals who received telehealth services
    • Most common barriers to eligible individuals receiving and practitioners furnishing telehealth

So, what does this actually mean?

Well, §1834(m)(1) of the SSA outlines Medicare reimbursement policies for telehealth services and is the source of originating and geographic site restrictions. Under current requirements, telehealth is only reimbursed in instances in which the eligible individual receiving services is in a defined rural locale such as a health professional shortage area. Additionally, payment is restricted to certain originating sites which generally preclude service from occurring while the beneficiary is at home.

Some states like New Hampshire have already permanently extended the additional flexibilities afforded to telehealth in response to COVID-19 such as modifying originating and distant site requirements, ensuring payment parity with Medicaid and commercial insurers, and expanding the list of providers that may furnish telehealth services.

While I think there is merit to the latter two, I don’t see Congress taking on these items just yet. I think the “easier” path (and quotations because getting anything through Congress is rarely easy) is to take up the issue of expanding providers able to bill for telehealth and the list of covered telehealth services to resemble something akin to Medicare Advantage.  Of course, getting Congress to do something more notable might prove hard in an election year but, my fingers are crossed that they can get something done.

Brittany McCullough photo

Brittany McCullough, Manager, Health Policy and Government Programs.

Brittany McCullough, URAC's Manager of Health Policy and Government Programs, tracks and analyzes legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external affairs portfolio and oversees compliance with government deemed programs. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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