Nearly everyone is talking about telehealth these days because of its increasing popularity over the last few months in light of the COVID-19 pandemic and honestly, it’s about time.
While telehealth is not new by any means, utilization has dramatically increased in large part due to policymakers waiving longstanding restrictions that impeded the practice. At the federal level, CMS has provided a great deal of flexibility to Medicare providers by using the additional section 1135 waiver authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).
Some of these flexibilities and other actions CMS has taken to increase access to telehealth during the ongoing public health emergency include:
- Waiving originating site restrictions
- Allowing additional provider types to bill for telehealth
- Expanding the types of services that can be offered via telehealth
- Forgoing requirements to have an established provider-patient relationship to furnish telehealth services
- Allowing for reimbursement of audio only services conducted via phone
Moreover, CMS has offered additional guidance to Medicare Advantage plans allowing them to waive cost sharing for telehealth and to states on how to leverage telehealth in Medicaid fee-for-service. The agency has also compiled a list of policies to consider as states try to expand telehealth in Medicaid and CHIP.
On the state side of things, the Center for Connected Health Policy has compiled a list of state actions related to telehealth, some of which I discussed in a previous blog. Most of these activities fall in the general categories of expanding access to telehealth, parity in reimbursement, expediting the credentialing process and allowing for other ancillary providers to provide telehealth services.
So, while there are concerns that the ongoing pandemic is not over, I do think it’s important we start thinking about what the world of telehealth, telemedicine, virtual care, digital health, or whatever else you want to call it, might look like in the future.
First, while CMS has indicated they would like to maintain some of the new flexibilities, not all of the power lies with them. As my colleague Aaron recently noted, Congress must act to ensure these new flexibilities remain because a number of barriers to telehealth, particularly with respect to Medicare, are found in existing statutes.
So, where exactly do we go from here?
There seems to be good bipartisan energy in Congress to pass legislation to make some of the new telehealth flexibilities permanent as indicated by a recent letter to Senate leadership. On the state side of things, Idaho’s governor issued an executive order to maintain more than 150 emergency orders and thereby permanently loosen regulations on telehealth. I expect other states to follow suit.
But, as with anything in government, if people do not prioritize what needs to get done first, the public health emergency will end, and we will be back to where we started.
Personally, I think one of the first things Congress should do is take up legislation to make originating site restrictions a thing of the past. To me, that is one of the most dated barriers in place today. Limiting the use of telehealth to beneficiaries living in a defined rural area completely discounts the value that telehealth can offer in urban communities. And, while telehealth historically has been considered as a means to alleviate access issues for those that lack providers in close geographical proximity, we’ve seen more recently that it can also offer access to safe, convenient care without leaving the comfort of one’s home.
Guess it’s a good thing after all that telehealth just might stick around after the pandemic ends.
To check out other policy considerations for telehealth in the post-pandemic world, click here.