Congress Considers the Future of Telehealth

"Providers and patients like telehealth, so let's do our best not to mess this up.”  This sentiment, expressed by Indiana Congressman Larry Bucshon, pretty well summarizes the discussion that took place at a recent bipartisan House hearing focused on the post-pandemic future of telehealth.

Telehealth and COVID-19 Public Health Emergency 

Just over a year ago, before the COVID-19 public health emergency (PHE) began, only 15,000 Medicare beneficiaries were receiving telehealth services each week. Then, the pandemic hit, the Centers for Medicare and Medicaid Services (CMS) made a series of emergency regulatory changes, and the world shifted towards virtual care. In April 2020, nearly half (43.5 percent) of Medicare FFS primary care visits were provided through telehealth. By last October, over 24 million seniors had participated in a virtual visit.

This rapid expansion in telehealth services was driven both by the necessity of virtual care during the pandemic and by the temporary relaxing of decades-old regulations. For Congress, the job now is to determine what telehealth laws should look like after the pandemic ends and the temporary waivers subside. 

Telehealth After the Pandemic 

With this mission in mind, on March 2, the U.S. House of Representatives Subcommittee on Health of the Committee on Energy and Commerce held a hearing titled, "The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care." The hearing featured testimony from a variety of perspectives across the industry, including officials from the American Medical Association, Harvard Medical School, Medicare Rights Center, Purchaser Business Group on Health, and Stanford Health. 

Key issues discussed during the hearing included:

• Permanently eliminating geographic and originating site restrictions.  Outside of the PHE, Medicare telehealth services are only available to patients residing in rural geographic areas.  Furthermore, patients cannot receive telehealth services at home.  Instead, they must be physically present at an approved healthcare facility in order to virtually see an approved provider at another location. Because these restrictions are so limiting, many lawmakers are pushing for legislation to permanently eliminate these geographic and originating site restrictions. If passed into law, this would permanently expand Medicare telehealth services to cover patients in all geographic areas and allow patients to receive these services at home. 
• Reimbursement and payment parity issues.  During the PHE, Medicare is reimbursing telemedicine visits at the same payment rates as in-person office visits.  But outside of the PHE, telehealth services are reimbursed at a lower payment rate (the facility rate tied to the place of service (POS) code for telehealth services.) For Congress, the question is in the long-term how should telehealth visits be reimbursed in comparison to in-person office visits? 
• Audio-only or telephone visits.  Typically, a Medicare telehealth service requires a patient and provider to interact via live audio and video technology. However, during the PHE, CMS waived the video requirement and is allowing certain services to be delivered via audio or phone only.  Furthermore, CMS is reimbursing these audio-only visits at the same rate as in-person office (and video) visits.  At the March 2 hearing, several witnesses argued against payment parity and even coverage for audio-only visits, stressing that phone visits likely offer a lower level of care than video or in-person visits. Others argued in favor of phone visits, noting their important role in extending access to care to as many seniors as possible. Ultimately, Congress will have to decide whether these visits will be covered and if so, at what level of payment compared to video and office visits for similar services.
• State licensing laws.  Physician and provider state licensing laws typically prohibit patients from receiving care from practitioners licensed in another state. For instance, state law does not allow a physician located and licensed only in North Carolina to perform a telehealth consultation for a patient in South Carolina. During the pandemic, most state governments temporarily suspended these licensing requirements; however, those laws will revert back when the emergency ends. Because these state laws impact telehealth not only for Medicare, but also for Medicaid and commercial payers, addressing this issue remains a key obstacle for the long-term future of telehealth.

Beyond these issues, concerns about fraud and abuse and consideration of which medical services should be eligible for telehealth are also key issues that Congress is contemplating.  

Potential Legislation

In late February, bipartisan groups of lawmakers in both the House and the Senate introduced the Telehealth Modernization Act, a bill that would permanently remove Medicare's geographic and originating site restrictions which require a patient to live in a rural area and be physically in a doctor's office or clinic to use telehealth services. With a bipartisan consensus building around removing these restrictions, the bill avoids more controversial telehealth policy issues such as payment parity and interstate licensing.  

There are several other telehealth legislative efforts also underway and the March 2 House hearing played an important part in gathering information and starting to develop a consensus on certain key issues.  With strong bipartisan support for telehealth, it is possible that a bill could pass into law in a matter of months.  On the flip side, Congress can also move very slowly.  But even from a pessimistic standpoint, it is likely that some form of telehealth reform legislation will be passed into law before the end of the public health emergency.  To echo Congressman Buschon, let’s hope they get it right.

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