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Katie Adams

The White House, CMS and other federal agencies have been issuing new policies and grants to expand telehealth access and use during the COVID-19 pandemic.

Below is a list of updated policies, grants and other actions taken to support telehealth in response to COVID-19.

March 6: President Donald Trump signed an $8.3 billion emergency funding bill in response to the coronavirus outbreak, including $500 million in waivers for Medicare telehealth restrictions. The benefits expanded telehealth coverage to all Medicare beneficiaries regardless of location. CMS previously restricted payment for communication technology to beneficiaries in rural areas.

March 13: President Trump declared a national emergency over the pandemic, which allowed HHS to waive federal licensing regulations to permit out-of-state physicians to treat patients via telehealth in states with large COVID-19 outbreaks.

March 17: President Trump further expanded telehealth capabilities for Medicare beneficiaries, allowing them to have common office visits, mental health counseling and preventive healthcare screenings via telehealth.

The president also announced his administration will not enforce HIPAA penalties and suggested allowing providers to virtually communicate with patients via their personal phones. This allows providers to use platforms such as Apple FaceTime, Zoom and Skype to perform telehealth visits with patients.

March 20: The FDA issued a new policy allowing manufacturers to expand their use of remote monitoring devices so healthcare providers can issue them to patients during the pandemic. The expansion included noninvasive vital sign measuring devices that capture body temperature, respiratory rate, heart rate and blood pressure.

The agency also issued an alert that it has not authorized any direct-to-consumer coronavirus testing kits despite multiple telehealth startups marketing the technology. The FDA said the tests may “pose serious health risks.”

March 24: CMS said it will not enforce any health insurance issuer that changes their health insurance policy mid-year to offer greater coverage for telehealth services or reduce cost-sharing requirements for telehealth. It said it would, however, continue to take enforcement action against any health insurer that tries to limit or eliminate other benefits to offset the costs of increased telehealth benefits.

On the same day, CMS also said it will not take enforcement action against any health insurance issuer that alters its emergency plans to provide pre-deductible coverage for telehealth services when a national emergency declaration is in effect.

March 27: Congress approved a $2 trillion COVID-19 relief package, which allocated $185 million to support telehealth programs for rural critical access hospitals. The stimulus package also expanded Medicare telehealth coverage and reimbursement to kidney dialysis providers.

March 30: CMS added an additional 85 services covered for Medicare when provided via telehealth, including emergency department visits and initial nursing facility and discharge visits. Physicians were also given permission to evaluate Medicare beneficiaries using any type of telephone.

April 2: The Federal Communications Commission voted to adopt a COVID-19 relief program providing $200 million to equip healthcare providers with telehealth technology and implementation support. Hospitals and health centers were eligible to apply for up to $1 million through the program to cover costs for internet-connected monitoring devices, broadband connectivity and telecommunication services.

The agency also approved the three-year Connected Care pilot program, which uses $100 million of the agency’s main budget to promote telehealth services. The program is for providers working on projects for broadband connectivity, network equipment and information services.

April 9: CMS loosened more regulations to increase the healthcare workforce, including immediately allowing physicians to care directly for patients at rural hospitals across state lines via phone, radio or online communication. 

April 11: The Trump administration issued new guidance that implemented the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act, requiring private health plans and employer group plans to cover COVID-19 testing with no extra costs. The coverage requirement waived cost-sharing for telehealth visits, urgent care visits and emergency room visits that result in a COVID-19 test order. 

April 16: The Federal Communications Commission approved its first wave of applications for its COVID-19 telehealth program. It gave more than $3 million to six providers, including Mount Sinai Health System in New York City, UPMC in Pittsburgh and Ochsner Clinic Foundation in New Orleans.

Under the $200 million program, part of the $2 trillion CARES Act, hospitals and health centers can apply for up to $1 million to cover costs for internet-connected monitoring devices, broadband connectivity and telecommunication devices. 

April 21: The FCC approved its second wave of COVID-19 telehealth program applications, funneling $3.7 million to five providers — including NYU Langone Health in New York City and University of Michigan Hospital in Ann Arbor. 

April 22: HHS awarded nearly $165 million to support 1,779 rural hospitals and provide additional funding to 14 Health Resources and Services Administration-funded telehealth resource centers. With the funds, the telehealth resource centers could extend technical assistance to rural and underserved areas for telehealth services in response to the COVID-19 pandemic.

HRSA’s Federal Office of Rural Health Policy also announced plans to use $11.5 million from its $150 million in funding through the CARES Act to support telehealth efforts. FORHP said it would award 14 telehealth resource centers the $11.5 million to provide hands-on telehealth support for areas including technical equipment, payment policy, system design, and licensing and credentialing.

April 23: The Trump administration released a toolkit that offers resources and guidance to help states expand telehealth coverage policies for Medicaid and Children’s Health Insurance Programs during the COVID-19 pandemic. 

On the same day, the FCC approved its third wave of COVID-19 telehealth program applications. The agency gave $2.56 million to six providers.

April 29: The FCC approved its fourth wave of COVID-19 telehealth program applications. The agency granted $4.2 million to 13 providers, including Rochester, Minn.-based Mayo Clinic.

April 30: CMS further expanded telehealth access and services for Medicare beneficiaries during the pandemic, allowing clinical practitioners — including physical therapists, occupational therapists and speech language pathologists — to deliver telehealth services. Before the update, only physicians, nurse practitioners and physician assistants could provide telehealth services.

Hospitals were also permitted to bill for services delivered remotely by hospital-based practitioners to Medicare patients. They were also allowed to bill as the originating site for telehealth services delivered by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home.

CMS also expanded its list of audio-only telephone services covered by Medicare, including various behavioral health and patient education services. CMS also increased payments for telephone visits between beneficiaries and their clinicians to match payments for similar office and outpatient visits.

The agency also changed its rule-making process, adding new telehealth services to the list of Medicare coverage on a sub-regulatory basis. CMS also waived the video requirement for certain telephone evaluation and management services covered under Medicare and paid for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.

On the same day, HHS awarded $20 million to increase telehealth access and infrastructure in response to the COVID-19 pandemic for providers including the American Academy of Pediatrics and the University of North Carolina at Chapel Hill.

May 6: The U.S. Department of Agriculture awarded $71 million to provide broadband service to underserved rural areas in Kansas and Oklahoma.

On the same day, the FCC approved its fifth wave of COVID-19 telehealth program applications, funneling $11.19 million to 26 providers including New York City-based Mount Sinai Hospital and Baltimore-based Kennedy Krieger Children’s Hospital.

May 13: The FCC approved its sixth wave of COVID-19 telehealth program applications, allotting $8.36 million to 33 healthcare providers.

May 20: The FCC approved its seventh wave of COVID-19 telehealth program applications, issuing $16.87 million to 43 healthcare providers nationwide, such as Yale New Haven (Conn.) Hospital.

May 22: CMS finalized a rule to encourage Medicare Advantage plans to increase telehealth benefits and plan options for beneficiaries in rural areas. The rule gives the plans flexibility to count telehealth providers in some specialty areas, including dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology and infectious disease, toward meeting CMS network adequacy standards.

May 28: The FCC approved its eighth wave of COVID-19 telehealth program applications, granting $68.22 million to 53 healthcare providers nationwide. University Hospitals Cleveland Medical Center and Philadelphia-based Temple University Hospital were among the round’s awardees.

May 29: The Federal Trade Commission sent a letter to CMS in support of broad access to telehealth for beneficiaries permanently. 

June 1: U.S. Rep. Robin Kelly, D-Ill., introduced legislation that would require the HHS secretary to conduct a widespread study on the effectiveness of telehealth before relaxed policies are rescinded. The Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020 calls for the study to collect nationwide data on the number of telehealth visits, the healthcare facilities providing telehealth and what services patients received.

June 3: The FCC approved its ninth wave of COVID-19 telehealth program applications, awarding another $16.46 million to 53 healthcare providers.

June 10: The FCC approved its 10th wave of COVID-19 telehealth program applications, awarding another $20.18 million to 67 healthcare providers. New York City-based NYC Health + Hospitals and Chicago-based Northwestern Memorial HealthCare both received $1 million.

June 17: The Senate Health, Education, Labor and Pensions Committee expressed support to make certain telehealth Medicare policies that were expanded during the COVID-19 pandemic permanent. 

On the same day, the FCC approved its 11th wave of COVID-19 telehealth program applications, granting another $23.25 million to 62 healthcare providers across the country. Baptist Hospital of Miami, New York City-based Maimonides Medical Center and Marshfield (Wis.) Medical Center all received $1 million.

June 24: The FCC approved its 12th wave of COVID-19 telehealth program applications, granting another $29.41 million to 77 healthcare providers. Fort Lauderdale, Fla.-based Broward Health Medical Center and New York City-based NewYork Presbyterian-Queens both received $1 million.

June 25: The House of Representatives introduced the Advancing Telehealth Beyond COVID-19 Act, a bill calling for the permanence of telehealth regulations introduced in the CARES Act.

July 1: The FCC approved its 13th wave of COVID-19 telehealth program applications, granting another $31.63 million to 70 healthcare providers. New York City-based BMS Family Health and Wellness Centers, New York City-based Montefiore Medical Center and University of Alabama at Birmingham all received $1 million.

July 2: Thirty-five senators signed a letter to HHS and CMS, urging the agencies to release details about its plans for telehealth since regulations were lifted during the coronavirus pandemic.

July 6: CMS released its telehealth guidance for electronic clinical quality measures for telehealth-eligible clinicians in 2021, listing 39 telehealth-eligible eCQMs for the next reporting period.

July 8: The Department of Veterans Affairs awarded Philips a 10-year, $100 million contract to expand the VA’s critical care telehealth program. The contract allows the VA to invest up to $100 million in tele-critical care technology and services, such as diagnostic imaging, sleep solutions and patient monitoring.

On the same day, the FCC approved the 14th and final wave of COVID-19 telehealth program applications, allotting another $10.73 million to 25 healthcare providers. Sacramento-based California Telehealth Network and Portland, Ore.-based OCHIN both received $1 million.

July 16: A group of bipartisan lawmakers introduced a bill, called the Protecting Access to Post-COVID-19 Telehealth Act, in the U.S. House, aiming to protect telehealth expansions in Medicare that were made during the coronavirus pandemic. 

On the same day, President Trump said during a news briefing that telemedicine is a top priority for his administration and that he is working to make the temporary regulatory changes permanent. “I have ordered federal agencies to look for ways to make these healthcare reforms totally permanent,” he said.

Aug. 3: President Trump signed an executive order to expand access to telehealth services in rural communities and make certain services permanent once the COVID-19 public emergency ends. 

Aug. 6: U.S. Sens. Joe Manchin, D-W.Va., and John Cornyn, R-Texas, introduced a bill that would allocate $400 million to restart the FCC’s COVID-19 telehealth program.

Aug. 10: The Trump administration launched an initiative to make 5G more accessible across the U.S. One hundred megahertz of contiguous, coast-to-coast mid-band spectrum was made available for commercial 5G deployment.

Aug. 19: The White House announced that it had asked private insurers to sign a pledge that would extend telehealth benefits to members over the long term. A press release stated that the White House launched the Pledge to Embrace Technology to Advance America’s Health, an initiative asking health insurers to expand flexible and affordable telehealth options, about a week earlier during a virtual roundtable discussion on technology and telehealth.

Aug. 20: HHS awarded more than $35 million to more than 50 rural healthcare organizations across 33 states. The funding will be used to develop telehealth programs, train healthcare employees, conduct clinical research, advance HIV care and provide technical support for rural healthcare providers.

On the same day, a group of 14 Democratic senators penned a letter to FCC chairman Ajit Pai detailing what they say is the agency’s failure to manage the Rural Health Care Program and COVID-19 Telehealth Program. In the letter, the senators said that FCC “has not made sufficient funding available, has delayed rural healthcare funding decisions, and has not been transparent about its operations,” regarding both the COVID-19 telehealth program, which launched in March, and the 1996-established Rural Health Care Program, which was updated in 2018 to provide more money for projects to increase broadband connectivity in rural areas of the country. 

Sept. 1: HHS, FCC and USDA signed a memorandum of understanding to collaborate on efforts to improve telehealth services and address health disparities in rural areas. The Rural Telehealth Initiative ultimately aims to use telehealth to supplement gaps in the healthcare system for rural Americans, who have been affected by hospital closures and lack of specialty care.

Sept. 3: HHS released the Rural Action Plan, an agencywide assessment of current and upcoming rural healthcare efforts, including increasing technology and innovation via telehealth expansions. Eighteen HHS agencies and offices collaborated to develop the plan, which includes 71 new or expanded activities for fiscal year 2020 and beyond. 

On the same day, the FCC published details on its $100 million Connected Care Pilot Program, which aims to enhance telehealth access for low-income Americans and veterans. The agency first introduced the Connected Care program in 2018, but it released additional details for the program as well as application instructions.

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