As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Congress appropriated significant funding for a number of telehealth programs and initiatives, including funding for programs administered by the Federal Communications Commission (FCC), the Department of Agriculture’s Rural Utility Service (RUS), the Department of Veterans Affairs, the Department of Health and Human Services (HHS), and the Indian Health Service.1 In addition, the CARES Act authorizes HHS to take a number of steps to make telehealth services more readily available nationally. This advisory focuses in-depth on the funding allocated to the FCC and surveys the other telehealth initiatives in the CARES Act.
Through the CARES Act, Congress appropriated $200 million for the FCC “to support efforts of healthcare providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services” during the pendency of COVID-19. On April 2, 2020, the FCC issued an order establishing a new, short-term program to distribute that money: the COVID-19 Telehealth Program.
The order also establishes a second new program, the Connected Care Pilot Program, which will complement the new COVID-19 Telehealth Program. The $100 million, three-year pilot had been in the works since last summer and will draw its funding from the federal Universal Service Fund (USF) rather than funds appropriated under the CARES Act. One of the main goals of the pilot is to give the FCC data on how to best structure a funding program for devices and services directly used by patients rather than solely by healthcare facilities themselves.
The COVID-19 Telehealth Program will be open to eligible healthcare providers, whether located in rural or non-rural areas, and will provide eligible healthcare providers support to purchase telecommunications, information services, and connected devices to provide “connected care services” in response to COVID-19.
The COVID-19 Telehealth Program will provide selected applicants full funding for eligible services and devices, in contrast with existing USF healthcare connectivity programs that require “co-pays” from the healthcare facilities. The $200 million will be awarded on a rolling basis until the funding is exhausted or until the current pandemic has ended. Grants are not expected to exceed $1 million per applicant. Applications will be accepted after publication of the FCC’s order in the Federal Register. Under the circumstances, we expect that could happen quickly.
The order defines “connected care services” eligible for support as telehealth services that use broadband internet access service-enabled technologies to deliver remote medical, diagnostic, patient-centered, and treatment-related services directly to patients outside of traditional brick-and-mortar medical facilities—including to patients in their homes, rather than at a healthcare provider’s physical location.
Services include, but are not limited to, remote patient monitoring (e.g., use of patient reporting outcome platforms, glucometers, pulse oximeters, sphygmomanometers, chest straps, wearables, passive sensors, or other devices to consistently monitor patient vitals), patient health education, store and forward services (e.g., asynchronous transfer of patient images and data for interpretation by a physician), and synchronous video consultations and visits.
Consistent with the law governing the USF healthcare support programs, the FCC has identified the following as eligible for funding under the COVID-19 program:
An important difference from existing FCC programs, however, is that non-rural entities may directly participate without needing to be part of a consortium of rural entities. Each separate site or location of a healthcare provider is considered an individual healthcare provider site for eligibility determination purposes.
Because of the FCC’s desire to move quickly, it has not issued a separate form for COVID-19 Telehealth Program funding applications. Rather, it has established a separate, streamlined application process. To be considered for participation in the COVID-19 Telehealth Program, interested eligible healthcare providers must submit applications that, at a minimum, contain the following information:
Additionally, COVID-19 Telehealth Program applicants will also be required to certify that they will comply with: the Health Insurance Portability and Accountability Act (HIPAA) and other applicable privacy and reimbursement laws and regulations; applicable medical licensing laws and regulations, as waived or modified in connection with COVID-19; and applicable COVID-19 Telehealth Program requirements and procedures, including the requirement to retain records to demonstrate compliance with the COVID-19 Telehealth Program requirements and procedures for three years following the last date of service, subject to audit.
Although not a creation of the CARES Act, the FCC’s April 2 order formally establishes the Connected Care Pilot Program, which will make available up to $100 million over three years to examine how the USF can support telehealth services. It will draw its funding from the federal USF rather than funds appropriated under the CARES Act. Existing USF healthcare connectivity programs do not subsidize devices or at-home telehealth communications services for patients, and almost exclusively fund rural healthcare facilities. Pilot Program funds will be available to medically underserved populations in both rural and non-rural areas.
The Pilot Program will partially subsidize eligible healthcare providers’ costs of providing telehealth services, with a particular emphasis on supporting these services for eligible low-income Americans and veterans, even in urban areas. This will be the first USF-funded healthcare program to provide funding on a means-tested basis or based on prior military service.
The deadline for filing applications for the pilot will be the later of:
The CARES Act provides additional funds for telemedicine in rural areas through the Rural Utilities Service (RUS) in the Department of Agriculture. The legislation directs an additional $100 million funding to the existing RUS pilot program for rural broadband loans and grants, known as the ReConnect Program. DWT previously summarized the ReConnect Program here. Entities eligible for these loans and grants include most state and local governmental entities, federally recognized tribes, nonprofits, and for-profit businesses.
The CARES Act also appropriates $25 million to support, among other things, telemedicine and broadband in rural areas. The Department of Agriculture issued a press release indicating that it will announce in coming weeks when these funds are available, in addition to opening up a new application window for other existing programs.
The CARES Act also includes several provisions easing regulatory requirements applicable to Medicare coverage for telehealth, and promoting the use of telehealth during public health emergencies.
In addition to the FCC, RUS, and Medicare programs, the CARES Act authorizes funding for other telehealth connectivity programs, described in the chart below.
|Description of Program||Funding Amount||Purpose of Funding|
|Health and Human Services (HHS) – Public Health and Social Services Emergency Fund||$27B||Funding for a variety of goals related to COVID-19 response, including “telehealth access and infrastructure.”|
|HHS Office for Advancement of Telehealth (new office est. by Act)|
Telehealth Resource Centers Grant Programs
|$29M per fiscal year, 2021-2025||Establishes telehealth network and telehealth resource centers grant programs.Network program focused on rural areas, frontier communities, and medically-underserved populations/areas. Can include health-related education activities.Resource center program focused on non-network aspects to same populations described above.|
|Health Resources and Services Administration – Rural Health and Telehealth||$180M||Funds are available until end of fiscal year 2022 for HRSA to carry out telehealth and rural health activities under sections 330A and 330I of the PHS Act and sections 711 and 1820 of the Social Security Act.|
|Dept. of Veterans Affairs – Telehealth for Veterans||Unclear||Authorizes the Secretary of the VA to enter into short-term contracts with telecommunications companies to provide fixed and mobile broadband services to deliver expanded mental health services to isolated veterans through telehealth or the VA Video connect program during COVID-19.Eligibility can be expanded to veterans who are receiving care from the VA but not otherwise eligible for mental health services or other services through telehealth. Priority is to be given to veterans in underserved/rural areas, and low income/mental health risk veterans.Secretary must ensure that telehealth capabilities are available for participants in Department of Housing and Urban Development–Department of Veterans Affairs Supportive Housing program.It is possible that funding for such services may come from the $14.4B made available to the VA through 2021 for “medical services.”|
|Indian Health Service||$1B||Funding for IHS includes telehealth and other IT upgrades.Not less than $450 million shall be distributed through IHS directly operated programs and to tribes and tribal organizations.|