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Connect for Health Act of 2021 Reintroduced

Tuesday, June 22, 2021

On 29 April 2021, Senator Brian Schatz (D-HI) reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, S. 1512 (the Act).¹ The bill, which currently has 59 cosponsors in the Senate,² aims to codify the currently expanded access to telehealth services provided for by the current Section 1135 waivers due to the COVID-19 public health emergency (PHE), in addition to other measures that support the provision of telehealth care. Prior to implementation of the Section 1135 waivers, telehealth visits were only reimbursable by Medicare under narrow circumstances, including the requirements that the services generally be provided in a designated rural area and from a qualifying originating site, which did not include a beneficiary’s home.³

BACKGROUND AND CONGRESSIONAL FINDINGS

Senator Schatz has introduced the Act in some form each session since 2016, but each time with the stated goal of reducing barriers to accessing telehealth services. This year, the effort is buoyed by the increased utilization of telehealth services during the PHE. After over a year of patients accessing quality care under the current waivers, the case for making the changes permanent is much easier to make. At this time, the text of the legislation has not been made publicly available, but the bill has been referred to the Senate Committee on Finance. Representative Mike Thompson (D-CA-5) has introduced the House of Representatives counterpart, where it is currently under review by the Committee on Finance.⁴

The findings in the Act acknowledge the value of telehealth services, including expanded access to health care, improved quality of care, reduced costs, and strengthening of the health care workforce expertise. The successful expansion of telehealth services during the COVID-19 PHE appears to have also heavily influenced the revised bill. In particular, the bill specifically states that the COVID-19 PHE demonstrated the benefits of telehealth, including reducing risk of infection for patients and providers and conserving space in facilities, and noted that the Centers for Disease Control and Prevention has recommended that “telehealth services should be optimized, when available and appropriate, during the pandemic.”⁵

REMOVING BARRIERS TO TELEHEALTH COVERAGE

The Act, which is also supported by over 150 advocacy and health organizations, acknowledges that practitioners can provide high-quality telehealth services in a safe and effective manner. As such, the legislation primarily seeks to promote higher quality of care, expanded access to telehealth services, and reduced Medicare spending through relaxation of current reimbursement rules and expanded coverage of additional telehealth services.

Specifically, the Act would amend the Social Security Act to promote the continued expansion of telehealth services by providing for the following:

• Permanently removing all geographic restrictions on telehealth services;
• Expanding the definition of originating site to include the home of an individual and granting the secretary additional flexibility to establish other sites as originating sites where deemed appropriate;
• Removing restrictions on the use of telehealth in emergency medical care;
• Requiring revisions to current process to add telehealth services in order to prioritize the addition of services that provide improved access to care;
• Permitting temporary coverage of certain telehealth services, in order to determine the potential benefit of covering such telehealth services permanently;
• Permanently adding federally qualified health centers and rural health clinics as eligible distant site providers;
• Removing restrictions on Indian Health Service and Native Hawaiian health care system facilities; and
• Allowing for recertification of hospice beneficiaries via telehealth.

The proposed Act also provides the Department of Health and Human Services (HHS) secretary with permanent authority to waive certain requirements for reimbursement of telehealth, including a qualifying originating site, geographic location requirements, limitations on the type of technology used, limitations on the types of practitioners that can furnish telehealth services, and limitations on the types of services provided via telehealth, subject to a finding that such waivers would adversely impact quality of care. 

The Act also requires the implementation of processes for public comment and periodic review and reassessment of such waivers, as well as public reporting on the impact and number of beneficiaries benefitting from the waivers.

Note that the expansion of Medicare reimbursement under the Act does not otherwise preempt licensure or geographic, technology or patient informed consent requirements that individual state licensing boards and other regulatory authorities may impose on licensed practitioners or change whether the appropriate standard of professional care is able to be met through a telemedicine encounter.

PROGRAM INTEGRITY

The Act includes multiple provisions to ensure program integrity by providing additional funding to the HHS office of Inspector General (OIG) for oversight of telehealth services through audits, investigations, and other oversight and enforcement activities. In addition, the Act establishes that the provision of technology to Medicare beneficiaries for the purpose of telehealth services, remote patient monitoring, and other digital health services is not considered “remuneration” under the prohibition on inducements provision of the Civil Monetary Penalties Law, provided certain conditions are met. Finally, the Act requires the Secretary to make available provider and beneficiary education resources on telehealth, including on reimbursement requirements, telehealth-specific privacy and security, and utilizing telehealth to engage and support underserved and high-risk populations.

DATA AND TESTING OF MODELS

The Act requires the Secretary to collect and analyze qualitative and quantitative data on the impact of telehealth services and other services utilizing digital health technology permitted under the COVID-19 PHE waivers and provided under alternative payment models and to report to Congress on the conclusions resulting from the collection and analysis of such data. Finally, the Act authorizes a testing model to evaluate allowing additional health care practitioners to provide telehealth services and encourages the Centers for Medicare & Medicaid Services Innovation Center to develop and test telehealth models under the Medicare program.

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May 4, 2021 – Canistota, SD – On Monday, FCC Commissioner Brendan Carr applauded legislation introduced in the Senate that would make permanent telehealth flexibilities that were made available during the COVID-19 pandemic and expand coverage of telehealth services.

The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, introduced by Senators Thune, Schatz, Wicker, Cardin, Warner, and Hyde-Smith on behalf of a bipartisan group of 50 senators, would permanently remove geographic restrictions on telehealth services, permanently allow health centers and rural health clinics to provide telehealth services, allow for the waiver of telehealth restrictions during future public health emergencies, and require a study to learn more about how telehealth has been used during the current COVID-19 pandemic.

Commissioner Carr has been leading the FCC’s efforts to develop telehealth initiatives, including the Connected Care Pilot Program, and issued the following statement:

“Three years ago, we identified a new trend in telehealth.  With smartphones and other connected devices, Americans could access health care services right from their homes or anywhere they have an Internet connection.  It was the health care equivalent of moving from Blockbuster to Netflix.  Since that time, I have been working with FCC colleagues and stakeholders to support this new trend.  Back then, we had no way of knowing that the COVID-19 pandemic would bring the benefits of telehealth services into such sharp focus.  But as the pandemic hit, the FCC took immediate and sustained action to ensure that our rules did not frustrate delivery of these important services.

“I expect that the momentum for delivering care directly to patients outside the confines of brick-and-mortar facilities will continue to build well after this devastating pandemic ends.  And as the reliance on telehealth technology continues to grow, it is critically important that these services are accessible regardless of the location of the patient, which is particularly important in rural areas.  I applaud Senator Thune and his colleagues for advancing this important, bipartisan legislation that will permanently remove unnecessary red tape and permanently expand access to telehealth technology throughout the country.”

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The home health industry hasn’t given up on securing telehealth reimbursement during the public health emergency. Their tenacity is being rewarded with recent legislative movement on Capitol Hill.

A group of bipartisan Senators on Thursday introduced S. 1309, the new version of the Home Health Emergency Access to Telehealth (HEAT) Act under the current Congress. The HEAT Act was previously introduced in both the House and Senate last October.

“The COVID-19 pandemic has firmly demonstrated the value of telehealth as a tool in meeting the clinical needs of home health patients,” National Association for Home Care & Hospice President William A. Dombi told Home Health Care News. “However, with the absence of any reimbursement for telehealth, home health agencies have not had the ability to make full use of it.”

Progress on in-home telehealth reimbursement has been a top legislative priority for the Washington, D.C.-based NAHC since last fall.

The advocacy organization described the current lack of telehealth reimbursement in home health care as a “glaring shortcoming in the era of the coronavirus pandemic.”

Similar to last year’s version, the new HEAT Act gives CMS the authority to issue a waiver that would allow for telehealth visits to count towards in-person visits as included on the plan of care only during a public health emergency. The COVID-19 public health emergency is expected to last throughout 2021, so such an action could be a huge difference-maker for home health agencies.

If enacted, the HEAT Act would help providers meet rising demand for home health services as a time when the supply of nurses and other in-home care professionals is at a premium. The bill’s potential passage would also allow agencies to conserve personal protective equipment (PPE) and minimize person-to-person contact during future outbreaks in any given area.

Senators Susan Collins (R-Maine) and Ben Cardin (D-Md.) introduced the original HEAT Act in 2020. 

They teamed up again this year, with backing from Senators Roger Marshall (R-Ky.) and Jeanne Shaheen (D-N.H.).

“The HEAT Act is a big step forward in modernizing the Medicare home health benefit,” Dombi said. “We thank the senators for their bipartisan sponsorship of the bill and look forward to an early passage.”

While the HEAT Act has overwhelming support in the home health industry, some skeptics have raised concerns about the overuse of virtual care when in-person visits are needed.

The new version of the legislation has a built-in mechanism to prevent that scenario, according to NAHC.

“During the drafting, concerns were raised of the need for patient protections to ensure for protection against fraudulent and improper behavior,” a NAHC analysis states. “To assuage these concerns, guardrails were added that would require for patient consent for telehealth services, as well as a requirement that telehealth visits can [account for] no more than half of all visits.”

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HELP IS ONLY A
BUTTON CLICK AWAY

The V.ALRT is a wearable help button that can be carried discreetly in a pocket or a bag, worn on the wrist, or around the neck as a pendant. The V.ALRT uses Bluetooth® SMART technology in association with a mobile application, to initiate calls and text
messages from a smartphone. With the push of the V.ALRT help button, your smartphone sends a personalized text message and GPS location to up to three pre-selected contacts.

WATERPROOF, LIFEPROOF

The V.ALRT Personal Alert Button is IP67 Compliant. This means the V.ALRT can go where ever you go. Whether that is
outdoors, to the pool, or even to the shower or bathtub

ANDROID & IOS COMPATIBLE

The V.ALRT works with iPhone 4S/iOS 7 or newer and any smartphone using Android 4.3 or newer with Bluetooth 4.0.

NO CHARGING NEEDED

The V.ALRT has up to one year of battery life and powered by a standard CR2032 watch battery. The battery is removable and replaceable by the user.

OUT OF RANGE NOTIFICATION

If the V.ALRT device travels out-of-range from the smartphone, both devices will receive an audio notification.

NO MONTHLY FEES

Since the V.ALRT operates through your smartphone, all of the features are available without any monthly service fees.

FALL DETECTION

The user can turn on Fall Detection to enable the alert to be sent automatically after a 60 second countdown.

GPS LOCATION

In addition to the alert text messages and phone calls, the location from your smartphone will be sent to your emergency contacts.

TEXT AND CALL

After pressing the button, the V.ALRT transmits a command to your smartphone to send a text message to your preset  contacts, followed by phone calls. This alert behavior is completely customizable.

WIRELESS RANGE

The V.ALRT must be within range of your smartphone to operate. It has a wireless range of up to 75′ indoor or up to 300′ outdoor using Bluetooth 4.0.

PRODUCT SPECS

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