Congress is expected to pass an omnibus spending bill this week that would extend pandemic-era Medicare telehealth waivers until the end of 2024. The bill would also keep in place the Centers for Medicare & Medicaid Services’ (CMS) innovative Hospital at Home program, and continue several other programs aimed at boosting connected health access and coverage.

Among several organizations praising the news is the American Telemedicine Association, which had long warned that the elimination of these waivers and programs would seriously hinder telehealth and digital health adoption.

“The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients,” Kyle Zebley, senior vice president of public policy for the ATA and executive director of ATA Action, said in a press release. “Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future.”

“The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans,” The Alliance for Connected Care said in a separate press release. “The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both.”

Generally, the bill, if passed, would:

• Remove geographic requirements and expand the list of originating sites for telehealth services;
• Expand the list of providers eligible to furnish telehealth services;
• Expand telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs);
• Delay in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology;
• Permit audio-only telehealth services, such as phone calls;
• Allow the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care during the emergency period; and
• Mandate a study on telehealth and Medicare program integrity.

The inclusion of audio-only telehealth services is a nice surprise for telehealth advocates. Federal and state regulators have long mandated that telehealth services be audio-visual, and have severely restricted any use of the telephone or an audio-only telemedicine platform for care delivery. But during the pandemic the telephone became a popular tool in regions where access to either telemedicine equipment or reliable broadband is limited. CMS has indicated it will return to those restrictions after the PHE ends, saying the platform isn’t reliable enough for care delivery.

Aside from the CMS telehealth waivers, which expanded access to and coverage for telehealth during the COVID-19 Public Health Emergency, the proposed omnibus appropriations bill would also extend by two years safe harbor provisions for telehealth referrals in high deductible health plans (HDHPs) and health savings accounts (HSAs).

The bill would also extend for two years the waiver for the CMS Acute Hospital Care at Home program, an innovative service launched by CMS that allows health systems to shift more care for acute patients from the hospital setting to the home, through a platform that includes remote patient monitoring, telehealth services and in-person care. More than 200 health systems have signed up to take part in the program, and many had said they would be forced to curtail, drastically change, or even cancel the program once CMS support for the program ends.

“We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services,” Zebley said in the ATA press release. “Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction.”

Not all the news was good, however. While the omnibus bill includes several measures aimed at addressing the nation’s substance abuse epidemic, it does not include an extension for a waiver that currently allows healthcare providers to prescribe controlled substances via telehealth for substance abuse treatment.

Federal law bans are severely restricts prescriptions of controlled substances through telemedicine. Federal regulation is channeled primarily through the Ryan Haight Act, passed in 2008, which prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.

The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment. Congress has been considering bills that would, if passed, create a special registration through the US Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.

The bill does direct the DEA to implement that special registration process, but the DEA has been asked to start that process for several years and has yet to do so.

While the omnibus bill, if passed as expected, would extend all of these freedoms for another two years, the ATA and others are lobbying to make many of the provisions permanent, rather than just pushing the finish line farther down the road.

“The hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff,’” Zebley said. “Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.” 

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In pursuit of broader telehealth affordability, the Alliance to Fight for Health Care organized a letter to Congress that requests an extension of the telehealth provision allowing employers to offer telehealth services pre-deductible to employees with a Health Savings Account (HSA).

The Alliance to Fight for Health Care is a group of businesses, patient advocates, employer organizations, unions, healthcare companies, and other stakeholders that centers its goals around supporting employer-provided health coverage.

With the signatures of 358 stakeholders, including the American Telemedicine Association, One Medical, and Blue Cross Blue Shield Association, the letter urges Congress to extend pre-deductible coverage of telehealth services in its year-end package. 

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The letter highlights the increase in demand for mental healthcare as a key reason to extend the provision.

“Regrettably, this popular provision expires at the end of this year,” the letter states. “Without legislative action, employers will be required to charge employees more to access telehealth services, creating a barrier to care, including telemental health. Unfortunately, more Americans need access to affordable mental and behavioral health services, not less.”

The letter’s signatories also cited the continued provision of telemental healthcare as an important reason to extend the provision.

“Protecting access to affordable telehealth to address mental health care needs is critical,” said James A. Klein, president of the American Benefits Council, in a press release. “People value, and now rely upon, access to affordable telehealth services. With health plans in place for 2023, this provision must be extended before the end of the year. Health care coverage is planned prospectively and is already in place for 2023. It can’t be adjusted retroactively.”

The letter noted that the overall support for affordable telehealth and telemental health is strong.

“Allowing employers and health plans to continue offering these important services pre-deductible improves affordability and expands access,” the letter states.

This letter follows one sent to Congress earlier this year that urged lawmakers to reinstate a provision allowing employers and health plans to provide pre-deductible coverage for telehealth services for those with high-deductible health plans coupled with Health Savings Accounts (HDHP-HSAs). More than 100 organizations signed the letter, including LifePoint Health, CVS Health, and Teladoc Health. 

Similarly, in March, 72 organizations, including the American Telemedicine Association (ATA) and the American Psychiatric Association, sent a letter to government agencies requesting continued access to controlled substances through telehealth without requiring initial in-person visits.

The goal of this request was to solidify access to clinically appropriate care amid the COVID-19 pandemic.

Written in September and addressed to the US Senate, another letter from the ATA and the ATA action requested that expanded telehealth access be solidified for two years.

Currently, telehealth flexibilities will be eliminated after the COVID-19 public health emergency is declared over. The letter noted that extending access to services would be beneficial as providers work toward creating and implementing more permanent regulations. 

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