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President Trump issued an Executive Order (the “Order”) on August 3, 2020, to improve rural health and telehealth access. The Order tasks several federal agencies with developing new programs and plans to address longstanding federal barriers to fuller telehealth access in rural areas, including payments, infrastructure, and policy.

According to the Order, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services (“HHS”) normally processes claims for approximately 14,000 virtual visits a week for its beneficiaries. For the last week of April, the Order states that number had jumped to almost 1.7 million virtual visits. This growth would not have been possible if not for changes in state and federal law that improved access by providing reimbursement coverage, easing technology restrictions, and waiving limitations in the federal health care programs that prevent Medicare beneficiaries in particular from getting the most out of virtual care.

In light of the recent experience, the stated purpose of the Order is to “increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth.” The four primary activities to achieve this purpose are innovative payment, technical infrastructure, health-focused policy initiatives, and post-pandemic flexibility. As explained below, the details of the new initiatives will be announced in the future. We will provide updates as the agencies implement these programs and initiatives.

Innovative Payment
The Order states that the HHS will rely on the innovation authority granted under 42 U.S.C. § 1315a to develop a model for rural providers to have increased flexibility under Medicare, predictable financial payments, and encourage movement toward value-based care. The Order calls on HHS to announce this new model within 30 days from the date of the Order.

Technical Infrastructure
In addition to HHS, the Order also tasks the Secretary of Agriculture and the Federal Communications Commission with roles in addressing rural lack of broadband access. Specifically, within 30 days from the date of the Order these three organizations, with additional agencies and departments involved as appropriate, are to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.”

Health-Focused Policy Initiative
The Order directs HHS to prepare and submit a report, also within 30 days, addressing existing and upcoming policy initiatives to:

  1. Increase rural access to health care by eliminating regulatory burdens that limit the availability of clinical professionals;
  2. Prevent disease and mortality by developing rural-specific efforts to drive improved health outcomes;
  3. Reduce maternal mortality and morbidity; and
  4. Improve mental health in rural communities

Post-Pandemic Flexibility
Finally, regarding the temporary expansion of telehealth services to Medicare beneficiaries during the pandemic, the Order instructs HHS to propose regulations to extend, as appropriate:

  1. The additional telehealth services offered to Medicare beneficiaries; and
  2. The services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas

This regulation is to be proposed within 60 days from the date of the order.

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