Article

December 9, 2020

Dear Majority Leader McConnell, Minority Leader Schumer, Speaker Pelosi, and Minority Leader
McCarthy:


The undersigned organizations represent millions of individuals facing serious, acute and chronic health
conditions across the country. Our organizations have a unique perspective on what individuals need to
prevent disease, cure illness and manage chronic health conditions. The diversity of our groups and the
patients and consumers we represent enables us to draw upon a wealth of knowledge and expertise and
serve as an invaluable resource regarding the ways patients are accessing care during the COVID-19
pandemic. The COVID-19 pandemic has been challenging for many of the patients our organizations
represent. Many people with pre-existing conditions are at increased risk of infection and adverse
health outcomes from COVID-191 and require routine monitoring and treatment from health care
providers in order to maintain their health. We appreciate that in response to the public health
emergency, federal and state agencies provided new, and in some cases time-limited, flexibilities for
telehealth services to enable patients to see providers from the safety of their homes in order to reduce
disruptions to care.


Congress has returned to Washington for the “lame duck” session and legislative action is more
important now than ever to address the role telehealth will continue to play through the end of the
COVID-19 pandemic and in the future. There are currently several pieces of proposed legislation before
Congress that seek to establish and inform what telehealth services will look like post-pandemic. Our
organizations previously agreed on a set of policy principles2
to inform our analysis of proposed
telehealth policy, and we believe several policy provisions included in currently proposed legislation are
critical to addressing challenges for patient access to telehealth services during the remainder of the
Public Health Emergency (PHE) and beyond.


Removing Geographic Restrictions
In response to the COVID-19 pandemic, Congress passed the CARES Act which granted the Department
of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) broad
waiver authority to make telehealth services more accessible to Americans, reducing their exposure to
the novel coronavirus. CMS took swift action, expanding the list of eligible services and providers who
could be reimbursed by Medicare for telehealth services and waiving several restrictions that limited
access to care for Medicare enrollees. Data released by CMS shows that the expanded access to
telehealth services led to a large increase in utilization. In the last week of April, roughly 1.7 million
Medicare beneficiaries received telehealth services, up from 13,000 per week prior to the pandemic.


Previously, the use of telehealth services for Medicare patients has been limited due to geographic
restrictions on both patients and providers. Federal law largely limited use of a patient’s home as the
originating site to those living in rural areas or with a specific condition. Federal law should be amended
to include a patient’s home as an originating site to ensure all patients can utilize this care modality.
H.R. 7663, the Protecting Access to Post-COVID-19 Telehealth Act, contains language that would
remove originating site geographic requirements in Medicare beginning December 31, 2020. It would
also expand eligible distant site providers to include rural health clinics and federally qualified health
centers (FQHCs). Other pieces of legislation such as the CONNECT Act (H.R. 4932/S. 2741) also include
provisions that would allow the Secretary of HHS to waive Medicare’s telehealth geographic
requirements. Our organizations support legislation to further increase access to telehealth by
designating the patient’s home as an originating site.


Creating pathways to enable better interstate access for telehealth would also be an important step in
addressing geographic barriers to care. Patients with chronic conditions often travel to other states in
order to receive the specialized care necessary to treat their condition. Currently, most healthcare
professionals must maintain a license in each state in which their patients reside. Many states waived
licensing rules during the pandemic, but the rules were inconsistent and highly burdensome for
providers. We support the inter-state access to telehealth provisions included in S. 4421, the Temporary
Reciprocity to Ensure Access to Treatment (TREAT) Act and urge Congress to pass the bill. Expanding
opportunities for providers in good standing in their home state to practice across state lines via
telehealth will increase access to care and improve care coordination for patients, particularly in
underserved areas for the duration of the COVID-19 pandemic and future public health emergencies.


Increasing the Evidence Base for Telehealth
The expansion of telehealth during the COVID-19 pandemic has been necessary to ensure patients
continue receiving timely and safe health care services and treatments from their providers. However,
barriers to care still exist for many patients and future legislation should pay special attention to
promoting health equity so that all populations have equal access to telehealth’s potential benefits.

Lawmakers should establish a system for collecting comprehensive data regarding the utilization of
telehealth services during the public health emergency and the potential areas in need of improvement
to inform which waivers should be made permanent. H.R. 7233, the Knowing the Efficiency and Efficacy
of Permanent Telehealth Options Act, requires both HHS and the Government Accountability Office
(GAO) to conduct a study on expanded access to telehealth during the COVID-19 pandemic and to
provide recommendations to Congress on what improvements can be made going forward. Conducting
research and analysis into how patient health outcomes have been impacted by expanded telehealth
access is important, but it is critical that demographic data is also collected, including race, ethnicity,
age, disability status, preferred language, sex, sexual orientation, gender identity, socio-economic
status, insurance coverage and geographic location. Other bills such as H.R. 7078, the Evaluating
Disparities and Outcomes of Telehealth During COVID-19 Emergency Act, charge HHS with submitting a
report to Congress which includes such an analysis for Medicare and Medicaid patients. Lastly, the
Enhancing Preparedness through Telehealth Act (S.3988) would direct HHS to inventory telehealth
programs across the country to learn how telehealth can be used more effectively in future public
health emergencies. This data should be made publicly available in an accessible, transparent manner
and used to inform lawmakers’ decisions about the future of telehealth services.


Conclusion
We are grateful for the bipartisan support that expanded telehealth access during the COVID-19 crisis
and stand ready to work with Congress and the Administration on future legislation. If the above
provisions are not enacted by the end of the year, we ask that Congress work on comprehensive
telehealth legislation that addresses these issues in the 117th Congress. If you have any questions about
this letter, please contact Hannah Lynch at hlynch@psoriasis.org.


Sincerely,
Alpha-1 Foundation
ALS Association
American Cancer Society Cancer Action Network
American Heart Association
American Kidney Fund
American Lung Association
Arthritis Foundation
Asthma and Allergy Foundation of America
Cancer Support Community
CancerCare
Crohn’s & Colitis Foundation
Cystic Fibrosis Foundation
Digestive Disease National Coalition
Epilepsy Foundation
Hemophilia Federation of America
JDRF
National Alliance on Mental Illness
National Health Council
National Hemophilia Foundation
National Kidney Foundation
National Multiple Sclerosis Society
National Organization for Rare Disorders
National Psoriasis Foundation
Pulmonary Hypertension Association
Susan G. Komen
The AIDS Institute
The Mended Hearts, Inc
United Way Worldwide

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