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President Donald Trump signed a new executive order Aug. 3 to expand access to telehealth services during the COVID-19 pandemic, notably in rural areas. The Trump administration also is extending some telehealth services even after the pandemic public health emergency ends.

The order requires the U.S. Department of Health & Human Services (HHS) to roll out new payment model testing innovations for rural hospitals to transform the care in their communities on a broader scale.

The order is meant to improve connectivity and directs the government to create a joint initiative within 30 days to improve health communication infrastructure and expand rural healthcare services.

HHS Secretary Alex Azar said the president is directing the agency to transform rural healthcare with new, more sustainable models, which it already has been working to do for some time.

Centers for Medicare and Medicaid Services (CMS) officials said they plan to issue a proposed Physician Fee Schedule rule to ensure flexibilities related to the reimbursement for telehealth visits, including some emergency room visits, nurse consultations, and speech and occupational therapy.

CMS’ annual Physician Fee Schedule and Quality Payment Program updates Medicare payment rates.

These telehealth expansions would build on the work CMS has done during the public health emergency to more than double allowable telehealth services.

The executive order issued Aug. 3 proposes to permanently add some services to the Medicare telehealth list, including prolonged office visits, mental health services like group psychotherapy, neuro-behavioral exams and other types of visits. A previous action also proposed to make telehealth for home health services available permanently.

Prior to COVID-19, about 13,000 people received telemedicine service in a week compared to more than 10.1 million beneficiaries from mid-March to early July.

During the pandemic, CMS has enabled Medicare to cover more than 135 services through telehealth.

A more sweeping extension of pandemic telehealth policies, including enabling patients to get telehealth visits at home, would require congressional action, CMS officials said.

“Revenue for rural providers varies significantly month to month, making it difficult to stay in business. Many are having a difficult time,” Trump said at the signing.

The order also directs the Departments of Agriculture and Health and Human Services and the Federal Communications Commission to form a task force to focus on improving broadband infrastructure in rural communities to support telehealth.

“One of the only good things that we’ve gotten out of this whole horrible situation is telehealth, has been incredible,” Trump said at a Aug. 3 press briefing.

POLITICO reports that some of the pieces unveiled in the executive order were considered for as long as two years. Federal health officials retooled the proposals to demonstrate they would save the federal government money.

Meanwhile, a new bill in Congress is designed to further remove barriers to telehealth expansion, specifically regarding interstate licensure.

Senators Chris Murphy (D-Conn.) and Roy Blunt (R-Mo.) unveiled the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, enabling healthcare providers in good standing to use connected health to treat patients in any state during the coronavirus pandemic.

“The COVID-19 pandemic has created unique challenges for our health care system, like reaching patients who are advised to avoid clinics and hospitals, allowing students to continue care when they’re away from campuses, or speeding reinforcements to areas with a high number of cases,” Blunt said in a press release. “The TREAT Act responds to those challenges by increasing flexibility for providers to care for patients wherever they are.”

Current guidelines require providers to have licenses in each state in which they practice.

The new bill is similar to the Equal Access to Care Act, introduced in June by Sens. Marsha Blackburn (R-Tenn.) and Ted Cruz (R-Texas). That bill would allow providers in any state to use telehealth to treat a patient in any location for up to 180 days after the national emergency.

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