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The executive order would call on the Department of Health and Human Services to develop a new pilot payment model for rural hospitals, and would set up a task force to improve broadband infrastructure in rural communities.

For the past few months, policymakers from the states to Congress have discussed plans to keep some of the loosened telehealth regulations after the pandemic. On Monday, President Donald Trump signed an executive order steering agencies to do that work and improve access to healthcare in rural communities.

The order directs Health and Human Services Secretary Alex Azar to propose a regulation that would extend expanded coverage of telehealth services for Medicare patients beyond the public health emergency.

Concerned with an influx of COVID 19 patients, Rochester Regional Health deployed Datos Health’s telehealth platform in only 4 days to protect hospital staff and better manage home hospitalized patients.

Prior to the pandemic, Medicare had several restrictions in place for virtual visits. Telehealth visits were only covered for patients in rural communities, and they still had to take place in a doctor’s office, hospital, or other health facility. The number of covered services was also limited.

Since the start of the Covid-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has waived those restrictions, allowing Medicare to cover 135 new services over telehealth, such as physical therapy or mental health services.

These changes have been widely supported, with a Senate committee discussing ways to extend Medicare coverage of telehealth, and several proposed bills seeking to accomplish the same. According to CMS, 10.1 million Medicare patients have used telehealth between mid-March and early July.

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Medicare adds to list of covered telehealth services

Concurrent with the executive order, CMS published a list of telehealth services that it plans to add to the Medicare physician fee schedule next year. Some examples include home visits for the evaluation and management of a patient, group psychotherapy and neurobehavioral status exams.

The agency is also temporarily expanding some telehealth services for the year in which the pandemic ends, to allow patients to more smoothly transition back to in-person care. Those services include emergency department visits and nursing facility discharge visits.

CMS Administrator Seema Verma tweeted that the agency is “seeking public input on other services to permanently add to the telehealth list beyond the (public health emergency) in order to give clinicians & patients time as they get ready to provide in-person care again.”

Some restrictions will kick back in again after the pandemic.

For remote patient monitoring services covered under Medicare, CMS will again require an established patient-physician relationship.

And while CMS is currently allowing for audio-only telehealth visits, it does not plan to continue to do so after the public health emergency ends. Still, CMS acknowledged, “…the need for audio-only interactions could remain as beneficiaries continue to try to avoid sources of potential infection, such as a doctor’s office.”

This could also pose a challenge for patients with limited broadband connectivity.

Addressing rural health

The executive order also includes provisions for HHS, the Secretary of Agriculture and the Federal Communications Commission to develop a strategy to improve the physical and communications healthcare infrastructure available to rural Americans. Earlier this year, the FCC put together a rural healthcare program using CARES Act funding to distribute funding to healthcare providers to help them get broadband internet and devices needed for healthcare services.

Separately, HHS is directed to put together a new payment model to direct rural healthcare providers toward value-based care models, giving them flexibility from existing Medicare rules and establishing predictable financial payments, according to the executive order.

HHS has not yet shared the details of this payment model.

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