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As 'telehealth cliff' Looms, Hundreds of Healthcare Orgs Urge Congress to Act

Mike Miliard, Healthcare IT News

July 2021

More than 400 healthcare and technology organizations are calling on Capitol Hill to eliminate arbitrary restrictions, while helping FQHCs and critical access hospitals offer wider access to virtual care.

Leading healthcare industry stakeholders on Monday implored top leaders in the House and Senate to help ensure, among other imperatives, that "Medicare beneficiaries [don't] abruptly lose access to nearly all recently expanded coverage of telehealth."

In a letter to Senate Majority Leader Chuck Schumer, House Speaker Nancy Pelosi, Senate Minority Leader Mitch McConnell and House Minority Leader Kevin McCarthy, 430 organizations – including the American Telemedicine Association, HIMSS (parent company of Healthcare IT News), Amazon, Amwell, Teladoc, Zoom, Epic, Allscripts, Kaiser Permanente, Mayo Clinic, Mass General Brigham, UPMC and many others – called on them to capitalize on the progress that's been made on telehealth before it's too late.

If they don't act before the end of the COVID-19 public health emergency, the groups said, Medicare beneficiaries "will lose access to virtual care options which have become a lifeline to many."

The groups also called on Congress to get rid of arbitrary restrictions on where patients can use telehealth services, remove limitations on telemental health services, authorize the Secretary of Health and Human Services to allow additional telehealth "practitioners, services and modalities," and help ensuring that federally qualified health centers, critical access hospitals, rural health centers and providers like them can can furnish telehealth services.

Flexibilities enabled under the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act "have allowed clinicians across the country to scale delivery and provide all Americans – many for the first time – access to high-quality virtual care," the groups wrote," the groups said. "In response, health care organizations across the nation have dramatically transformed and made significant investments in new technologies and care delivery models, not only to meet COVID driven patient demand, but to prepare for America’s future health care needs.

"Unfortunately, this progress is in jeopardy," they wrote. "Many of the telehealth flexibilities are temporary and limited to the duration of the COVID-19 public health emergency. Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 PHE ends. This would have a chilling effect on access to care across the entire U.S. healthcare system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health."

Telehealth, these stakeholders argue, "is not a COVID-19 novelty, and the regulatory flexibilities granted by Congress must not be viewed solely as pandemic response measures. Patient satisfaction surveys and claims data from CMS and private health plans tell a compelling story of the large-scale transformation of our nation’s health care system over the past year and, importantly, demonstrate strong patient interest and demand for telehealth access post-pandemic."

The letter notes that over the past year and half, virtual care has become ubiquitous, popular, efficient – and has helped address care disparities.

One in four Medicare beneficiaries – 15 million – accessed telehealth between the summer and fall of 2020, and 91% of them said they were satisfied with their video visits. Some 75% oof Americans "now report having a strong interest in using telehealth moving forward," the letter notes.

"Congress not only has the opportunity to bring the U.S. health care system into the 21st century, but the responsibility to ensure that the billions in taxpayer funded COVID investments made during the pandemic are not simply wasted but used to accelerate the transformation of care delivery, ensuring access to high quality virtual care for all Americans," the groups said.

The letter calls on Congress to ensure HHS Secretary Xavier Becerra "has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services."

In addition, it asks lawmakers to attend to four key priorities:

1. Remove Obsolete Restrictions on the Location of the Patient and Provider. Congress must permanently remove the Section 1834(m) geographic and originating site restrictions to ensure that all patients can access care where they are. The response to COVID-19 has shown the importance of making telehealth services available in rural and urban areas alike. To bring clarity and provide certainty to patients and providers, we strongly urge Congress to address these restrictions in statute by striking the geographic limitation on originating sites and allow beneficiaries across the country to receive virtual care in their homes, or the location of their choosing, where clinically appropriate and with appropriate beneficiary protections and guardrails in place.

2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and Modalities for Telehealth. Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, Congress should ensure that HHS and CMS maintain the authority to add or remove eligible telehealth services – as supported by data and demonstrated to be safe, effective, and clinically appropriate – through a predictable regulatory process that gives patients and providers transparency and clarity. Finally, Congress should give CMS the authority to reimburse for multiple telehealth modalities, including audio-only services, when clinically appropriate.

3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics Can Furnish Telehealth Services After the PHE. FQHCs, CAHs, and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act and through executive actions. Congress should ensure that FQHCs, CAHs, and RHCs can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers and better equip our healthcare system to address health disparities.

4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services Offered Through Telehealth. Without Congressional action, a new requirement for an in-person visit prior to access to mental health services through telehealth will go into effect for most Medicare beneficiaries. We urge Congress to reject arbitrary restrictions that would require an in-person visit prior to a telehealth visit. Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities by restricting access for those individuals with barriers preventing them from traveling to in-person care.15 Removing geographic and originating site restrictions only to replace them with in-person restrictions is short-sighted and will create additional barriers to care.

The concept of a "telehealth cliff" – an abrupt end to the progress made in expanding and enabling virtual care once the pandemic is finally over – has been of concern for some time.

Since early 2021, an array of telehealth-focused bills have been introduced in the House and Senate, but the major concerns outlined in the July 26 letter are still outstanding and yet to be addressed by statute.

"With 430 stakeholders in lockstep, and unprecedented bipartisan support for these legislative priorities, we urge Congress to act swiftly to ensure that telehealth remains permanently available following expiration of the public health emergency," said Kyle Zebley, VP of public policy at the American Telemedicine Association in a statement. "The ATA remains committed to working collaboratively to ensure Medicare beneficiaries can continue to access care when and where they need it."

“Evidence-based connected care has been at the core of our nation’s health resiliency throughout the COVID-19 pandemic and has established its important role in improving healthcare quality, access, and value for all Americans," added Rob Havasy, managing director of the Personal Connected Health Alliance. "HIMSS and PCHAlliance urge Congress to swiftly act to make the Medicare coverage changes permanent, to give patients and providers access to the tools they need and deserve."

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