At present, CCHP is tracking over 100 pieces of telehealth legislation in the current federal legislative session. This month we have seen a number of bipartisan bills introduced, continuing the federal push to expand telehealth availability and codify flexibilities allowed during the COVID-19 public health emergency (PHE).

A good majority of the recently introduced bills focus on increasing telehealth reimbursement, however a few look to increase funding for telehealth services and infrastructure. It is notable the significant amount of support from both sides of the aisle for telehealth. For instance, representatives Dan Newhouse (R-WA) and Tom O’Halleran (D-AZ) introduced the Rural Remote Monitoring Patient Act (HR 4008) that would establish a pilot grant program to support the use of remote patient monitoring in rural areas. Senator John Kennedy (R-LA) introduced as part of a package of telehealth bills a reintroduction of a bill similar to legislation from 2020 titled the Telehealth Health Savings Account (HSA) Act (S 2097). The Telehealth HSA Act would allow employers to offer high-deductible health plans that include telehealth services without limiting employees’ ability to use health savings accounts. According to Kennedy’s press release, “a current IRS regulation stops employees from making or receiving contributions to HSAs if they hold a high-deductible health plan that waives the deductible for telehealth services, meaning employees holding high-deductible health plans often need to pay out of pocket for telehealth services. The Coronavirus Aid, Relief and Economic Security (CARES) Act (HR 748) temporarily waived this regulation, but S 2110 would make the waiver permanent.”

We have also seen a few of the recent bills look at audio-only and codifying pandemic telehealth flexibilities. The Protecting Rural Telehealth Access Act (S 1988) by Senator Joni Ernst (R-Iowa) and also sponsored by Senators Jerry Moran (R-Kan.), Joe Manchin (D-W.Va.), and Jeanne Shaheen (D-N.H.), would:
*Allow payment parity for audio-only telehealth services
*Make permanent the ability for patients to be treated at home
*Let rural health clinics (RHCs) and federally qualified health centers (FQHCs) serve as distant
sites for telehealth services

The Advancing Telehealth Beyond COVID-19 Act of 2021 by Representative Liz Cheney (R-Wyo.), introduced with Representative Debbie Dingell (D-MI), makes the following permanent changes:
*Removes originating site and geographical limitations
*Maintains telehealth flexibilities for RHCs/FQHCs
*Expands coverage for audio-only services
*Removes restrictions that limit clinicians’ ability to remotely monitor and track patient health
and provide them access to innovative digital devices

Additionally, we have seen bipartisan support around broadband legislation, such as from Senators Michael Bennet (D-Colo.), Angus King (I-Maine), and Rob Portman (R-Ohio), who recently introduced legislation which seeks to address the digital divide. Their Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act of 2021 would allow states to deploy “future-proof” networks able to meet communities’ broadband needs, including supporting local initiatives on affordability, adoption, and inclusion. According to Bennet’s press release, The BRIDGE Act would:
*Provide $40 billion to States, Tribal Governments, and U.S. Territories for affordable, high-
speed broadband
*Prioritize unserved, underserved, and high-cost areas with investments in “future proof”
networks
*Encourage gigabit-level internet wherever possible while raising the minimum speeds for new
broadband networks to at least 100/100 Mbps, with flexibility for areas where this is
technologically or financially impracticable
*Emphasize affordability and inclusion by requiring at least one affordable option
*Increase choice and competition by empowering local and state decision-making, lifting bans
against municipal broadband networks, and allowing more entities to compete for funding

Lastly, additional information was just released regarding Cures 2.0 – another bipartisan bill, which creates the Advanced Research Projects Agency for Health (ARPA-H), a President Biden budget request proposal. According to a discussion draft and section-by-section summary, Cures 2.0 will address a variety of areas, including telehealth access, while incorporating and building upon several additional bipartisan bills, such as the Telehealth Improvement for Kids’ Essential Services (TIKES) Act (H.R. 1397 / S. 1798) and Telehealth Modernization Act (H.R. 1332 / S. 368).

The telehealth provisions proposed in Cures 2.0 include:
*Review the impact of telehealth on patient health and encourage better collaboration
*Provide guidance and strategies to states on effectively integrating telehealth into their
Medicaid program and Children’s Health Insurance Program (CHIP)
*Make many of the COVID-19 PHE flexibilities post-pandemic permanent, such as:
-Removing the geographic and originating site restrictions
-Expanding the range of health care providers that can be reimbursed by Medicare for
furnishing telehealth services to any health care professional eligible to bill Medicare
-Enhancing telehealth services for use by FQHCs, RHCs, hospices, and for home
dialysis

The authors anticipate that the Cures 2.0 bill will be introduced in the coming weeks and hope to see it signed in the fall. While the fate of these telehealth bills is yet to be seen, it does seem to highlight strong federal support for expanding access to telehealth post PHE with such a large amount of bipartisanship support behind them. Given Medicare’s historically conservative approach in regard to telehealth pre-PHE, any additional shift would be significant. CCHP will continue to update its tracking tools and monitor the ever evolving telehealth landscape as we continue to move through the current federal legislative session.