Support Builds to Add Telehealth Options for Critical Access Hospitals

A new bill before Congress aims to expand telehealth access for patients living with mental health concerns at rural hospitals.

The Rural Health Behavioral Access Act, sponsored by US Reps. Dan Kildee (D-MI) and Brad Wenstrup (R-OH), was unveiled last week during a press conference that emphasized the level of support behind the bill, an important factor given the number of telehealth bills now on Capitol Hill. Among those backing the bill are the Alliance for Connected Care, the Ascension health system, the National Rural Health Association and the National Association for Rural Mental Health.

While Congress has expanded telehealth access and coverage during the public health emergency caused by the coronavirus pandemic, many of these freedoms will end with the PHE. Telehealth advocates are pressuring Congress to come up with a long-term telehealth policy.

The bill targets connected health programs for the nation’s 1,350 critical access hospitals (CAHs), which are strictly defined by Congress and limited – much like federally qualified health centers and rural health centers – in how they’re reimbursed by Medicare for telehealth services. In many cases they miss out on telehealth reimbursement because of federal requirements that target payments to “a physician or practitioner” instead of the hospital.

Supporters say these hospitals are struggling to stay open and viable, with many operating at negative margins and losing revenues because of the COVID-19 crisis. They need the support to use telehealth to expand their reach into the communities around them, and to offer more services they don’t require bringing the patient to the hospital.

Specifically, this bill would allow Medicare to reimburse CAHs for outpatient telemental health services delivered to patients outside the hospital. It would allow these hospitals to initiate new treatment via a telehealth platform as long as that’s the first step of a treatment plan that includes both virtual and in-person care, and it would establish coverage for audio-only telehealth services if audio-visual access is not available.

“This important legislation would allow critical access hospitals to continue providing behavioral health services via telehealth beyond the duration of the public health emergency,” Alan Morgan, the National Rural Health Association’s chief executive officer, said in a press release. “Mental health needs have spiked in rural communities since the beginning of the pandemic. Allowing continued access via telehealth in these communities will save lives.” 

“This is a population that has especially relied on advances in virtual care during the pandemic, and Congress must act to allow these services to continue,” added Peter Leibold, Ascension’s executive vice president and chief advocacy officer. “In addition, we believe it is critically important that Congress enact broader changes to the current virtual care legal framework.”