Telehealth Supporters See Little to Celebrate in Pandemic Relief Bill

Telehealth advocates aren’t impressed with the lack of support for connected health services in the latest pandemic relief package.

While the $900 billion bill, passed by Congress and signed by President Donald Trump shortly before Christmas, does include funding for broadband expansion – including the Federal Communications Commission’s COVID-19 Telehealth Program – and Medicare coverage for telemental health and telehealth at rural hospitals, it doesn’t extend telehealth access and coverage provisions enacted during the coronavirus pandemic.

Organizations like the American Telemedicine Association, Alliance for Connected Care and Connected Health Initiative, healthcare providers and dozens of lawmakers had lobbied to make at least some of those emergency provisions permanent. But those calls were largely ignored.

“The noticeable lack of permanent reform or a guaranteed extension of the telehealth flexibilities in this relief package is disheartening for the millions of Americans who relied on telehealth to access care, and our healthcare providers still on the frontlines of the pandemic,” ATA CEO Ann Mond Johnson said in a press release issued a day after Trump signed the bill. “We believe arbitrary restrictions on telehealth must be permanently removed to make way for a modernized and more accessible healthcare system.”

To be fair, the news wasn’t all bad. The bill did add critical access Hospitals (CAHs) and small, rutral hospitals with less than 50 beds to the list of sites eligible for reimbursement through Medicare for certain telehealth services, opening the door to the expansion of telehealth services in parts of the country where access is a challenge. And it eliminates geographic restrictions for the mental health treatment delivered via telehealth, while also allowing patients to be treated in their homes.

The bill also increases funding for a variety of programs aimed at expanding broadband to underserved regions and populations, including the FCC’s COVID-19 Telehealth Program, Broadband Infrastructure grant program and Tribal Broadband Connectivity Program, and it adds $60 million to the Department of Agriculture’s Distance Learning and Telemedicine grant program.

Those provisions were met with approval, and also some disappointment. Critics noted the Centers for Medicare & Medicaid Service still has a strict definition for “rural,” and it limits what telehealth services can be provided to rural sites. And the telemental health coverage comes with the condition that patient and provider meet in person within six months of the first telehealth session and have in-person exams at regular intervals.

“We are disappointed that the telemental health provision includes an in-person requirement, as we strongly believe a provider-patient relationship can be established via telehealth,” Johnson said in the ATA’s press release. “Particularly in light of the crippling provider shortage, this in-person pre-existing relationship requirement will unnecessarily deprive Medicare beneficiaries of telemental health options, and we are hopeful Congress will remove this provision in the near future.”

“While this provision would expand access to tele-mental health care, we are very disappointed to see an in-person requirement added to statute,” the Alliance for Connected Care added in a separate news release this week. “Years of telehealth advocacy have been devoted to removing these restrictions. Adding an in-person requirement prevents people that are homebound, transient, or have existing healthcare access challenges from using telehealth – really negating so much of the value that telehealth creates in helping people that NEED expanded access to care.”

On a more positive note, the bill adds $6.5 million to the Telehealth Centers of Excellence program and directs the program to take on HIV prevention, care and treatment. It also provides $1 million for a national study of rural telehealth investments, and it encourages the Substance Abuse and Mental Health Services Administration (SAMHSA) to support the use of telehealth in tackling the nation’s opioid abuse epidemic.

It also urges the US Drug Enforcement Administration to follow through on a long-delayed pledge to create a special registration process to allow healthcare providers to prescribe controlled substances via telehealth for substance abuse treatment. That registration process was included in the Ryan Haight Act of 2008 and reinforced by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act in 2018.

Telehealth advocates and lawmakers have lobbied the federal government to create that registration process, and the Trump administration had said it would do so, but no action has been taken.

Supporters are now focusing on the more than a dozen bills still before Congress, and hoping that the administration of President-elect Joe Biden and a new Congress will pick up the slack.

“We applaud Congress for starting down this path this year but urge state and federal lawmakers to take definitive measures next year to act on permanence,” Johnson said. “There is still much work to be done to set the course ahead for access to telehealth following the PHE. The ATA remains optimistic that we will see movement in the new Congress during the months ahead and will continue to work to ensure access to telehealth becomes a permanent modality in a hybrid delivery system that includes both in-person and virtual care.”