A powerful House chairman introduced a bill Thursday that would permanently remove restrictions on where Medicare patients can access telehealth services but would make other telehealth coverage policies only temporary.Rep. Lloyd Doggett (D-Texas), who chairs the Ways and Means Committee's Health Subcommittee, sponsored legislation that would permanently lift a restriction that says patients must live in rural areas and receive telehealth services at participating health facilities for it to be covered by Medicare. Rep. Devin Nunes (Calif.), the senior Republican on the subcommittee, is a cosponsor.
The government has temporarily waived those restrictions during the pandemic, allowing Medicare patients from all over the country to receive telehealth services in their homes in every part of the country. Without congressional intervention, that benefit will end when the COVID-19 public health emergency declaration does.
Lawmakers from both parties and advocates have pushed Congress to permanently eliminate the coverage restrictions before then, calling it an outdated barrier to care.
"Expanded access to telehealth, permitted by emergency waivers, has transformed healthcare delivery—helping patients connect easily and safely with their physicians in a timely manner," Doggett said in a news release. "As the pandemic enters an unpredictable new stage and emergency waivers may expire, patients and providers should not face a cliff of uncertainty."
The public health emergency is set to end in mid-January, but it will likely be extended for at least another 90 days as COVID-19 continues to pummel the U.S.
Congressional staffers and lobbyists expect Congress to act before the end of the emergency so Medicare enrollees don't lose access to telehealth services to which they have become accustomed since last year.
Expanded access to telehealth hasn't been a top priority for lawmakers this year even as Congress advances other healthcare legislation along with President Joe Biden's domestic agenda. Lower-priority items frequently aren't addressed until the last minute, so Doggett's telehealth measure likely will have to wait until next year, perhaps as soon as February when Congress tackles its annual spending bills.
"I would be surprised if the [public health emergency] were to end and nothing has happened" on telehealth, said Christina McCauley, legislative director for Rep. Doris Matsui (D-Calif.), who has worked on several telehealth bills.
Eliminating the geographic and site restrictions is not expected to be controversial. Another bill that would do so has 61 sponsors in the Senate—enough to evade a filibuster and pass. The list of sponsors includes two of the top three GOP leaders in the upper chamber, Sens. John Thune (S.D.) and John Barrasso (Wyo.), who is a medical doctor.
Lawmakers have introduced dozens of bills in the past few years to expand telehealth access, illustrating the broad support for action on the issue. But these measures differ on whether other telehealth services should be covered permanently or just for a few years while data is collected.
The Doggett bill would temporarily extend other emergency authorities for two years after the public health emergency, allowing Medicare coverage of a wider range of providers via telehealth, including occupational therapists and speech-language pathologists.The legislation would also temporarily allow Critical Access Hospitals to continue providing outpatient behavioral therapy services through telehealth and allow payment for audio-only services for two years after the public health emergency.
Some lawmakers and advocates want these changes to be made permanent immediately, but the Medicare Payment Advisory Commission has recommended temporary extensions of so policymakers can evaluate telehealth utilization and efficacy.
Telehealth utilization in Medicare increased massively during the pandemic, from 840,000 visits in 2019 to 53 million in 2020, according to data the Health and Human Services Department released last week. About 92% of those patients received services at home, which was not covered before the pandemic. About one-third of the visits were for behavioral health.
The legislation would also put restrictions on some telehealth services to crack down on potential fraud, including requiring in-person appointments within six months prior to ordering high-cost durable medical equipment or major clinical laboratory tests. Lawmakers pointed to charges the Justice Department brought against telehealth executives and doctors in 2019 for ordering unnecessarily back, shoulder and knee braces as well as cancer genetic tests.
Correction: An earlier version of this article misidentified the commiteee Rep. Lloyd Doggett (D-Texas) chairs.
