By Sean Slone, CSG senior policy analyst
This is the first in a series of reports on how telehealth is being impacted by policy changes and investments during the coronavirus pandemic. Future articles will address state policy activities, continuing challenges for telehealth access, how telehealth is impacting care during the crisis and whether the changes of the last few weeks will survive the pandemic to reshape telehealth’s future.
While the concept of telemedicine has been around for more than a quarter century, its adoption by patients and doctors alike has been relatively slow to evolve and a patchwork of state and federal regulations governing it—not to mention an underdeveloped technology infrastructure—has made it difficult to overcome that hesitation. But it appears the extraordinary circumstances presented by the pandemic could be changing that. Actions taken by Congress and a number of federal government agencies over the last two months are helping to advance the accessibility of telehealth during a time when in-person doctor visits are fraught with public health concerns.
Medicare Changes Lead the Way
The Center for Medicare and Medicaid Services (CMS) stepped in early to change Medicare rules so that telemedicine could replace in-person visits to reduce the spread of coronavirus among beneficiaries, which by definition make up one of the most high risk populations in the pandemic.
“This created a huge opportunity for telemedicine companies to serve a large and brand-new market,” writes Dr. Bob Kocher in Fast Company. Kocher was recently chosen by California Gov. Gavin Newsom to serve on the state’s public-private coronavirus testing task force. “Under this new waiver, Medicare now pays for telemedicine at the same rate as in-person visits. Previously, Medicare had strict requirements for telehealth, requiring that patients live in a rural area and travel to a local medical facility to conduct a virtual visit, and generally not allowing patients to receive telehealth services in their home.”
Various actions taken during the pandemic have addressed location and licensing requirements, allowable services and telehealth modalities, all of which have been seen as barriers to greater telehealth access in recent years.
The expansion of telehealth coverage to Medicare beneficiaries regardless of location was part of the emergency funding bill signed by the President on March 6, which also included $500 million in waivers for Medicare telehealth restrictions.
In the national emergency declaration on March 13, the Department of Health & Human Services (HHS) was given the authority to waive federal licensing regulations to permit out-of-state physicians to treat patients via telehealth in states with large COVID-19 outbreaks.
The President further expanded the allowable telehealth services for Medicare beneficiaries on March 17 and March 30. Previously the only way that would have happened would have been through the CMS rulemaking process.
For as long as the COVID-19 emergency lasts, CMS is waiving limitations on the types of clinical practitioners that can provide telehealth services under Medicare. Previously, only doctors, nurse practitioners, physician assistants and certain others could deliver telehealth services. The waiver allows other practitioners including physical therapists, occupational therapists and speech language pathologists to provide services as well.
In addition, hospitals can now bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home.
Medicare is also paying for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. CMS notes that some Medicare beneficiaries don’t have access to interactive audio-video technology for other telehealth modalities or choose not to use it even if offered by their practitioner. Waiving the video requirement and allowing the audio-only option expands access to these beneficiaries.
HHS, FCC, USDA Expanding Telehealth Access
Elsewhere, the federal government is also seeking to invest in the technologies necessary to make telehealth even more accessible.
The $2 trillion Coronavirus Aid, Relief and Economic Security (CARES) Act, approved by Congress on March 27 allocated $185 million to support telehealth programs for rural critical access hospitals administered by the Health Resources & Services Administration (HRSA).
HRSA’s Maternal and Child Health Bureau recently awarded a total of $15 million to four recipients to increase telehealth capability, capacity and access to distant care services for providers, pregnant women, children and families. Recipients included the American Academy of Pediatrics and the Association of Maternal and Child Health Programs. An additional $5 million from HRSA’s Federal Office of Rural Health Policy will go toward helping telehealth clinicians nationally on licensure and credentialing needs by funding programs through the Association of State and Provincial Psychology Boards and the Federation of State Medical Boards of the United States.
Just over $800,000 went to 12 regional and two national centers that make up the National Consortium of Telehealth Resource Centers and will be used to provide technical support in technology acquisition, payment policy, system design and licensing and credentialing, according to mHealth Intelligence.
The Federal Communications Commission on April 2 voted to adopt a program that will provide $200 million to equip healthcare providers with telehealth technology and implementation support. The funding was included in the CARES Act. Under the program, hospitals and health centers can apply for up to $1 million to cover the costs for internet-connected monitoring devices, broadband connectivity and telecommunication services. Eligible organizations include medical schools and academic teaching hospitals, nonprofit hospitals, rural health clinics, community health centers and long-term care facilities. Facilities in New York City, Newark, Del., Annapolis, MD, Atlanta, Cleveland, Pittsburgh, New Orleans and Baton Rouge, LA are among those that have already received funding, mHealth Intelligence reported.
Delaware’s ChristianaCare, a two-hospital health system, is using a $700 thousand grant to expand telehealth services in underserved parts of the state and ensure the broadband infrastructure for a home-based connected health program, according to mHealthIntelligence.
A network of federally qualified health centers in Massachusetts that received funding from the program plans to use their million-dollar grant to expand telehealth programs to improve care management not only during the pandemic but once the emergency is over.
In addition, the FCC plans to distribute as much as $9 billion through the Universal Service Fund to establish 5G wireless broadband connectivity in rural parts of the country as part of the 5G Fund for Rural America.
The FCC also has a longer-term program called the Connected Care Pilot Program to study how telehealth could be be a permanent part of the agency’s Universal Service Fund. The program will allocate $100 million over the next three years to help defray the cost of telehealth services among health care providers. The goal of the program is to benefit underserved populations, especially low-income residents and veterans.
“We’ve been funding connections to hospitals (and) we’re going to keep doing that, but what the CARES Act did was give us the funding to stand up a new connected care proceeding, and that is about those connections to people in their homes,” FCC Commissioner Brendan Carr said recently. “It makes total sense right now — with COVID, we don’t want people going to a facility unless they need that type of care.”
The U.S. Department of Agriculture last month announced a second window for rural healthcare providers to apply for telemedicine grants under the agency’s existing Distance Learning and Telehealth program, which issued 74 grants for telehealth programs last year. In addition, a USDA rural development program was bolstered by $25 million from the CARES Act.
It appears likely that broadband expansion, which could benefit not only telehealth but also distance learning and telework as well, could stay on the agenda for Congress and the federal agencies in the months ahead. Roll Call reported recently that House Democrats are pushing for $86 billion in broadband funding in the next COVID-19 relief bill.