LeadingAge Advocacy Goals
- Advocate for permanent changes to Medicare, Medicaid, and commercial payer telehealth policy based on lessons learned from the pandemic.
- Ensure all aging services providers are included in future permanent telehealth expansions.
- Permanently remove Medicare’s restrictions of patients’ homes as an originating site for audio-only, synchronous audio-only, and asynchronous biometric remote patient monitoring (RPM) and for individuals with chronic conditions living independently, and for individuals with chronic conditions living independently but helped by home health clinicians. Also, promote the use of synchronous audio-video telehealth in skilled nursing homes and assisted living communities.
- Create an equitable payment policy for the post-pandemic era that balances providers’ costs with patient protections.
- Promote the adoption of interoperable electronic health records, including funding and technical support.
- Promote the use of standards-based health information exchange between aging services providers and their partners including primary/acute care providers and payers.
- Ensure equitable internet connectivity for all aging services providers and older adults, including in affordable housing where Wi-Fi access should be federally funded.
- Promote policies that support the use of technology to reduce social isolation.
Health IT Incentives:
Secure government funding for the Office of National Coordinator (ONC) at the U.S. Department of Health and Human Services (HHS) to:
- Establish electronic health record (EHR) Interoperability Certification Criteria/Program relevant to long-term, post-acute care (LTPAC) providers, but aligned, where possible, with the acute care certification program.
- Establish health IT education and training for staff in LTPAC providers, like the Regional Extension Centers (RECs) that supported small physician practices.
- Fund technical assistance resource centers to provide technical assistance for LTPAC providers, like the RECs that supported small physician practices.
- Direct financial incentives for LTPAC Providers (SNFs/NFs, home health, hospice, long-term acute care hospitals (LTACHs), in-patient rehabilitation facilities (IRFs) to:
- Upgrade to interoperable EHR technology;
- Upgrade their infrastructure and broadband connectivity;
- Subscribe and connect to health information exchange entities or networks, and add technically competent staff to support use;
- Conditional Sustainable Use financial incentives/payment modifiers that, tied to quality measures, would be impacted by effective exchange of health information with partners for the next five years.
Access to Broadband:
- Extend the subsidized broadband connectivity rates available for certain health care providers in rural areas under the FCC’s Rural Health Care Program to additional aging services providers by amending the Social Security Act (as was done in the 2015 Rural Connectivity Act, which added nursing homes to the definition of healthcare providers).
- Create funding opportunities for congregate affordable low-income housing providers to collectively apply for and receive broadband internet connectivity to the building and to their residents’ units, to ensure equitable access to services.
THE ISSUE
Massively increased flexibilities, particularly in the Medicare program, making it possible to utilize technology to deliver all types of care became an essential lifeline for our health care system during the pandemic, a time of unparalleled challenges and strains. If there is any “silver lining” to the pandemic, it has been an increase in the use of technology to deliver appropriate and timely care to keep people safe, healthy, and well-connected.
The ability to use telehealth during the COVID-19 emergency was vitally important not only to protecting staff and patients’ health, but also to expanding the reach of overextended health care personnel. Waivers in Medicare rules that allowed the home to be an originating site of care, expanded the types of technology that can be used for telehealth visits (e.g., Facetime and even audio-only in some cases) and expanded the types of providers that can bill for telehealth services were all significant changes from the pre-pandemic state of play and have proven to be valuable in many ways.
The ongoing question is how to capitalize on the progress made and lessons learned during the pandemic, which in many ways has served as the “demo” of telehealth that many have asked for in the past. Concerns for the future include how to make sure that telehealth is incorporated into practice in an equitable, cost-effective (for both the government and providers), and accessible way. What is clear is that we need to continue moving forward.
In addition to making permanent many of the pandemic flexibilities, aging services providers need policies that support their ability to adequately pay their staff. These staff can either deliver interventions, including therapy via under a physician-approved care plan, or can assist a remote physician during an asynchronous telemedicine visit. Moreover, providers need support to maintain and upgrade technology. Hence, they need adequate reimbursement from all payer sources to sustain and maintain the investments they already made in delivering care via telehealth.
Broadband investment, especially in rural and underserved areas, is critical to making sure telehealth is an accessible service nationwide—including in affordable senior housing communities, many of which lack connectivity and where federal investment in wireless internet capability is imperative. Continued investment in broader health information technology to support information management and the secure exchange of health information are also critically important and need to be inclusive of aging services providers.
Finally, those providers who treat patients in their own home—like home health, hospice, and PACE—who have not been able to take full advantage of the affordable internet connectivity like healthcare peers in rural areas, or telehealth in the past, or even the expanded telehealth flexibilities, need to be included.
Advocacy Action 2024
118th Congress
- LeadingAge supports the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (H.R.4189/S. 2016), which addresses many of our policy priorities noted below and supports the use of telehealth models to improve care across the continuum of aging services. LeadingAge joined multiple stakeholders to provide input on this legislation prior to its introduction in both the previous and current Congresses, including the need for federal financial support to ensure nationwide interoperability of Health Information Technology – specifically in the long-term and post-acute care sector. Outside of the coalition effort, we also asked that the CONNECT for Health Act include reimbursement for telehealth in the home health program and that audio only visits count toward risk adjustment for PACE providers. The updated CONNECT for Health Act of 2023 would build on that by expanding coverage of telehealth services through Medicare and making permanent the COVID-19 telehealth flexibilities that the 2023 Consolidated Appropriations Act extended through 2024, including permanently removing all geographic restrictions on telehealth services and expansion of originating sites to include the home and other sites; allowing more eligible health care professionals to utilize telehealth services; removing unnecessary in-person visit requirement for tele-mental health services; and permanently authorize hospice face to face recertification to take place via telehealth.
- Keeping key pandemic flexibilities. We support keeping the following pandemic flexibilities in place permanently:
- Permanently removing the geographic restrictions on telehealth;
- Allowing the home to be an originating site of care beyond the COVID-19 public health emergency (PHE);
- Permanent expansion of the providers who can furnish telehealth services relating to both physical and mental health.
- LeadingAge supports the bi-partisan Expanded Telehealth Access Act (H.R. 3875/S. 2880) which would permanently allow audiologists, occupational therapists, physical therapists, speech language pathologist, and facilities that provide these services to bill these services via telehealth permanently and permits HHS to expand the list of providers.
- Continued flexibility in the type of modality allowable for video-audio connections (e.g., allowing the use of FaceTime or other smartphone technology) to utilize all tools available, including audio-only, to deliver telehealth services as appropriate and look to work with Congress on the intersection of accessibility and privacy (e.g., HIPAA concerns).
- Hospice face-to-face recertification. We support allowing the hospice face-to-face recertification to take place via telehealth on a permanent basis.
- Reimbursement for home health telehealth visits. We support legislative efforts that allow virtual home health visits to be reimbursed under Medicare with appropriate guardrails.
- PACE and telehealth. We support legislation that would allow audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustment to payments for PACE and Medicare Advantage programs.
- Housing and technology. We support federal funding for the installation and service fees for wireless broadband internet in all HUD-assisted senior housing community units.
- Meaningful use. Aging services providers were not included in previous funding efforts that supported health care providers’ transition to electronic health records (EHR) systems that contain the medical and treatment histories of patients. We will continue to advocate for funding and payment incentives, including incentives tied to quality, to assist aging services providers in accessing EHR technology that is interoperable with that of their physician and hospital partners and peers and encourage the bi-directional exchange of information.
- Affordable rural internet connectivity foraging services providers. We support legislative action aimed at expanding the scope of the 2015 Rural Healthcare Connectivity Act, which added nursing homes to the definition of healthcare providers that may access subsidized broadband connectivity, to include home health, hospice, and other aging services providers in the home and community. Such action would allow all aging services providers to benefit from lower internet connectivity costs offered to acute care and nursing homes.
Executive Branch
- CMS-commissioned study on telehealth services. HHS announced in a December 2021 research report massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic. The report also provides insights into telehealth visits conducted in 2020, which increased 63-fold from approximately 840,000 in 2019 to 52.7 million. Additionally, the report found: specialists such as behavioral health providers saw the highest utilization relative to other providers; telehealth services were accessed more in urban areas than rural communities; and Black Medicare beneficiaries were less likely than White beneficiaries to utilize telehealth. In light of this report, LeadingAge encourages CMS to continue to focus on improving health equity in telehealth services as highlighted by the COVID-19 PHE and to expand access among underserved populations.
- CMS Extension of Telehealth Flexibilities. LeadingAge supported CMS’s inclusion in the Calendar Year 2024 Physician Fee Schedule Final Rule of regulations implementing the extension of various COVID-19 PHE telehealth flexibilities (in alignment with the Consolidated Appropriations Act of 2023) through December 31, 2024. Among others, these flexibilities include:
- temporarily removing geographic and site requirements for the patient location at the time a telehealth interaction occurs, allowing beneficiaries to receive services at home.
- temporarily allowing a more expansive list of eligible providers in Medicare to provide services via telehealth such as physical and occupational therapists; and
- temporarily allowing outpatient therapy services delivered by institutional providers—including skilled nursing facilities, and home health agencies (to individuals who are not homebound) —to be furnished via telehealth, including to beneficiaries in their homes.
- LeadingAge will continue to advocate for CMS to review the telehealth and technology waivers established during the PHE to identify which can be made permanent without Congressional action, including utilization of telehealth for hospice routine home care visits and flexibility in licensure requirements in the Medicare and Medicaid program.
- Remote patient monitoring. LeadingAge will work to ensure that all appropriate aging services providers can utilize and bill for asynchronous remote patient monitoring, which is critical and effective tool to support the health of individuals with chronic conditions.
- Advocate for the creation of claims codes or modifiers to document hospice virtual visits. Hospice providers utilized telehealth for routine home care during the COVID-19 PHE. We will advocate for the creation of claims codes or modifiers that will allow for the analysis of these encounters for a variety of purposes including quality measurement.
- Advocate for the use of data from new claims codes documenting home health virtual visits. Home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the analysis of the recently created G-Codes for these encounters for a variety of purposes including quality measurement.
- Advocate for allowing home health nurses to bill for services. Therapists and other appropriately licensed professionals are allowed to use telehealth and home health agencies to bill for such services beyond the pandemic. Remote patient and medication adherence monitoring improve chronic care management, reduce hospitalizations, hospital stay, and readmissions, and consequently reduce cost. Chronic care management reimbursement codes currently exist for physicians, physician assistants, and nurse practitioners, but are woefully underutilized. We will advocate for the creation of claims codes or modifiers that will allow the appropriate staff at home health agencies to perform, and for agencies to bill for, a variety of appropriate chronic care management and therapy interventions approved by a physician’s plan of care using telehealth, including remote patient and medication adherence monitoring technologies.
- Make demonstrations include telehealth. New and current CMS demonstrations should include waivers to allow for the broad utilization of telehealth and technology. We will advocate for CMMI to continue to build the evidence for the role these areas will continue to play in healthcare delivery.
- Affordable Connectivity Program. Ensuring that all older adult federally assisted housing residents have access to quality, affordable internet is an on-going policy priority. In August 2023, HUD and the Federal Communications Commission (FCC) announced a new partnership to urge HUD-assisted residents to enroll in the Affordable Connectivity Program (ACP), which provides discounts on monthly internet service, and LeadingAge will continue to advocate for HUD to streamline enrollment of HUD multifamily residents in the ACP.
- Tele-Prescribing of Controlled Medications. In response to COVID, the Drug Enforcement Agency (DEA) granted temporary exceptions under the Ryan Haight Online Pharmacy Consumer Protection Act that allowed healthcare providers to prescribe certain controlled substances via telemedicine without the need for an in-person examination, for the duration of the COVID-19 PHE. The DEA has issued a temporary rule extending these flexibilities through November 11, 2024. However, the agency is working to finalize a separate, permanent rule that, as proposed, would be more restrictive than the flexibilities in place during the PHE. LeadingAge is advocating for DEA to allow patients enrolled in hospice and palliative care, as well as nursing home residents, to be included in the exemptions as authorized under the Ryan Haight Act.
ACTIONS YOU CAN TAKE NOW
- Visit the Advocacy Action Center to identify opportunities to let your Representative and Senators know your views on eliminating barriers to the utilization and expansion of telehealth services in the Medicare program and other technology policy issues.
- Host Congress in Your Neighborhood to help your Members of Congress understand how policies related to technology and telehealth models in Medicare affect older adults.
ADDITIONAL RESOURCES
