Hearing: Charting the Path Forward for Telehealth

Legislation | April 30, 2021 | by Andrea Price-Carter

The House Ways and Means Subcommittee on Health held a hearing on April 28, 2021, on “Charting the Path Forward for Telehealth” which highlighted how telehealth has been prominently used during the pandemic. The hearing provided an opportunity to determine how telehealth will be preserved.

The House Ways and Means Subcommittee on Health held a hearing on April 28, 2021, on “Charting the Path Forward for Telehealth.”

Subcommittee Chair Lloyd Doggett (D-TX), highlighted how telehealth has been prominently used during the pandemic, and the hearing provided an opportunity to determine how telehealth will be preserved. “For Medicare, this transformation was made possible thanks to waivers granted by CMS to cover 144 telehealth services during the Public Health Emergency,” said Chair Doggett in his opening statement. “This flexibility allowed for a rapid and prolific expansion of services for 24 million Medicare beneficiaries last year from mid-March to mid-October, alone. With CMS telehealth waivers currently extended through year end, we need a plan to assure no abrupt suspension.”

Rep. Devin Nunes (R-CA), ranking Republican on the Subcommittee, in his opening remarks said, “CMS data shows that early in the COVID-19 pandemic, the national weekly average of telehealth users jumped from 13,000 per week to around 1.7 million, which was largely due to the unprecedented increase in telehealth flexibilities provided by Congress and the previous Administration during the COVID-19 emergency.” Rep. Nunes said, “CMS waived geographic restrictions to benefit patients nationwide, removed originating site restrictions which allowed beneficiaries to communicate with their doctor from their home. In addition, CMS expanded the telehealth options, which include video conferences on a connected portal, FaceTime calls, and changes to temporarily covering audio-only calls.”

Bipartisan support for telehealth as a tool that can improve access to care and expanding access after the public health emergency (PHE) was on display during the Subcommittee hearing. Chair Doggett announced during the hearing that he plans to introduce a bill to extend existing telehealth waivers beyond the PHE. Additionally, there is strong support within the Subcommittee for permitting MedPAC and HHS to evaluate the impact of the telehealth during the pandemic, on health care delivery, Medicare spending and utilization as well as to assessing the quality of care delivered in order to provide evidence-based recommendations to Congress, prior to making recommendations for permanent changes to Medicare.

Prior to the Subcommittee hearing, LeadingAge urged Subcommittee members to elevate support for “The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act,” which would permanently expand access to audio-only telehealth for MA and PACE individuals who cannot access the video component during telehealth visits during the COVID-19 pandemic, during the hearing. LeadingAge also urged members to highlight the need for providing a reimbursement for Medicare home health and PACE to access telehealth payments, and providing parity for all visits and provider types.

Multiple lawmakers asked about the appropriateness of permanently extending pandemic protections for audio-only telehealth for enrollees who cannot access the video component during telehealth visits. One witness, Ateev Mehrotra, M.D., Associate Professor of Health Policy and Medicine, Harvard Medical School, said “My concern is that this research has been used to support the idea that all forms of telemedicine are safe and therefore should be reimbursed. Telemedicine video visits are limited by the inability to complete a full physical exam and obtain ancillary testing. Though data comparing phone visits to video visits are limited, there are reasonable concerns that in many clinical situations the lack of visual input will result in inferior care through a phone visit.”

There was considerable attention during the hearing on how the U.S. is plagued with persistent health inequities that can inflict worse health on and shorten the lives of Black, Latinx, Asian Americans, Pacific Islanders and American Indians, and how the coronavirus pandemic brought new challenges to these communities. Several lawmakers wanted to ensure that any additional broadening of telehealth works to reduce long-standing health inequities, and does not unintentionally exacerbate them. Suggested steps to achieve this goal raised at the hearing include ensuring that appropriate tools and incentives are implemented to safeguard taxpayers and patients from fraud or overutilization while transitioning to value-based models of care delivery and reimbursement. And making sure communities can access broadband were also topics that were addressed.

A full House Ways and Means Committee markup on telehealth proposals that have been put forward by the Committee’s members is expected to take place this spring.

During the 117th Congress, LeadingAge will continue to advocate for the following telehealth policies:

  • The CONNECT for Health Act of 2021, which would permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. It would permanently allow hospice providers to perform the face-to-face recertification via telehealth and also require a study to learn more about how telehealth has been used during the current COVID-19 pandemic.
     
  • The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act, which would allow PACE organizations to make risk adjustment submissions for participants based on audio-only telehealth visits and audio-only telehealth services to MA enrollees. Additionally, the bill would ensure that providers will be adequately compensated by requiring MA plans to reimburse them for audio-only telehealth visits as if they were in person visits unless both parties have agreed to a separate payment policy.
     
  • The Home Health Emergency Access to Technology (HEAT) Act, which would provide payments for home health services furnished through visual or audio telecommunications systems during a public health emergency. It would put in place appropriate guardrails, and create a system to determine equivalency between in-person and virtual visits.