The American Telehealth Association is working with Congress and several federal agencies to shape the fate of policies and payments for telehealth services that experienced a rapid uptake during the COVID-19 pandemic.

WHY IT MATTERS

Now that President Joe Biden has declared the COVID-19 pandemic over, the ATA's Telehealth Awareness Week policy update webinar explored how federal and state telehealth policies may be affected as Congress decides whether or not to end the public health emergency (PHE).

Federal priorities for telehealth have evolved with the pandemic with restrictions lifted by a Congress deciding if the limiting of certain restrictions should be lifted permanently. 

The PHE must be reviewed every 90 days, so Congress will have to revisit the renewal by mid-October, according to policy experts presenting during Wednesday's online event.

"As we know, [President] Biden has said in recent days that the pandemic is over, so it's possible that the technical public health emergency might expire sometime in the very near future," said Megan Herber, director at Faegre Drinker who advises ATA and ATA Action on all things Federal policy. 

Telehealth payments and provider practices are highly regulated on the Federal level, said Quinn Shean, strategic advisor at Tusk Ventures and the state policy advisor for ATA and ATA Action.

But even if providers do not serve Medicare populations, "Medicare policy trickles down," added Herber.

For example, before the pandemic, patients had to be in a rural area in a hospital or clinical setting to receive reimbursement for telehealth.

"That is the current status quo right now – as long as the COVID-19 public health emergency is in place," Herber explained. But in about five months, "all of those waivers go away automatically unless Congress does something."

Approaches to policy can be different in different contexts, noted moderator Alexis Gilroy, co-leader of the healthcare and life sciences practice at Jones Day. "Where do you come at it based on the particular lane it sits in?"

In terms of state-level telehealth policy, there are multiple state priorities because states differ in their approaches to telehealth coverage requirements for public and private health plans, reimbursement for services provided via telehealth, and eligibility to deliver reimbursable services.

States also differ in how they regulate synchronous and asynchronous telehealth and remote patient monitoring. They vary on which types of providers can deliver telehealth, what establishes a valid patient/provider relationship and if out-of-state practitioners can treat patients in the state remotely without a license, explained Shean.

"We have a patchwork of 50 different state requirements here," she said.

The ATA has been focused on developing a consistent regulatory framework so telehealth can be deployed across states and fully leveraged. 

"The ATA is committed to modality-neutral policies," instead of dictating which tools clinicians choose to use to deliver telehealth, she said. ATA is pushing for fair payment for telehealth and home health as well as licensure flexibility across state lines.

"It's really aligning our state frameworks with the 21st Century care model," and the states are moving quickly, she said. There have been hundreds of pieces of legislation to update state telehealth policies.

The organization is also working with the U.S. Drug Enforcement Agency and Congress to address the future of online prescribing of controlled substances.

Many of the barriers to telehealth policy have been based on perceptions that telehealth is somehow substandard and that romanticizes in-patient care, but telehealth has often delivered care where there was no prior access to healthcare, said Shean.

"We need to recognize the access gaps that telehealth can fill" and recognize the guardrails that are in place with telehealth as they are with other care settings, said Shean.

As more retail providers like CVS, Amazon and others enter the space through mergers and acquisitions, they will also have an impact on the direction of telehealth policy, including how to protect the patient data these companies will have more access to.

But with more stakeholders pushing for telehealth on the state level, "having a broader tent now helps show the different patient populations that can be served here and brings more focus," Shean pointed out.

THE LARGER TREND

Under the CARES Act, Congress granted the Centers for Medicare & Medicaid Services authority to waive certain restrictions for Medicare coverage of telehealth.

The agency was able to remove geographic restrictions, expand care at home, increase the amount of Medicare-covered services via telehealth and more.

Additional legislative proposals, including the Telehealth Benefit Expnasion for Workers Act, Telehealth Extension Act and others, suggest broadening access to telehealth.

"Throughout the pandemic, telehealth has proven to be a vital tool for Americans to receive timely and quality care from their own home," said Tim Walberg, R-Mich, during the bill's introduction at the Capitol in March. 

"For rural communities in particular, telemedicine has helped remove barriers to care, expand access to specialists and improve health outcomes."

ON THE RECORD

"There is urgency [for Congress] to act – don't wait until four months and 20 days after the pandemic ends; we need some stability," said Herber.

"We'd love to make it permanent, and a lot of these policies we have been asking for since before the pandemic, so it's not really new," she concluded.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS publication.