Although telehealth has been in use for quite some time, uptake has been low. In particular, an inconsistent policy landscape presents a number of obstacles, such as site restrictions on where telehealth can be delivered, provider restrictions on who can deliver services, and reimbursement restrictions around payment for services.
However, some recently developed policies aim to reduce barriers to telehealth uptake. These policies aim to improve the reimbursement landscape, eliminate antiquated restrictions on how care can be delivered, and promote the development of infrastructure and practices needed to support telehealth.
Legislative Changes to Improve Reimbursement
Some of the policies enacted in 2018 removed geographical criteria that limited reimbursement for telehealth to rural areas and removed requirements around where the patient must be located in order for reimbursement to occur. For example, the Bipartisan Budget Act of 2018 allows non-rural hospitals to be reimbursed as the originating site (where the patient is located) for treatment of acute stroke via telehealth. Similarly, the SUPPORT for Patients and Communities Act added an individual’s home as an eligible originating site for telehealth-based substance abuse treatment.
Oct 3, 2019 Executive Order to Remove Provider Barriers to Telehealth Provision (Exec. Order No. 84 FR 53573)
On Oct 3, 2019, President Trump signed an executive order to protect and improve Medicare for our nation’s seniors. Telehealth was mentioned in three separate sections as part of the plan to improve quality and lower costs. Each of these sections directs the Secretary of HHS to propose regulations in the following areas:
- Section 3: Providing More Plan Choices to Seniors – provide beneficiaries with more diverse and affordable plan choices. This aims to encourage innovation in Medicare Advantage benefit structures and plan designs that promote innovations in telehealth services.
- Section 4: Improving Access Through Network Adequacy – adjust network adequacy requirements for Medicare Advantage plans to account for the enhanced access to health outcomes made possible through telehealth services.
- Section 6: Encouraging Innovation for Patients – propose changes that encourage access to innovation by streamlining the approval, coverage, and coding process to bring products to market faster and ensure appropriate reimbursement. This section explicitly notes telehealth and related technologies as a focus of this effort.
Executive orders do not have the force of law. Rather, they provide guidance to the Department of Health and Human Services to propose rules within a year. Once HHS develops proposals around these items, there will be a public comment period before new rules or guidance take effect.
In addition to the executive order, a few proposed bills in Congress address telehealth, all of which carry bipartisan sponsorship. Some of these also address aspects of the Executive Order.
The CONNECT for Health Act (S. 2741 and H.R. 4932)
The Creating Opportunities Now for Necessary and Effective Care Technologies (Connect) Health Act of 2019 [PDF] was introduced in both the House and the Senate in October of 2019. This bill
would allow the Secretary of HHS to:
- waive telehealth restrictions;
- remove some geographic and originating site (where the patient is located) restrictions;
- allow rural and community-based health centers to provide telehealth services; and
- promote a study to explore ways to expand telehealth services, especially for home health care.
Better Respiration through Expanding Access to Tele-Health (BREATH) Act (H.R. 2508)
The BREATH Act, introduced in the House, proposes a pilot study to allow respiratory therapists to provide services to Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) via telehealth. This three-year pilot would conclude with an evaluation of costs and outcomes.
Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act (H.R. 3417)
The BETTER act proposes to improve care quality and access for Medicare beneficiaries by:
- extending Medicare funding for the National Quality Forum and State health Insurance programs;
- improving beneficiary education; and
- improving the value-based purchasing program for Medicare skilled nursing facilities.
Additionally, this bill proposes to remove the originating site (where the patient is) restriction for behavioral health services.
Expectations for the future of telehealth policy
Policy makers and leaders in the health care industry have recognized the potential impact of telehealth services. As the legislative environment changes, we can expect to see more policy movement towards expansion of telehealth services. We will monitor any changes as they occur.
Saira Haque
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Jordan Albritton