Policy Update: Recent Developments in Telehealth Regulation

May 2024

Telehealth has rapidly emerged as a crucial component of healthcare delivery, especially in light of the COVID-19 pandemic. As regulatory frameworks evolve, policymakers strive to balance patient access with quality care and regulatory oversight.

On May 6, the House Committee on Ways & Means introduced legislation, H.R.8261, the Preserving Telehealth, Hospital and Ambulance Access Act, to extend Medicare telehealth flexibilities for two years. This bill, led by Rep. David Schweikert (R-AZ), aims to maintain key telehealth provisions such as allowing telehealth visits from anywhere, delaying in-person requirements for telemental health, and extending audio-only telehealth. It also includes a five-year extension for the Hospital at Home waiver program. The bill is moving quickly and was passed out of the Ways & Means Committee on May 8; it received unanimous bipartisan support (41-0) and advanced to the House Floor.

Here are several of the provisions outlined in the Preserving Telehealth, Hospital, and Ambulance Access Act for the Medicare program:

Removal of originating and geographic site restrictions for Medicare telehealth services until December 2026.
Expansion of the types of providers authorized to furnish telehealth until December 2026.
Extension of telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs) until December 2026.
Postponement of the in-person visit requirement for telemental health services until January 2027.
Permission for rural health clinics to continue offering telemental health services until January 2027.
Continuation of the ability to bill for audio-only telehealth until December 2026.
Prolongation of the use of telehealth encounters before recertification of eligibility for hospice care until December 2026.

Significantly, the bill also includes various measures to counterbalance its effects, such as introducing delinking policies in Medicare Part D and enhancing transparency/reporting. This provision, which disconnects PBM compensation from drug prices in Part D, mirrors language approved by the Senate Finance Committee and Energy & Commerce Committee. Nearly all members supported eliminating the distorting incentives of PBMs and adopting delinking policies, with several advocating for similar actions in the commercial market. Other committee members voiced apprehension that delinking measures might escalate premiums and disrupt the pharmaceutical market, potentially leading to higher prices for seniors.

The bill is just one part of ongoing efforts in Congress to expand and regulate telehealth services amid the COVID-19 pandemic. Several legislative proposals to modernize telehealth regulations in Congress were discussed in an earlier House Energy and Commerce Committee hearing on April 10th.

At the hearing, reviewed by LUGPA’s team in Washington DC, experts discussed potential legislation to expand and safeguard telehealth, including addressing Medicare billing and misuse concerns. Members expressed unanimous support for telehealth's significance and discussed bills like the Telehealth Modernization Act.

Concerns about the overuse of telehealth were raised by Subcommittee members, emphasizing the need for CMS and Medicare to access more data. Discussions also focused on making telehealth permanent, with concerns about temporary extensions impacting patient reliance and investment in crucial resources like hospital-at-home and telephysical therapy.

The subcommittee discussed several bills; the most prevalent of those was H.R. 7623, The Telehealth Modernization Act of 2024. Introduced by a bipartisan group of Representatives, H.R. 7623 seeks to modernize telehealth regulations. This bill aims to expand telehealth services, improve reimbursement mechanisms, and address regulatory barriers to telehealth adoption. It is a significant step toward ensuring broader access to telehealth services for patients nationwide.

In May, an Amendment in the Nature of a Substitute (AINS) to this bill was unanimously approved by the Committee with a 21-0 vote. It extends crucial telehealth flexibilities through the end of 2026 and incorporates PBM reforms from the Protecting Patients Against PBM Abuses Act. These reforms include banning patient steering and spread pricing, increasing transparency, and addressing conflicts of interest within the PBM industry.

Other Legislative Proposals:

H.R. 134: This bill aims to amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services. By eliminating geographic restrictions, this bill seeks to enhance access to telehealth services for patients residing in underserved and rural areas.
H.R. 1110: The KEEP Telehealth Options Act of 2023 focuses on preserving patient telehealth options. This bill aims to ensure that patients continue to have access to telehealth services even after the COVID-19 public health emergency ends.
H.R. 3875: The Expanded Telehealth Access Act aims to broaden access to telehealth services by addressing regulatory barriers and expanding coverage for telehealth visits.
H.R. 4189: The CONNECT for Health Act of 2023 focuses on leveraging telehealth to improve access to healthcare, particularly for underserved populations. This bill aims to promote telehealth adoption and remove barriers to its implementation.
H.R. 5611: The Helping Ensure Access to Local TeleHealth (HEALTH) Act of 2023 seeks to ensure that patients can access local telehealth services. This bill aims to improve access to care for patients in rural and underserved areas by enhancing local telehealth infrastructure and support.

As telehealth continues to play an increasingly vital role in healthcare delivery, policymakers must collaborate to modernize regulatory frameworks and ensure equitable access to telehealth services for all patients. LUGPA will continue to monitor Congress for any reforms that will affect telehealth and how our members can incorporate these services into their practices.