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Telehealth Post-Pandemic, LUGPA Update

April 2023

During the COVID-19 pandemic, telehealth services played an essential role in maintaining access to healthcare for millions of Americans. Healthcare providers of all sizes embraced the new technology, and patients widely supported telehealth’s improved access. This expansion was boosted by regulatory changes at the state and federal levels that lowered many of the previous barriers to telehealth expansion.

Unfortunately, at the end of the COVID-19 public health emergency, some of the best regulatory changes for telehealth have been allowed to expire, like telehealth payment parity and cross-state licensing. LUGPA supports bipartisan legislation that would build on the coverage gains made during COVID-19 and make this expansion permanent.

Telehealth Coverage Expansion Extended Past End of PHE

The rapid growth of telehealth and the public’s increasing acceptance of remote care has led lawmakers and CMS regulators to delay their expiration and examine their effectiveness in managing costs and expanding care. In March 2022, Congress extended several of the telehealth coverage expansions implemented during the pandemic, including:

  • Expansion of Originating Sites: This expansion allowed Medicare beneficiaries to receive telehealth services from any location, most notably their homes.
  • Expansion of Eligible Practitioners: This expansion allowed additional providers to provide telehealth service to Medicare beneficiaries previously prohibited from providing remote care, including physical therapists, occupational therapists, speech therapists, and audiologists.
  • Expansion of Telehealth Services and Reimbursement to FQHCs and RHCs: This expansion allows Federally Qualified Health Centers and Rural Health Clinics to continue to be reimbursed by Medicare for providing telehealth services.
  • Delay of Periodic In-Person Visit Requirement for Mental Health Services: This change delayed the implementation of an in-person visit requirement for mental health practitioners which stipulated that providers needed to see patients in person within six months before providing mental health services via telehealth. This requirement would expand to every 12 months after the initial visit until January 1, 2025.
  • Expansion of Audio-Only Services: This expansion allows Medicare coverage of audio-only services, but only in situations that are deemed appropriate and necessary.

The Consolidated Appropriations Act (CAA), signed into law on December 31, 2022, extended many telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. The CAA also requires the HHS Secretary to submit a report to Congress regarding the use of telehealth services by April 2026.

The telehealth extensions and HHS report indicate that Congress, CMS, and HHS are examining data to determine if the telehealth expansion works and could be permanently extended in future legislative or regulatory reforms.

Cross State Licensing and Improved Rural Access to Care

During the PHE, every state and Washington DC temporarily waived several aspects of state licensure requirements, allowing providers with equivalent medical licenses via telehealth in other states. The future status of these waivers differs by state. While some states linked their waivers to the federal PHE, others extended the waiver or made the expansion permanent.

The Federation of State Medical Board Tracking website is here for more information: https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf.

LUGPA’s Recommendations for Regulatory Reform:

  • Remove geographic and originating site restrictions for telehealth: Expanding the definition of “originating site” to mean any site at which an eligible telehealth individual is located at the time the telehealth service is provided, including the individual’s home, would expand access to telehealth by allowing patients to receive care in a location most comfortable and convenient to them. This is especially important for America’s seniors, who may view travel to a doctor’s office as a deterrent to receiving care.  
  • Keep reimbursement rates for telehealth visits at E&M reimbursement rates: Retention of the expanded list of telehealth services outlined in the CMS 1135 waiver and the sub-regulatory processes used to modify the services on the list, including the continuation of Medicare reimbursements for telehealth visits at E&M payment rates, allows physicians to seamlessly continue providing high-quality care to our patients, who have relied on the expanded access to telehealth to continue their treatments and manage their diseases during the COVID-19 pandemic.  

  • Require reimbursement parity for telehealth services: Telehealth payment parity requires insurers to reimburse the same rate for telehealth services as in-person care. During the public health emergency, Medicare paid the same rates for telehealth and in-person care, including audio-only telehealth. Many state governments also mandated telehealth payment parity in Medicaid programs and for private payers. Under current Medicare rules post-pandemic, payment parity has ended. Making payment parity permanent will provide stability and financial certainty for telehealth providers and ensure long-term viability. Action on parity has been slow because the authority to set reimbursement is done through existing CMS authority.

  • Remove coverage limits for asynchronous telehealth: Federal law currently limits Medicare’s telehealth coverage of store-and-forward or asynchronous telehealth. Store-and-forward telehealth is an effective and affordable means of communicating with patients that should be reimbursed at the same level as video conferencing. Embracing this form of care would expand access to underserved areas where video conferencing may not be possible.