Lawmakers and rural advocates are optimistic that pandemic-era Medicare flexibility for telehealth services can be extended by Congress before a March 31 deadline.
Congress gave Medicare more options to finance telehealth services during the COVID-19 public health emergency. While the emergency declaration has ended, some flexibility was extended through last Dec. 31.
But last year's short-term extension legislation pushed the expiration to March 31. Some members hoped to include a two-year extension of these flexibilities in the end-of-year stopgap funding bill, however, that provision was removed along with several other policy riders after Elon Musk and Donald Trump, then the president-elect, came out against the legislation.
Now, without congressional intervention, the flexibility could end. However, rural health advocates and lawmakers note there is bipartisan support for a full two-year extension.
The specific policies set to expire in the coming months include a removal of geographic originating site restrictions and a policy allowing federally qualified health centers and rural health clinics to be distant site providers. Authority for some Medicare telehealth visits to use audio-only technology also is set to expire.
Over the last several years, these expanded provisions have proven beneficial, particularly for rural health providers and patients.
Rural communities often face greater shortages in health care providers and longer distances to access care. Ability to access services remotely through telehealth is really important to small-town residents, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association.
Rural hospitals tend to use telehealth for more specialized services, like radiology, emergency or trauma-related care, and behavioral health, she added.
“There’s lots of ways that telehealth has really, really improved care and enhanced people’s access in the last several years,” Cochran-McClain said.
Former Sen. Heidi Heitkamp, D-N.D., said there’s longstanding bipartisan understanding that telehealth, particularly tele-mental health services, are critical for rural communities. These areas are “dramatically” underserved when it comes to mental health professionals.
“If I want to lose 30 pounds, I can cut off my leg. It’s not exactly a strategy for success,” Heitkamp said. “What we see is all these ideas for cost savings that will have a dramatic effect on the availability of services but also could be life and death for people in rural communities.”
Cochran-McClain said conversations on the Hill and among advocates have focused on a two-year extension of Medicare telehealth. The December continuing resolution allowed rural health clinics to be reimbursed at a higher rate for telehealth services. She hopes to see that in the extension.
She said while telehealth use increased during the pandemic, rural communities often had lower uptake because of the limited resource base to invest in long-term telehealth systems.
Cochran-McClain said NRHA would like to see the flexibilities be made permanent. However, like anything in the Medicare program, these policy changes would cost money. The two-year extension could give Congress time to find funding to make these permanent.
Generally, she believes there is bipartisan support for telehealth in rural areas, and cited the enthusiasm of Senate Majority Leader John Thune, R-S.D., for the service. There are some things advocates need to educate lawmakers on, such as audio-only telehealth technology.
“There's certain elements of the conversation where there's a little bit less support, a little bit more skepticism,” Cochran-McClain said. “We still know it's really important."
She is optimistic that a two-year extension could be included in a spending package that Appropriations committees agree to ahead of the March 15 deadline.
House Appropriations Chair Tom Cole(AP Photo/Jacquelyn Martin, file) House Appropriations Chair Tom Cole, R-Okla., said Tuesday that his Democratic counterparts are negotiating in good faith and the two sides are fairly close on top-line funding levels.
Cole said he said he would like to have a deal by March 15, but he said a short-term continuing resolution to allow subcommittees to finalize individual spending bills may be necessary. There’s also discussion of a year-long CR, which Democrats have warned they would vote against.
He said the telehealth provisions still need to be negotiated but he supports including them in the funding bill.
“I think telehealth is one of the good things that really got boosted during COVID and it’s a huge benefit for my district, so much of which is rural, where people really can reach folks in small communities where obviously they don’t have the medical professionals that you’ve got in the metropolitan area,” Cole said. “So, all for it.”
On the Senate side, Sen. John Hoeven, R-N.D., said there’s support for extending the telehealth flexibilities as they leverage resources in rural America and generally “makes sense.”
“It’s just the when and how,” Hoeven said. “We’re going to keep it going, it’s just which vehicle.”
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