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On March 13, 2020, President Trump declared a national state of for COVID- 19, initiating the expansion of Medicare’s telehealth benefits under the section 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.4

The Centers for Medicare & Medicaid Services (CMS) worked with Congress to waive Medicare’s restrictions on telehealth utilization, such as geographic restrictions and provider reimbursement. Prior to the public health emergency (PHE), an average of 13,000 fee-for- service (FFS) Medicare beneficiaries received telehealth services per week. At the end of April 2020, the number of FFS beneficiaries receiving telehealth services per week reached 1.7 million.

The flexibilities that Congress expanded in order to increase patient access to telehealth services during the COVID-19 Public Health Emergency were extended through the end of 2024 in the Consolidated Appropriations Act of 2023. Additionally, CMS has also continued certain telehealth regulatory flexibilities to align with the statutory extensions. Notable flexibilities that are set to expire at the end of 2024 include:

– – The ability for Medicare patients to receive telehealth services in their home;
– – Removal of geographic restrictions for originating site for non-behavioral/mental telehealth services;
– – Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are permitted to serve as a distant site provider for non-behavioral/mental telehealth services;
– – The ability to deliver certain non-behavioral/mental telehealth services using audio-only communication platforms;
– – Removing the requirement for an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter; and
– – Allowing telehealth services to be provided by all eligible Medicare providers.

During an hours-long House Energy and Commerce subcommittee hearing this week, lawmakers considered 15 different legislative proposals surrounding telehelath access, noting changes in Medicare will impact decisions of private insurers.

There’s an urgent need to extend these flexibilities because it’s going to run out,” said Rep. Anna Eshoo, D-Calif. “We need to take action on this.”

Lawmakers lauded the benefits of telehealth during a hearing Wednesday, but House members also raised questions about cost, quality and access that still need to be answered as a year-end deadline looms. As a December deadline draws closer, legislators are working to hash out details about extending or making pandemic-era telehealth flexibilities in Medicare permanent.

Telehealth offers promising support to providers struggling to keep pace with current workforce shortages. The Health Resources and Services Administration (HRSA) projects a shortage of 139,940 physicians by 2036. Currently, there are 39.8 primary care physicians per 100,000 people in rural areas, compared to 53.3 primary care physicians per 100,000 people in urban areas

Telehealth and remote patient monitoring can help alleviate some of these workforce challenges. According to a 2022 survey, 8 in 10 practitioners reported that retaining telehealth for health care practitioners would make them more likely to continue working in a role that maintains flexibility.

According to the testimony at Wednesday’s hearing of Eve Cunningham, M.D., group vice president and chief of virtual care and digital health at Renton, Washington-based Providence health system said: “Telehealth has become an integrated part of Providence’s care delivery system making up about 20% of ambulatory care visits. Telehealth services are deployed across 93 acute care hospitals, including 42 hospitals from other health systems, and two high schools, with more than 1.2 million telehealth visits annually,”

“Telehealth is no longer a nice to have, but a core function of our healthcare delivery,” Cunningham said. She added, “Telehealth expands access to high-quality, coordinated care to more people in more places. Telehealth enables us to offer specialty services in remote and rural areas like Kodiak, Alaska, while also allowing us to care for underserved communities in urban areas like Los Angeles,” she said.