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Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on virtual care.
This is the public update of the Alliance, issued quarterly. The biweekly Alliance newsletter is now members-only. Was this email forwarded to you? Subscribe here or feel free to contact us about membership.
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| ALLIANCE WINS IN MEDICARE PFS |
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While CMS does not currently have statutory authority to waive geographic and originating site restrictions for telehealth, it has proposed a number of important steps to preserve access to telehealth in the CY2025 Physician Fee Schedule.
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Extension of provider location reporting flexibility
Proposed continuation of current policy through 2026 allowing a distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home. The Alliance has aggressively advocated for permanent change, most recently in a June letter to CMS.
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| Permanent authority for audio-only |
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CMS proposes to permanently allow two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology.
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| Virtual Direct Supervision |
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CMS has proposed a new permanent authority for virtual direct supervision of incident to services. It has also continued broader existing virtual direct supervision authority through 2025. This includes the current policy allowing teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in teaching settings who are offering a virtual service.
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Rejection of separate coding for telehealth
CMS has proposed not to cover new telehealth codes that duplicate existing telehealth-eligible services covered by Medicare. The Alliance applauds this decision, which follows our advocacy this spring to ensure Medicare telehealth services remain equivalent to in-person care. We believe that telehealth is a modality for providing health care, it is not a different service.
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Participation in the Alliance for Connected Care creates new opportunities for members. Not only do members help to advance access to virtual care, as leaders in the coalition they are instrumental in shaping the policy agenda across Washington DC and the nation.
Learn more about our current work, recent accomplishments, and opportunities for participation.
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Alliance News
Alliance Comments on the 21st Century Cures Initiative (8/2) - The Alliance for Connected Care provided input into refining the goals of the 21st Century Cures initiative. After four years of experiencing the benefits of expanded telehealth services, patients expect telehealth and remote patient monitoring as an option in their care treatment plans. We believe the Cures 2.0 effort has the potential to modernize an antiquated reimbursement system to better serve patients in need and realize the potential of digital technologies through better integration into care patterns.
Stat News: Disruptions Loom for Telehealth Providers and Patients (7/29) – The telehealth legislation moving through Congress has bipartisan support, and there’s broad confidence among stakeholders that extensions will be passed. Hold ups include ensuring there are sufficient offsets to pay for the telehealth services and safeguards to prevent fraud. Chris Adamec, executive director of the Alliance for Connected Care, pointed out that there are differences between the bill that was passed by the House Ways & Means Committee and the one being considered by Energy & Commerce; the Senate has yet to take up legislation.
Telehealth Stakeholder Letter to Congressional Leadership (7/19) - The Alliance for Connected Care joined a telehealth stakeholder letter to congressional leadership, urging swift action on legislation that would extend current Medicare telehealth flexibilities.
Alliance Requests the Centers for Medicare and Medicaid Services (CMS) to Consider Administrative Burden on Telehealth Practitioners (6/28) - The Alliance for Connected Care sent a letter to the Centers for Medicare and Medicaid Services (CMS) regarding ongoing decisions by CMS that will dramatically increase administrative burden for both practitioners offering telehealth services and CMS itself through the requirements for the reporting of multiple addresses for a clinician offering telehealth. Unfortunately, this policy is set to expire after December 31, 2024. The Alliance for Connected Care respectively requests that CMS consider making permanent its existing policy allowing a practitioner to bill from their in-person practice location.
Alliance Leads Letter to Congressional Appropriators to Support Telehealth Resource Centers FY 2025 (6/28) - The Alliance for Connected Care led a letter asking Congressional Appropriators to include a $14 million request for the Telehealth Resource Centers (TRC) program at the Health Resources and Services Administration (HRSA) in FY2025 appropriations. This increase in funding would provide a critical boost to the TRCs, which saw an 800% increase in demand for telehealth assistance during the COVID-19 pandemic.
Mental Health Groups Sent Letter on Schedule IIN Non-Narcotic Prescribing (6/11) - Mental health groups are pushing the agency to allow Schedule IIN non-narcotic drugs to be prescribed without an in-person visit. Those include stimulants used to treat attention-deficit/hyperactivity disorder. A coalition of mental health groups, including the American Psychiatric Association, the American Academy of Pediatrics and the Kennedy Forum, wrote to the DEA, saying that not allowing such drugs to be prescribed without an in-person visit as it previously proposed would be a mistake. The Alliance was pleased to support the effort around this letter.
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Congress
Telehealth Congressional State of Play - Congress is steadily moving forward with legislation to extend current telehealth flexibility - most likely for two years - until December 31, 2026. All signs indicate that an extension package will pass in the lame-duck session of this Congress at the end of the year. The Alliance continues to advocate for advancement in the fall.
Congressional Budget Office (CBO): Medicare’s Coverage of Telehealth: Considerations From the Congressional Budget Office (7/1) – CBO presented at the 2024 AcademyHealth Annual Research meeting. In its presentation, CBO described some key factors that CBO considers when assessing the budgetary effects of policies that would change Medicare’s coverage of telehealth. Specifically:
- How have the use of telehealth and spending on telehealth changed under policies that have temporarily expanded its coverage?
- What is the payment rate for telehealth services?
- Do telehealth services substitute for in-person Medicare services, or are they delivered in addition to in-person services?
- Does the receipt of telehealth services change beneficiaries’ likelihood of using downstream services?
- Estimates of the effects of some policy changes may require more specific considerations. For instance, how does telehealth use vary among specialties or distant sites?
House Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies: Markup of Appropriations (6/27) – On June 27, the House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee approved its Fiscal Year 2025 bill. Most notably, the Subcommittee provided $44 million for the Office for the Advancement of Telehealth, including grants, contracts, and cooperative agreements for the advancement of telehealth activities. The President’s Budget requested $38 million for the Office for the Advancement of Telehealth. Bill summary can be found here.
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Administration
Center for Medicare & Medicaid Services (CMS): Calendar Year (CY) 2025 Medicare Physician Fee Schedule (7/10) - On July 10, CMS issued the CY 2025 Medicare Physician Fee Schedule proposed rule. Notable telehealth provisions that CMS is proposing:
- To continue to permit the distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home - through 2025.
- To extend for one-year virtual direct supervision flexibility. Specifically, CMS proposed to make permanent direct virtual supervision for some services that are typically offered “incident-to” and the services described by CPT 99211 and to continue its current policy to allow teaching physicians to have a virtual presence.
- To permanently allow two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology.
- Addition of several codes to the Medicare Telehealth Services List on a provisional basis, including HCPCS codes G0011, G0013, G0248, GCTD1-3, and GCTB1-2, and CPT Codes 97550, 97551, 97552, 96202, and 96203.
Comments are due September 9, 2024.
CMS: Hospital Outpatient Payment Rule (7/10) - On July 10, CMS proposed Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services. The rule includes a robust conversation about the potential billing of Diabetes Self-Management Training (DSMT) and medical nutrition therapy services (MNT) under the OPPS rather than under the fee schedule. They ultimately have not proposed to adopt OPPS billing. The rule did not include coverage for virtual intensive cardiac rehabilitation services as the Alliance had supported. The rule includes many of the same limitations on telehealth due to expiring statutory authority that exist in the PFS. Comments are due September 9, 2024.
Office of Management and Budget (OMB): Spring 2024 Regulatory Agenda (7/5) – OMB released its spring regulatory agenda, which lists anticipated rulemaking from federal agencies over the next year or so. In the document attached to this email is an excerpted version of the full agenda, which includes key rulemaking from CMS and other agencies. In particular,
- The DEA telemedicine proposed rule is anticipated for release September 2024, as per the Department's regulatory agenda.
- The DEA telemedicine proposed rule also changed its title from "Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have not had a Prior In-Person Medical Evaluation" to "Special Registrations for Telemedicine and Limited State Telemedicine Registrations".
Supreme Court of the United States: On June 28, the Supreme Court announced
that it will overturn ‘Chevron deference,’ a decades-long legal precedent that empowered federal agencies to use discretion in issuing regulations when an aspect of a federal law is determined to be ambiguous. This ruling will have significant implications for federal rulemaking, including regulations issues by the Department of Health and Human Services (HHS). It is also expected to impact Congressional activity, and will likely result in a demand for Congress to be more specific in its legislation.
Centers for Disease Control and Prevention (CDC): Declines in Telemedicine Use Among Adults (6/20) – This report examines changes in telemedicine use among U.S. adults between 2021 and 2022 by selected sociodemographic and geographic characteristics. Overall, the percentage of adults who used telemedicine in the past 12 months decreased from 37.0% in 2021 to 30.1% in 2022. This pattern was observed across several sociodemographic and geographic characteristics, such as sex, family income, education, region, and urbanization level. Women, adults with a college degree or higher, and adults living in more urban areas were all more likely to use telemedicine in 2022.
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Telehealth Research, Reports and Surveys
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Cross-State Telehealth
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CCHP’s published an Out-of-State Telehealth Provider Policies Chart and a fact sheet, which organizes out-of-state telehealth provider policies by state.
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Mental Health
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This white paper reveals that state telehealth registries and state licensing exemptions are not effective in increasing continuity of care across state lines and make the case for sweeping action.
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Mental Health |
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Waivers primarily enhance access to care of established patients by enabling the transition of in-person out-of-state health care online.
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Telehealth Report
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The Bipartisan Policy Center released an update to its federal telehealth policy recommendations.
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June 5, 2024
Virtual musculoskeletal (MSK) solutions aim to expand access to care—particularly virtual physical therapy (PT)—that can improve pain and functional status for people with a range of MSK disorders. By making care more available and convenient, these solutions aim to improve patient outcomes and avoid unnecessary treatment.
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Telehealth News and Market Developments
KevinMD: The Risks of Digital Health Companies to Psychiatric Patients (6/26) – Arthur Lazarus, a former Doximity Fellow, published an op-ed on the Department of Justice indictment on Cerebral and Done. Dr. Lazarus offers a recommendation to mitigate bad actors: It is crucial to implement stringent regulatory measures, including thorough verification of patient identity and medical history, regular audits of telehealth practices, and enhanced training for providers on the unique challenges of delivering psychiatric care remotely. Ensuring equitable access to technology and support for those who may have difficulty using digital platforms is also essential. By addressing these vulnerabilities, we can optimize the benefits of telehealth while safeguarding the well-being of psychiatric patients.
Stat News: Ateev Mehrotra, the Researcher the Telehealth Lobby Loves to Hate, Isn’t Backing Down (6/24) – Mehrotra, a physician and academic, is a seasoned congressional witness, often presenting the results of painstaking examinations of health care costs and quality in front of powerful legislative panels. But as Washington takes a hard look at telehealth and its impact on Medicare spending, his opinions have not always endeared him to advocates. Lobbyists say lawmakers keep inviting him back to testify because he’s advocated for caution, which plays into what can be their collective aversion to sweeping and expensive policy change. He’s also known for fact-checking assertions that others accept as fact, especially that telehealth and in-person care are largely interchangeable.
UC Davis Health: New At-Home Monitoring Program for Patients with High Blood Pressure (6/20) – UC Davis Health launched a program that monitors patients with high blood pressure at home. To support this initiative, the health system is working with Best Buy Health’s care-at-home platform, Current Health. Patients will use connected devices including blood pressure cuffs and scales. Readings from the devices will be sent to the Current Health platform and also transferred to the patient’s UC Davis Health electronic medical chart. All readings sent from the patient’s home can be accessed by the UC Davis Health Connected Care Center in real time.
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