January 8, 2025

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 contact us about membership. 

On December 21, President Biden signed into law, a continuing resolution (CR) funded the federal government through March 14, 2025 and extended telehealth access through March 31, 2025.

Alliance News

Alliance Coleads 300 Stakeholder Letter to Congressional Leaders (12/11) - The Alliance coled a letter, signed by 300 groups to House and Senate leadership calling for no less than a calendar year extension of telehealth right as end of year negotiations started to change. The group letter was highlighted in Stat News, Healthcare IT News, Modern Healthcare.

Alliance Statement in Response to the DEA's Third Temporary Extension (11/15) - The Alliance released a statement in response to the DEA’s third temporary extension of controlled substance prescribing via telemedicine rulemaking. Additional coverage can be found in Health Leaders and Healthcare Dive. This action followed a large stakeholder effort led by the Alliance for Connected Care as well as Congressional letters from the Senate and House. We are still expecting a proposed rule for a permanent policy from the Biden Administration, but there will no longer be time to complete it this year. The Trump Administration will be responsible for completing a rule in 2025. The Alliance will continue to convene stakeholders for a permanent solution.

Alliance Letter Urges Congressional Leaders to Include Telehealth Extension in 2024 End of Year Package Discussions (11/8) - The Alliance sent a letter in response to developments related to an end-of-year package to congressional leaders requesting their continued bipartisan leadership in assuring the public that access to telehealth services will not be allowed to lapse on December 31. 

Alliance and Over 150 Organizations Request CMS to Ensure Telehealth Practitioners Location Are Protected (10/2) - The Alliance for Connected Care led more than 150 stakeholder organizations in a letter requesting that the Centers for Medicare and Medicaid Services (CMS) to take action on preserving the benefits of telehealth by ensuring telehealth practitioners working from a home-based (or other) location do not need to report that private residence to the federal government for purposes of either enrollment or billing. The ability to bill a currently enrolled location does not alleviate barriers for virtual-only practitioners without a physical practice location to report other than their homes. The signers respectfully request CMS to work with stakeholders to develop an alternate method of determining location for the purposes of payment that does not require the reporting of a home address, such as through the convening of a roundtable or a similar effort, to ensure the experiences of virtual-only practitioners are considered.

Alliance Letter to HHS OIG on RPM Report (9/24) - The Alliance for Connected Care sent a letter to HHS OIG regarding the report on remote patient monitoring. The Alliance highlights inaccuracies and subjective nature of the report. The Alliance requests HHS OIG to consider retracting the report, and amending it to accurately reflect the way that RPM services are required to be delivered in Medicare, as well as reducing the bias language.

The Future of Remote Physiologic Monitoring and Current Medicare Cuts (9/9) - The Alliance for Connected Care led a group letter, calling attention to the need for strong CMS support of patient access to remote monitoring services that are vital in prevention and treatment for Medicare beneficiaries. The letter was submitted to CMS through the PFS public comment process.

Congress

Sen. Schatz (D-HI): Bipartisan and Bicameral Group of 100 Lawmakers Call for Extension of Medicare Telehealth (12/9) – Sens. Schatz (D-HI), Wicker (R-MS), and Reps. Thompson (D-CA), and Schweikert (R-AZ) led a bipartisan and bicameral group of 100 lawmakers in calling for the extension of expanded Medicare coverage of telehealth services to be included in a year-end appropriations package. The Alliance for Connected Care supported lead offices in garnering sign-on support.

Rep. Steel (R-CA): Bipartisan Group Calling for Telehealth Access Extension (11/25) - Reps. Steel (R-CA), Lee (D-NV), Smith (R-NE), and Schneider (D-IL) sent a letter signed by over 30 members to congressional leaders urging for an extension of telehealth services in the commercial market. The Alliance and others supported the effort to secure signers on the congressional letter.

Rep. Matsui (D-CA): Reps. Matsui (D-CA) and Carter (R-GA) Applauds Extension of Telemedicine Prescribing Flexibilities for Controlled Substances (11/18) – Reps. Matsui (D-CA) and Carter (R-GA) applauded the Drug Enforcement Administration (DEA) and Health and Human Services (HHS) decision to extend current flexibilities for telemedicine prescribing of controlled substances for an additional year. The announcement comes after the lawmakers led a group of 18 House colleagues in urging the DEA and HHS to issue such an extension earlier this year.

Sen. Thune (R-SD): Sen. Thune (R-SD) Elected Senate Majority Leader for Next Session (11/13) – Sen. Thune (R-SD) was elected to be the Senate Majority Leader for the 119^th Congressional Session. He has been a big supporter on telehealth. He has publicly noted support for telehealth, with his website stating: “South Dakota has long been a leader in telehealth, which helps ensure that patients in rural areas have access to needed primary and specialty care. We have made great strides to expand telehealth, both when it comes to building infrastructure and advancing reimbursement. I’m committed to continuing this momentum.”

Administration

Assistant Secretary for Planning and Evaluation (ASPE): Understanding the Optimal Balance of Using Telehealth and In-person Services to Support Adults with Serious Mental Illness and Children (12/6) – ASPE published a data brief, which examined access to and use of tele-mental health services among individuals with serious mental illness (SMI) and children with serious emotional disturbance (SED) and behavioral health consumer and provider perceptions of the optimal balance of telehealth and in-person services for people with SMI and SED. Behavioral health systems and policymakers can provide practical guidance to providers on how to choose between these modalities of care, can incentivize provider participation in insurance networks, can ensure adequate network adequacy standards for behavioral health and can monitor the quality and outcomes of care to safeguard against potentially inappropriate substitution of telehealth for in-person services.

ASPE: Trends in In-Person and Telehealth-Involved Controlled Medication Initiations Among Adults with Private Insurance (12/6) – This data brief presents trends in the initiations of selected, frequently prescribed controlled medications among individuals with private health insurance coverage. Results show that the majority of privately insured individuals received their initial controlled medication prescriptions without telehealth involvement, throughout the COVID-19 PHE.

Drug Enforcement Administration (DEA): One-Year Extension of Telemedicine Flexibilities Through 2025 (11/15) – The DEA in concert with the Department of Health and Human Services (HHS) issued a third extension of telemedicine flexibilities for the prescribing of controlled medications, through December 31, 2025. This action followed a large stakeholder effort led by the Alliance for Connected Care as well as congressional leaders from the Senate and House. While the extension provides some temporary relief for continuity of patient access and providers, it is not a permanent solution. The permanent regulation which concerned stakeholders this summer is still progressing. DEA and HHS also released an accompanying statement.

Centers for Disease Control and Prevention (CDC): Telemedicine Use Among Adults With and Without Diagnosed Prediabetes or Diabetes (11/14) – The CDC released a study which found that, telemedicine was used by approximately half of US adults diagnosed with prediabetes or diabetes in 2021, with a noticeable decrease in use in 2022. In 2021 and 2022, telemedicine use prevalence was 34.1% and 28.2% among adults without diagnosed diabetes or prediabetes, 47.6% and 37.6% among adults with prediabetes, and 52.8% and 39.4% among adults with diabetes, respectively. Findings suggest that telemedicine use can be improved among select populations with prediabetes or diabetes.

Department of Veterans Affairs: Proposal to Eliminate Copays for Telehealth (11/11) – The Department of Veterans Affairs (VA) published a proposed rule, which would eliminate copayments for all VA telehealth services and establish a grant program to fund designated VA telehealth access points in non-VA facilities, with a focus on rural and medically underserved communities. Comments are due January 12, 2025.

Centers for Medicare and Medicaid Services (CMS): Calendar Year (CY) 2025 Medicare Physician Fee Schedule (11/1) – On November 1, CMS issued the CY 2025 Medicare Physician Fee Schedule (PFS) final rule. Read the Alliance comments to the proposed rule here. Notably for telehealth, CMS attempted to preserve some importance, but limited, flexibilities within its authority and expand the scope of and access to telehealth services where appropriate.

• CMS finalized, as proposed, to continue to permit certain practitioners to provide direct supervision via a virtual presence of auxiliary personnel, when required, virtually through immediate availability via real-time, audio-video technology. CMS also finalized temporary extensions to allow teaching physicians to be present virtually when they furnish telehealth services involving residents in teaching settings.
• CMS also notes that, absent congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services, including geographic and location restrictions and scope of practitioners who are able to provide Medicare telehealth services.

CMS: CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment Final Rule (11/1) – On November 1, CMS issued the Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule, which finalized payment rates and policy changes effective January 1, 2025. Read the Alliance's comments to the proposed rule here. Most notably, CMS included a few telehealth provisions:

• CMS noted that the in-person visit requirement for professionals billing for mental health services via Medicare telehealth applies again beginning January 1, 2025. CMs continues to align payment policy across OPPS and PFS. It may consider refinements through future rulemaking.
• CMS received comments around its policies for outpatient therapy, DSMT, and MNT services when furnished by hospital staff with the Medicare telehealth policies that apply when these services are billed by the same clinicians but in private practice. CMS noted it requires actions from Congress to continue to align its policies with Medicare telehealth policies in January 2025.
• CMS did not consider HOPD payment for telemedicine evaluation and management service. CMS states that, as it is not finalizing payment for the telemedicine E/M CPT codes under the PFS, it does not believe there is a programmatic need to recognize these codes for payment under the OPPS.

Department of Health and Human Services (HHS) Office of Inspector General (OIG): Additional Oversight of Remote Patient Monitoring in Medicare is Needed (9/24) – HHS OIG released a report, examining RPM in Medicare. HHS OIG found:

• The use of remote patient monitoring in Medicare increased dramatically from 2019 to 2022.
• About 43 percent of enrollees who received remote patient monitoring did not receive all 3 components of it, raising questions about whether the monitoring is being used as intended.
• OIG and CMS have raised concerns about fraud related to remote patient monitoring.
• Medicare lacks key information for oversight, including who ordered the monitoring for the enrollee.

Telehealth Research, Reports, and Surveys

FAIR Health: Telehealth Utilization Decreased Nationally and in Every US Census Region in September (12/16) – According to FAIR Health’s Monthly Telehealth Regional Tracker, telehealth utilization decreased nationally and in every US census region in September 2024. Nationally, telehealth claim lines dropped from 4.96 percent of medical claim lines in August to 4.80 percent in September, a decrease of 3.3 percent. At the national level and in every region, mental health conditions remained the most common diagnostic category.

Concord Monitor: Telehealth Prescriptions Should be Available for More Mental Health and Substance Use Patients (12/9) – The New Hampshire Commission to Study Telehealth Services published a report finding that it should be legal for telehealth providers to prescribe certain medications for mental health and substance use disorders without requiring an in-person visit. Data from 2023 showed that between one-third and one-half of doctors’ visits for mental health and substance use disorders in the state were done via telehealth, compared to 5% or less for other types of visits.

JAMA Health Forum: Health Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care (11/22) – In this cohort study, compared with in-person visits, telemedicine visits were associated with less prescribing and ordering, modestly higher rates of in-person visits, and slightly more ED visits. The findings suggest that primary health care delivery that uses telemedicine appears to be meeting patients’ pediatric primary care needs.

Paragon Health Institute: Evaluating Telehealth: What Congress Needs to Know (11/11) - Paragon Health Institute released a paper on telehealth and includes several recommendations:

• Congress should direct CMS or another agency to determine if the increase in telehealth utilization, which has been particularly large and persistent for mental health services, represents costly overutilization or is meeting previously unmet needs while providing health-enhancing services at a reasonable cost.
• Temporary extensions should be coupled with requirements to conduct research into the quality and cost effectiveness of telehealth and strict controls to limit fraud, waste, and abuse.
• Congress should not make telehealth flexibilities outside of mental health permanent until there are answers to the important questions raised.
• There should be relaxation of barriers to telehealth across state lines. Most of the interstate telehealth visits occurred between a patient and clinician located in an adjacent state, usually within a few miles of the state border, suggesting that the telehealth visit was substituting for in-person visits where, in normal times, travel for in-person services was not especially difficult or costly.

JAMA Network Open: Primary Care Practice Telehealth Use and Low-Value Care Services (11/7) – In this cohort study of Medicare fee-for-service beneficiaries who received care from primary care practices in Michigan, some low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. The findings suggest the potential for telehealth to help reduce office-based low-value care and could reassure policymakers concerned about telehealth encouraging unnecessary or wasteful care due to added convenience. Read more in the press release.

Peterson Health Technology Institute: Digital Hypertension Management Solutions (10/28) – PHTI released a health technology assessment on digital hypertension management solutions. The report assessed the clinical effectiveness of these digital hypertension management solutions compared with usual care across 13 different outcome measures, including primary outcomes that focus on reducing systolic blood pressure (SBP) and increasing the proportion of patients achieving BPC. The report found that medication management delivered clinically meaningful decreases in SBP relative to usual care, and support faster improvements in hypertension than what typically occurs under usual care.

Telehealth News and Market Developments

Urology Times: Chad Ellimoottil, MD on Positive Momentum to Extend Telehealth (12/16) – Lawmakers made available several telehealth flexibilities during the COVID-19 pandemic in an effort to expand access to care. These flexibilities are set to expire on December 31, 2024 if Congressional action is not taken. In this interview, Chad Ellimoottil, MD, MS, detailed the issue further. Ellimoottil is the medical director for telehealth and an associate professor of urology at the University of Michigan in Ann Arbor.

Advisory Board: How Stanford Health Care 'De-Risked' its Remote Patient Monitoring Strategy (12/10) – Stanford Health Care received multiple requests from vendors and clinicians to integrate remote patient monitoring (RPM). Through various pilots, the Stanford Health Care team tried new processes and learned valuable lessons that ultimately helped them create a better program. To avoid the trap of perpetual pilot mode, Stanford Health Care leaders set defined end dates for their initiatives. Shiva Modarresi and Leah Rosengaus reviewed more about Stanford’s RPM strategy.

Scientific American: Addiction Telemedicine Has Saved Lives. Let’s Keep It Going (12/10) – Robert Kent drafted an op-ed urging for continued flexibilities of telehealth buprenorphine-prescribing. He previously served as the general counsel in the White House Office of National Drug Control Policy during the first two years of the Biden-Harris Administration. “We have nearly three years of evidence showing the benefits of buprenorphine prescribing without the need for an in-person visit. Nothing shows that there has been an increase in diversion, or an increase in drug related deaths caused by easier access to buprenorphine.”

Intermountain Health: Intermountain Health Enhances Access to Care for Students Thru School Based-Telehealth (11/24) – Intermountain Health has recently expanded virtual, clinical services through Intermountain Health’s Connect Care team and collaboration with local health providers in Utah, providing acute medical care for students’ acute medical care for students during school hours. The School-Based Telehealth program aims to reduce healthcare costs by treating conditions that can be seen through telehealth services. Telehealth is a valuable tool to reduce disparities and provide equitable access to healthcare for families.

Healthcare IT News: MedStar Extends Acute Care at Home to Baltimore (11/5) – MedStar Health announced that its acute care at home is now available to Baltimore patients of its Franklin Square Medical Center, Good Samaritan, Harbor and Union Memorial hospitals. Through the collaboration, Dispatch Health offers prescheduled home visits daily, including weekends and holidays, following discharge from emergency departments and inpatient hospital units – typically within 72 hours. Acute-care conditions treated range from cardiology and respiratory to dermatology, musculoskeletal, neurological and others. At-home high-acuity care through the service could include medical treatments, like administration of IV fluids and medications, and certain diagnostic and lab services.

Stanford Medicine: Digital Health Symposium Highlights Trustworthy and Equitable Innovation (10/31) – At Stanford Medicine’s Center for Digital Health symposium, speakers discussed he need to build trust in science and emerging technologies, and what it will take to ensure that digital health technologies flourish around the world — not just in high-income populations.

Fierce Healthcare: Cadence and Lifepoint - Remote Monitoring Show Promise to Drive Better Health for Rural Patients (9/11) - Cadence's three-year partnership with Lifepoint Health currently serves over 5,000 patients in remote monitoring programs—including two-thirds from underserved communities. Patients in these rural areas are hitting their health targets at rates comparable to or exceeding those in urban areas, proving that this type of care can break down barriers and extend improved outcomes to those who need it most.

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