Despite a spate of high-profile cases among the “DC elite” in recent weeks, the federal government seems eager to turn the page on COVID-19.
Anthony Fauci, M.D. recently announced that we are no longer in a “pandemic phase” of the disease and most observers expect the recent extension of the Public Health Emergency (PHE) to be the final 90-day renewal. If this is indeed the case, the federal PHE will end on July 15, and the many telehealth waivers that are tied to it will end 151 days thereafter, per the recently-passed 2022 budget.
Several states have already begun rescinding their own PHEs, and in a memo dated April 7, the Centers for Medicare & Medicaid Services declined extending some of its own emergency-related policies for specific providers, including the use of telehealth in nursing facilities. This has alarmed many in the long-term care world and led industry organizations to seek reconsideration or clarification from CMS. The April 7 memo has been a wakeup call that the federal government really is ready to sunset many of the policies of the COVID-19 era, no matter how popular they are.
Advocacy for greater telehealth utilization and reimbursement significantly predates the COVID-19 pandemic, but the range of waivers and permissions granted by Congress and CMS since March of 2020 has spurred greater activity on Capitol Hill, with advocates hoping to capitalize on newfound political will and cohesion to pass real reform.
Stakeholders hoped the widespread uptake and popularity of telehealth over the last two years would finally permanently turn the tide on an issue that many in Congress and the Congressional Budget Office have long-deemed too expensive. Unfortunately, despite patient support for virtual care, and data that illustrates its cost, access and outcomes efficacy in a range of settings, many lawmakers still deem the price tag too high to make PHE reimbursement policies permanent.
Asked in March to weigh in on proposals to extend the PHE telehealth waivers for one or two years, the CBO predicted just five months of extended policies would cost $633 million. The Committee for a Responsible Federal Budget recently extrapolated that figure forward, predicting a cost of $25 billion for 10 years.
Unless Congress and the CBO embrace the increasing trove of data that suggests that telehealth is in fact fiscally comparable to in-person visits, we are likely to see a significant rollback of currently available and reimbursable telehealth services come December.
There is still time to lobby Congress for permanent changes, but there will be competition over what stays and what goes. There are dozens of bills out there ranging from broad telehealth reform such as repeal of 1834(m)’s geographic and originating site restrictions — a provision included in numerous pieces of legislation including the high-profile Cures 2.0, to more narrow proposals like continued audio-only reimbursement for mental health visits.
On the long-term care side, Senators Cardin (D-MD) and John Thune (R-SD) have once again introduced the RUSH Act, which would create a Medicare Shared Savings Program for facilities that demonstrate a reduction in hospitalizations through the use of telehealth in skilled nursing facilities. Capitol Hill will be awash with stakeholders advocating for their slice of the telehealth pie for the rest of the year.
It remains to be seen which proposals will win permanent support when the 151-day extension ends, presumably in December: Will Congress pass wide-ranging telehealth legislation, or will just a few niche areas receive permanent approval?
Patients and providers who want to see their virtual care continue have only a few months to get their message — and data — to lawmakers. COVID-19 has created a unique laboratory for innovation in healthcare delivery and it would be a shame to waste this opportunity to finally pass bold telehealth reform.
Liz Westbrook is a Senior Advisor, Government Relations for Buchanan Ingersoll & Rooney. She has spent over a decade on Capitol Hill and in various federal agencies, including the Office of the National Coordinator for Health IT, Patient-Centered Outcomes Research Institute and Veterans Health Administration. She focuses her work on the complicated intersection of rapidly advancing technologies and the regulatory process with an eye toward innovation and telehealth.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.