During the COVID-19 pandemic there was a sharp increase in the use of telehealth – a 1,000 percent increase in March 2020 and a 4,000 percent increase in April 2020.  Even more extreme, telehealth utilization among Medicare beneficiaries increased 13,000 percent in just a month and a half. This was largely due to federal and state governments relaxing decades-old laws and regulations. However, many of these laws and regulations were only temporarily changed – meaning that at the end of the COVID-19 public health emergency (PHE) period, the restrictions will go back into effect unless legislators enact permanent changes.

Thankfully, there is widespread agreement among stakeholders and legislators that we cannot go back to how it was before, but agreeing on exactly what permanent policies should look like is proving difficult. This week, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021 was reintroduced in the Senate and in the House. The Senate Working Group members Senators Brian Schatz (D-HI), Roger Wicker (R-MS), Ben Cardin (D-MD), John Thune (R-SD), Mark Warner (D-VA), and Cindy Hyde-Smith (R-MS) introduced the legislation along with 50 of their colleagues in the Senate. Identical legislation was introduced in the House by Telehealth Caucus members Representatives Mike Thompson (D-CA), Peter Welch (D-VT), David Schweikert (R-AZ), Bill Johnson (R-OH), and Doris Matsui (D-CA). The legislation is supported by more than 150 stakeholder organizations, including eHI.

While the CONNECT for Health Act led the way as landmark comprehensive telehealth reform legislation beginning in the 114^th Congress, it is certainly not the only legislative approach to ensuring telehealth reimbursement post-COVID. Others include the Telehealth Modernization Act of 2021 (HR 1332/S 368), the Protecting Access to Post-COVID-19 Telehealth Act of 2021 (HR 366). At the crux of the debate around permanently removing restrictions on Medicare reimbursement of telehealth services are questions around controlling for overutilization of unnecessary services and protecting both the Medicare program and beneficiaries from potential fraud and abuse. These were common lines of questioning from members of the House Ways & Means Health Subcommittee, which held a hearing this week entitled Charting the Path Forward on Telehealth (find the full hearing recording here and an eHI-prepared summary here). In his opening statement, Subcommittee Chairman Lloyd Doggett (D-TX) stated his intention to introduce legislation that would enact recent recommendations from MedPAC, which calls for a temporary extension of current statutory and regulatory flexibilities while data is collected and analyzed to help inform permanent policies. In order to combat fraud and abuse, MedPAC recommended requiring in-person appointments prior to ordering high-cost durable medical equipment (DME) and lab tests. This is meant to target areas of concern outlined by OIG whereby “telefraud schemes” are used to fraudulently prescribe DME and high-cost lab tests like genetic tests. OIG clarified that in many cases, the telefraud perpetrators do not bill for the telehealth service. Ensuring program integrity and protecting patients is essential; however, we should not let the potential bad actions of a few prevent all from benefiting from what has proven to be a lifeline during the pandemic. Any legislation addressing Medicare reimbursement for telehealth services should not replace the existing arbitrary restrictions on telehealth with different arbitrary restrictions like prior in-person visit requirements. 

All of this to say: we don’t know exactly what lies ahead for any of these telehealth bills, but we do know that never before has telehealth policy been at the forefront of so many healthcare discussions in D.C., and it’s certainly not a matter of if but of when. eHI and our members will continue to be a part of these on-going debates and provide updates and engagement opportunities. If you have any questions in the meantime, feel free to reach out to me at catherine@ehidc.org.