Abstract
The Public Health Emergency (PHE) declared by the U.S. Department of Health and Human Services in 2020 allowed coverage of telehealth—the use of electronic communication to deliver care remotely—by federal payers during the COVID-19 pandemic. However, the PHE could end in the coming months, so legislators have introduced bills in Congress to continue coverage for certain types of virtual visits under federal programs. Telehealth measures may be attached to the bill funding the federal government for fiscal year 2022, which could be enacted in mid-March.
The Public Health Emergency (PHE) declared by the U.S. Department of Health and Human Services on January 31, 2020, allowed coverage of telehealth—the use of electronic communication to deliver care remotely—by federal payers during the COVID-19 pandemic. Renewed several times, the PHE was due to expire at the end of 2021, which would have ended coverage, but in January, the PHE was renewed for another 90 days.
“This extends all of the flexibilities for federal payers,” such as Medicare, says Robin Zon, MD, chair of the American Society of Clinical Oncology's “Telehealth in Oncology: Standards and Practice Recommendations” panel and report. However, “commercial payers make their own decisions, and, in addition, some states are beginning to pull back on the earlier flexibilities they allowed.”
For example, the PHE allowed telemedicine to overcome geographic barriers to care, but inconsistent state licensing laws hindered some access to telemedicine, preventing more widespread use. The Interstate Medical Licensure Compact permits physicians to practice across state lines, but not all states participate. Some insurance plans had allowed physicians to “see” patients in other states, minimizing patient travel to out-of-state doctors. However, a number of plans and facilities are pulling back on this provision, prompting some patients to drive into their doctor's state to have telemedicine appointments from their cars.
“We have been hearing a lot … about the flexibilities being lifted by the states and the impact on patients, and we are continuing to monitor this,” says Zon. “Individual practices/providers will no doubt be adapting their practices in ways they think best for their patients.”
Multiple bills have been introduced in Congress that would extend or continue coverage for certain types of virtual visits under federal programs. For example, the bipartisan Telehealth Extension and Evaluation Act was introduced in the Senate in February. It would ensure the continuation of most services for 2 years after the PHE ends, avoiding the “telehealth cliff,” whereby patients would experience an almost immediate reduction in telehealth services, potentially compromising care.
New legislation, says Edith Mitchell, MD, director of the Center to Eliminate Cancer Disparities at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA, could extend certain allowances and/or impose new requirements. For example, provisions that help protect against fraud or limit the use of expensive lab tests could be added. However, the ability to prescribe controlled substances, without the need for an in-person visit, could be extended. In addition, says Mitchell, waivers related to geographic locations could increase the number of telehealth providers and allow audio-only telehealth services rather than just audiovisual services.
“All of these additions to the emergency act that was instituted in 2020 will … give better utilization [for patients], better protection of the clinicians,” says Mitchell.
Telehealth has experienced an unprecedented rise in popularity since the pandemic began, especially among patients with debilitating diseases, including cancer.
“Most industry observers believe that … the pandemic accelerated roughly 10 years’ worth of anticipated growth,” says Kyle Zebley of the American Telemedicine Association. Although the Telehealth Extension and Evaluation Act or a similar bill may not be passed into law as written, he hopes that telehealth measures will be considered and attached to the bill funding the federal government for fiscal year 2022, which could be enacted in mid-March.
“We really hope the upcoming bill will include some telehealth policy provisions,” says Zebley, noting that if the act is passed in its original or near-to-original form, it could take effect when the PHE comes to an end. –Victoria Forster
