It appears Medicare coverage for telehealth is here to stay—at least for the next six months.
When the House of Representatives and Senate passed a budget on March 11 and 14, respectively, they not only avoided a government shutdown, but also extended a resolution for Medicare to cover nonbehavioral health telehealth appointments until Sept. 30.
This policy began during March 2020 at the start of the Covid-19 pandemic as a way to treat patients remotely. But it’s no secret that telehealth has since become popular with patients and providers: While 15.4% of clinicians used telemedicine pre-pandemic in 2019, that jumped to 86.5% in 2021, according to the CDC.
The policy, which was set to expire on March 31, has been extended several times since 2020, and while Medicare hasn’t found a permanent solution yet, telehealth has been broadly adopted by most commercial health plans.
Industry support…for now
Experts around the industry celebrated the extension, though some told Healthcare Brew a long-term fix is required to truly address the needs of different patients, such as older adults who may have trouble getting transportation to appointments or those who live in rural communities.
“It’s a good thing for America’s seniors that their access to synchronous telehealth is restored at least until Sept. 30. There is more work to be done, however, to ensure ongoing access by seniors to synchronous and asynchronous telehealth services,” Lucia Savage, chief privacy and regulatory officer at digital health company Omada Health and former HHS employee, said in an emailed statement.
Robert Andrews, CEO of employer collective Health Transformation Alliance and former congressman, said it was “certainly welcome news” because “easier access to telemedicine generally leads to better health results.”
Though it passed Congress, he hopes a more permanent solution comes in the next six months.
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“I would like to see a longer-term extension so that planners have more stability,” he said. “Companies can invest, and hospital systems can invest in better quality care over time. No one’s going to invest in something that might not be there six months from now.”
Rurally speaking
Sarah Hohman, director of government affairs for the advocacy group National Association of Rural Health Clinics, is in favor of the extension, but she said Congress has long overlooked rural health clinics in these telehealth extensions.
In March 2020, when the telehealth extensions went into effect, they didn’t include rural health clinics (RHCs) or federally qualified health centers (FQHCs), which are community clinics that often provide primary care.
Through the CARES Act in 2020, however, Congress added a payment rule that allowed RHCs and FQHCs to bill for telehealth services under a separate code. However, it bills for about $96 for claims, which Hohman said is “significantly less than what [RHCs and FQHCs would] be receiving for an in-person encounter.” It also made it difficult for these providers to collect data on how they have used telehealth to advocate for their needs, she added.
Meanwhile, providers that aren’t classified as RHCs or FQHCs have been getting reimbursement parity—meaning they are paid the same for in-person and virtual appointments—since March 2020, Hohman said. The extension is “just a continuation of the disparate policy for our RHCS and FQHCs,” she added.
Long term, she said she hopes RHCs and FQHCs are reimbursed the same as other providers for telehealth services.
“Telehealth technology is really expensive, and when we’re getting paid so much less to do telehealth, it’s not incentivizing providers to invest in those technologies,” she said.