Telehealth flexibilities restored as government shutdown ends

Flexibilities for Medicare telehealth coverage are back in place after Congress passed legislation this week aimed at ending the longest government shutdown in U.S. history.

The bridge funding bill, which was signed by President Donald Trump on Wednesday evening, restores pandemic-era virtual care policies until January 30. These policies include changes such as eliminating geographic restrictions for virtual care and allowing all eligible Medicare providers to offer telehealth.

Additionally, the spending plan reauthorizes CMS’s Acute Hospital Care at Home program – another initiative launched during the pandemic that allows hundreds of hospitals across the country to provide inpatient care in patients’ homes – until January 30.

The spending law comes after telehealth providers were left in limbo for six weeks during the government shutdown, forced to either continue offering virtual care to Medicare beneficiaries without clarity on reimbursement or close their programs.

And although the legislation allows retroactive payment for telehealth services offered since the shutdown began in October, “time is running out” before the flexibilities can expire again, said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association and executive director of the group’s advocacy arm ATA Action, in a statement released Thursday.

Telehealth groups have argued that the healthcare industry needs certainty about Medicare coverage of virtual care.

“Short-term, and even year-to-year, expansions are no longer sustainable for a model of care that is now central to how America delivers health care,” Chris Adamec, executive director of the Alliance for Connected Care, said in a statement. “Telehealth is an integral part of healthcare delivery, and the current system must take this into account. »

Telehealth providers and advocates call for long-term solution

Telehealth flexibilities were first implemented during the pandemic to preserve access to care amid social distancing. Policies have significantly expanded telehealth in Medicare, where coverage previously was primarily limited to beneficiaries living in rural areas or certain types of facilities or services.

While these flexibilities are popular with lawmakers on both sides of the aisle, they have recently been caught up in funding fights between Democrats and Republicans on the Hill.

In December, a bill that would have preserved these flexibilities for two years collapsed at the last minute, and a replacement spending plan only extended them until March. Another short-term deal kept them in place for another six months.

But lawmakers missed a deadline to extend them again in September as they clashed over more generous financial aid for plans from the Affordable Care Act, which expires at the end of the year.

Today, Congress signed an agreement to reopen the government without action on these grants. Meanwhile, telehealth’s lack of flexibility meant fewer Medicare beneficiaries could access virtual care during the shutdown, according to an analysis from the Center for Advancing Health Policy through Research at Brown University’s School of Public Health.

The share of visits provided by telehealth decreased 24% in the first 17 days of October compared to July through the end of September, according to the report. The impact has been worse in some states, such as Florida, Washington, Maryland and New York, where telehealth use has fallen by nearly 40% or more.

This decline is likely due to uncertainty among clinicians about whether virtual care visits would be reimbursed retroactively after the government reopens, the researchers wrote.

Christi Siedlecki, CEO of Grants Pass Clinic, an independent medical group in southern Oregon, told Healthcare Dive last month that they canceled telehealth appointments because the group didn’t want to provide services that weren’t covered.

The federal government should make these flexibilities permanent, she said.