More Than 100 Organizations Urge Congress to Reinstate Virtual Care Access for Individuals with HDHP-HSAs
Letter to Congressional Leaders Stresses Urgency of Reinstating Telehealth Safe Harbor
Washington, DC – January 14, 2021 – Today, more than 100 organizations sent a letter to Congress to urge policymakers to reinstate the telehealth safe harbor enacted in the CARES Act that enabled employers and health plans to provide pre-deductible coverage for telehealth services for individuals with high-deductible health plans coupled with Health Savings Accounts (HDHP-HSAs). The letter was convened by the Alliance for Connected Care and includes a diverse mix of signers including patient groups, clinician organizations, employer coalitions, and digital health platforms.
During the pandemic, Congress took swift action as part of the CARES Act to ensure employees could receive covered telehealth services before their deductible is met by allowing employers to provide pre-deductible coverage for such services for individuals with HDHP-HSAs. This safe harbor was not tied to the public health emergency (PHE), and unfortunately expired on December 31, 2021.
The ability to offer pre-deductible telehealth services for employees is a meaningful expansion of health care access for the 32 million Americans with HDHP-HSAs. Congress must act soon to reinstate the virtual care provisions in the CARES Act for individuals with HDHP-HSAs so that millions of Americans can once again access these lifesaving telehealth services on a pre-deductible basis.
“During the COVID-19 pandemic, Congress enabled employers to offer pre-deductible coverage for telehealth services, expanding access to care and reducing out-of-pocket costs for millions of Americans. Unfortunately, this flexibility expired on December 31, 2021 despite the ongoing pandemic and recent surge in cases due to the Omicron variant,” said Alliance for Connected Care executive director Krista Drobac. “This was the first pandemic-era telehealth policy to expire, which has and will continue to impact access to needed virtual care services for millions of Americans if Congress does not act to reinstate this provision.”
Bipartisan and widely supported legislation has been introduced in the U.S. Senate and House of Representatives that would extend this access for patients. The Telehealth Expansion Act of 2021 (S. 1704/H.R. 5981) would permanently extend the CARES Act authority for employers and health plans to offer pre-deductible coverage for telehealth services for individuals with HDHP-HSAs. The Primary and Virtual Care Affordability Act (H.R. 5541) would extend this CARES Act authority through December 31, 2023, and expand this provision to primary care. We strongly urge Congress to take up and consider this legislation and to retroactively reinstate this provision as part of the next possible legislative vehicle.
To read the full letter, click here or see below. For background information on this issue, click here.
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Open in new tab HHS OIG Telehealth Work Plan Items
The Alliance keeps a tracker of HHS Office of Inspector General (OIG) telehealth-related
work plan items. Please see below a list of pending and released OIG reports.
View other federal data releases here.
Reports in Development
Title
Report Number
Expected Release
Description
Telehealth Services in Select Federal Health Care Programs OEI-02-22-00150 2023 HS-OIG will work with the other OIG members in and leadership of the Pandemic Response Accountability Committee (PRAC) to produce a report describing the types of telehealth services that are available, including those that were expanded during the pandemic, and key program integrity risks associated with the use of telehealth across six selected Federal health care programs. Audit of Home Health Services Provided as Telehealth During the COVID-19 Public Health Emergency W-00-21-35864 2022 We will evaluate home health services provided by agencies during the COVID-19 public health emergency to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements. We will report as overpayments any services that were improperly billed. We will make appropriate recommendations to CMS based on the results of our review. Audits of Medicare Part B Telehealth Services During the COVID-19 Public Health Emergency W-00-21-35862 2022 Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use disorder, end-stage renal disease, and psychotherapy (Work Plan number W-00-21-35801) meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met. Home Health Agencies’ Challenges and Strategies in Responding to the COVID-19 Pandemic OEI-01-21-00110 2022 This nationwide study will provide insights into the strategies HHAs have used to address the challenges presented by COVID-19, including how well their emergency preparedness plans served them during the COVID-19 pandemic. Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks OEI-02-20-00720 2022 This review will be based on Medicare Parts B and C data and will identify program integrity risks associated with Medicare telehealth services during the pandemic. We will analyze providers’ billing patterns for telehealth services. We will also describe key characteristics of providers that may pose a program integrity risk to the Medicare program. Use of Medicare Telehealth Services During the COVID-19 Pandemic OEI-02-20-00520 2022 This review will be based on Medicare Parts B and C data, and will look at the use of telehealth services in Medicare during the COVID-19 pandemic. It will look at the extent to which telehealth services are being used by Medicare beneficiaries, how the use of these services compares to the use of the same services delivered in-person, and the different types of providers and beneficiaries using telehealth services. Medicaid—Telehealth Expansion During COVID-19 Emergency W-00-20-31548 2022 Our objective is to determine whether State agencies and providers complied with Federal and State requirements for telehealth services under the national emergency declaration, and whether the States gave providers adequate guidance on telehealth requirements.
Completed Reports
Title Report Number Release Date Description Data Snapshot: Review of Beneficiaries Relationships With Providers for Telehealth Services OEI-02-20-00521 Released: 10/18/2021 Findings: Most beneficiaries received telehealth services from providers with whom they had an established relationship. Notably, 84 percent of beneficiaries received telehealth services only from providers with whom they had an established relationship. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. This pattern persisted among virtually all of the most common telehealth services. Beneficiaries tended to see their providers in person about 4 months prior to their first telehealth service, on average. Use of Telehealth to Provide Behavioral Health Services in Medicaid Managed Care (Part 1) OEI-02-19-00401 Released: 9/20/2021 Findings: While most States can identify which services are provided via telehealth, a few reported being unable to, limiting their ability to evaluate and oversee telehealth. In addition, only a few States have evaluated the effects of telehealth in their State; these States found increased access and reduced costs. Based on their own experiences, other States believe that telehealth increases access, has uncertain impacts on costs, and raises concerns about quality. Further, despite concerns about fraud, waste, and abuse, many States do not conduct monitoring and oversight specific to telehealth. Use of Telehealth to Provide Behavioral Health Services in Medicaid Managed Care (Part 2) OEI-02-19-00400 Released: 9/20/2021 Findings: Most States reported multiple challenges with using telehealth, including a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers’ protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers. Some States also reported other challenges, including a lack of licensing reciprocity and difficulties with providers obtaining informed consent from enrollees. These challenges limit States’ ability to use telehealth to meet the behavioral health needs of Medicaid enrollees.
New Federal Telehealth Data
HHS released new CMS data and an Assistant Secretary for Planning and Evaluation (ASPE) report of Medicare telehealth utilization in 2020 and early 2021. Overall, nearly 53 million virtual visits occurred in traditional Medicare in 2020, compared to about 840,000 in 2019. Of those, nearly all (92%) of visits occurred in patients’ homes, which was not permissible prior to the pandemic. Furthermore, 44% of Medicare visits were in rural areas and 55% were in urban areas, demonstrating beneficiaries, regardless of location, utilized telemedicine for access to health care services during the pandemic.
- HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE): Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location (12/3) – HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report of Medicare Part B visits and use of telehealth in 2020 during the COVID-19 PHE, including by beneficiary characteristics, provider specialty and location. The analysis found that the share of Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million. The report also found insightful trends on the kinds of services Medicare beneficiaries sought through telehealth. In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8 percent of visits to primary care providers and 3 percent of visits to other specialists.
- CMS: Medicare Telemedicine Data Snapshot Overview (12/3) – CMS released a new data snapshot of Medicare fee-for-service and Medicare Advantage telehealth utilization from March 1, 2020 through February 28, 2021. Overall, more than 28 million beneficiaries used telemedicine – representing a more than 3,000% increase over the previous pre-pandemic period. In addition, 44 percent of rural beneficiaries and 55 percent of urban beneficiaries used telemedicine.
Below are additional key findings and discussions from the agency.
- Overall utilization: 52.7 million or 5% of Medicare FFS clinician visits, were provided via telehealth in 2020 – a 63-fold increase from 2019.
- Overall total health care utilization in 2020 was 11.4% below levels from 2019, reflecting 179 million fewer visits, even after accounting for the increased use of telehealth services in 2020.
- CMS found 53 percent of beneficiaries in traditional Medicare and private Medicare Advantage plans used telehealth between March 2020 and the end of February 2021.
- Visits by specialty: Prior to the pandemic, telehealth made up less than 1% of visits across all visit specialties but increased substantially in 2020.
- Telehealth increased to 8% of primary care visits, while specialty care had the smallest shift towards telehealth (3% of specialist visits).
- Visits to behavioral health specialists showed the largest increase in telehealth in 2020. Telehealth comprised a third of total visits to behavioral health specialists, with up to 70% of these telehealth visits during 2020 potentially reimbursable for audio-only services.
- Visits broke down by race: Black people had slightly lower telehealth use than White people, while Asian people and Hispanic people had higher use. However, all groups had a similar overall decrease in health care services in 2020.
- White beneficiaries had more telehealth visits overall, but the percentage of beneficiaries who had at least one telehealth visit was higher among Black beneficiaries.
- Telehealth made up 6.4 percent of Asian beneficiaries’ visits, 6.2 percent of Hispanic beneficiaries’ visits, 5.3 percent of white beneficiaries’ visits, 4.7 percent of Black beneficiaries’ visits and 5.6 percent of American Indian/Alaska Native beneficiaries’ visits.
- HHS suggested that barriers to internet access could be behind racial and geographic disparities, as well as patients’ preferences and comfort with using digital technology.
- Telemedicine use by Geography: Telehealth use varied by state, with higher use in the Northeast and West, and lower in the Midwest and South.
Discussion of health outcomes and costs findings:
- HHS indicates that more research is needed on the impact of telehealth on health outcomes and costs, as well as the role of value-based purchasing in supporting telehealth.
- HHS acknowledged the difficulty predicting how much virtual visits will substitute for in-person care in a post-pandemic world and states that “extending telehealth flexibilities in a post-pandemic world could lead to higher health care utilization, especially if providers are paid the same rates for telehealth as in-person visits.”
- Note that overall total health care utilization in 2020 was 11.4% below levels from 2019, reflecting 179 million fewer visits, even after accounting for the increased use of telehealth services.
CMS releases an update to the State Medicaid & CHIP Telehealth Toolkit
Today, the Centers for Medicare & Medicaid Services (CMS) released updates to the State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version and the Supplement to clarify that states may deliver covered services via audio-only telehealth both during the COVID-19 Public Health Emergency (PHE) and beyond.
This release provides additional support state Medicaid and CHIP agencies in their adoption and implementation of telehealth.
Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care
JAMA: Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care
According to a new study, 66.5 percent of participants surveyed wanted at least some video visits in the future, but when they had a choice between an in-person and a video visit when out-of-pocket costs weren’t a factor, 53% preferred an in-person visit. Exposure to video telehealth video visits affected participants’ views. The survey found 45% of participants reported having at least one video visit with providers since the COVID-19 pandemic began in March 2020. Among that group, 44.2% preferred in-person, and 31.4% would rather use video. But for those who didn’t have experience with video visits, 60.2% preferred an in-person visit, and only 12.2% preferred video.
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Nine out of ten healthcare organizations provide telehealth services, yet almost half face patients’ mistrust towards privacy
Kaspersky: Nine out of ten healthcare organizations provide telehealth services, yet almost half face patients’ mistrust towards privacy
New global research from Kaspersky reveals that 91% of medical organizations have already implemented telehealth capabilities, with 44% starting to use them after the pandemic. At the same time, 52% of respondents have experienced cases where patients refused telehealth services due to security concerns. Medical organizations have adapted to the new conditions, and today, 56% of healthcare institutions are planning to increase their investment in telehealth and virtual care solutions. Kaspersky surveyed healthcare decision-makers to learn how the digital transformation of the industry is going and which problems they believe should be solved to create a world in which everyone can gain access to affordable, fast, and quality care.
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Attitudes and Perceptions of Multidisciplinary Cancer Care Clinicians Toward Telehealth and Secure Messages
JAMA: Attitudes and Perceptions of Multidisciplinary Cancer Care Clinicians Toward Telehealth and Secure Messages
A new study finds that the majority of cancer care clinicians were satisfied with telehealth and expressed intent to continue to use the care modality in the future. Just over 75 percent of respondents said they were somewhat or very satisfied with telehealth. Additionally, 84 percent of clinicians said that they thought their patients were somewhat or highly satisfied as well. Around three-fourths of the participants reported that they thought patient caregivers, colleagues, and non-clinician staff were satisfied with telehealth—76 percent, 81 percent, and 73 percent, respectively.
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States Allowing Telehealth Prescriptions for Opioid Use Disorder
National Academy for State Health Policy (NASHP): States Allowing Telehealth Prescriptions for Opioid Use Disorder
Early on in the COVID-19 pandemic, the federal government implemented several telehealth flexibilities to allow states to maximize access to medications for opioid use disorder (MOUD). While these flexibilities remain allowable until the end of the federal public health emergency (PHE), state approaches to prescribing MOUD via telehealth currently vary greatly. NASHP produced a map of current telehealth MOUD state policy 18 months into the COVID-19 pandemic. Currently, roughly 50 percent of states explicitly allow MOUD via telehealth, and three have ended provisions for MOUD via telehealth.
Telemedicine, modernized licensing can help bridge health disparity gap
The Commonwealth Fund: Telemedicine, modernized licensing can help bridge health disparity gap
A report by the Commonwealth Fund found pervasive racial and ethnic inequities across health systems in all 50 states. The state-by-state analysis pointed to policy changes that could help bridge the gap, such as policies to help ensure health coverage, reduce administrative burden and improve service delivery – including via telemedicine and licensure modernization. When it comes to improving the delivery of services, one recommendation was to ensure that telemedicine remains an option, as it is an effective strategy for providing patients with convenient access to care. Another recommendation was to modernize medical licensing by allowing health care professionals to more easily practice across state lines.
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Evaluation of Telemedicine Use Among US Patients With Newly Diagnosed Cancer by Socioeconomic Status
JAMA Oncology: Evaluation of Telemedicine Use Among US Patients With Newly Diagnosed Cancer by Socioeconomic Status
Newly diagnosed cancer patients with high socioeconomic status were more likely to have a telehealth visit in the 30 days following their diagnosis compared to patients with low socioeconomic status, according to a new study. Researchers from the University of Kansas analyzed 16,006 patients who were newly diagnosed with breast, lung, prostate, or colorectal cancer between January 1 and August 31, 2020. Around half of the patients were between 18 and 64 years old while the other half were over 65. Despite telehealth visit volumes rising from 0.4 percent in January to its height of 54 percent in April 2020, telehealth use among the study population was divided based on socioeconomic status.