Protecting Patients and Telehealth Access: More Than 230 National Organizations Urge Governors Across the Country to Maintain and Expand Licensure Flexibilities Throughout Federal Public Health Emergency
Letter to Governors Stresses Urgency of Expiring Licensure Waivers and its Impact on Patient Access to Care
Washington, DC – November 1, 2021 – Today, more than 230 organizations sent a letter to all 50 state governors urging them to maintain and expand licensure flexibilities enacted at the start of the pandemic for the duration of the federal public health emergency, to better address patient needs during the ongoing pandemic. The letter was convened by the Alliance for Connected Care, ALS Association, and National Organization for Rare Disorders (NORD), and includes a diverse mix of signers ranging from patient advocacy organizations, hospitals and health systems, academic medical centers, higher education, digital health companies, health information management associations, and many more.
During the public health emergency, governors across the country used emergency authority to waive some aspects of state licensure requirements to facilitate greater patient access to care, allowing providers more flexibility to treat patients across state lines. However, over the past few months, many states have allowed such flexibilities to expire along with the expiration of COVID-19 emergency declarations, leading to a reduction in access to vital care as the pandemic continues.
Many patients relied on telehealth throughout the pandemic to see their specialists who reside in another state, made possible by licensure flexibilities enacted at the start of the pandemic, so as not to risk exposure to the virus and to maintain continuity of care through virtual options. These patients are now faced with canceling these vital appointments or risking an in-person visit and thus exposure to COVID-19. As such, this letter urges state governors to act now to ensure patients can access the care they need where they reside and when they need it, and outlines a set of principles to consider for licensure policies that should be in place right now to ensure patient access to care.
“Improved access to telehealth services during the pandemic has been a lifeline for many in the rare disease community,” said Peter Saltonstall, President and CEO, NORD. “A 2020 NORD survey found that nearly 40% of rare disease patients travel more than 60 miles for their medical care, which means robust telehealth access, including access to providers across state lines, is critical. NORD has been working to ensure that state-based licensure flexibilities do not expire, so that rare disease patients can continue to have access to ongoing and necessary patient care while the threat of COVID-19 remains. NORD is proud to come together with this diverse coalition to prevent a reduction in access for patients, many of whom are still at high risk for COVID-19. Our state governments must heed the call of all stakeholders – from patient advocacy organizations to hospitals to digital health companies – and maintain access to vital health care providers now and into the future.”
“Telehealth has provided much-needed and cost-effective opportunities for people with ALS to access specialized ALS care,” said Neil Thakur, Chief Mission Officer of The ALS Association. “The debilitating nature of ALS — which robs people of their ability to move, eat, and eventually, breathe – makes travel very challenging. Because the number of ALS clinics is very limited, some people with ALS need to access care across state lines. Access to multidisciplinary care is critical and has been shown to extend life, which is significant considering the average life expectancy after ALS diagnosis is two to five years. We strongly urge Governors to take the steps needed to keep or restore access to specialized care for ALS and similar conditions.”
“We must build on the lessons learned from the pandemic and ensure patients can access care from their providers regardless of where they live, especially as the pandemic continues. Patients and their families seek care across state lines for many reasons, and the licensure flexibilities put in place throughout the pandemic have been critical for expanding patient access to care, improving care coordination and continuity of care, and addressing workforce shortages. State governors must act to ensure these flexibilities continue, and consider solutions to address the ongoing needs of patients both during the pandemic and in the future,” Krista Drobac, Executive Director, Alliance for Connected Care
The letter has been sent to all 50 governors across the United States. To read the full letter and view the list of organizations who signed on, click here or see below. State-specific letters can be found linked here: AL, AK, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY.
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Open in new tab More Than 70 Organizations Urge Congress to Extend Virtual Care Provisions in the CARES Act for Individuals with HDHP-HSAs
Letter to Congressional Leaders Stresses Urgency of Impending Expiration of Telehealth Safe Harbor
Washington, DC – October 26, 2021 – Today, more than 70 organizations sent a letter to Congress to urge policymakers to address the impending expiration of the telehealth safe harbor enacted in the CARES Act that enabled employers and insurers 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, and employer coalitions.
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 is not tied to the public health emergency (PHE), and will expire on December 31, 2021 regardless of how long the PHE lasts if Congress does not act.
The ability to offer pre-deductible telehealth services for employees is a meaningful expansion of health care access for the 35 million Americans with HDHP-HSAs. Congress must act soon to extend the virtual care provisions in the CARES Act for individuals with HDHP-HSAs beyond the current deadline of December 31 2021, especially as we approach open enrollment for plan year 2022.
“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,” said Alliance for Connected Care executive director Krista Drobac. “Congress must act now to ensure individuals with HDHP-HSAs can continue to have ready access to virtual care services before the end of the year when this provision will expire.”
Bipartisan and widely supported legislation recently introduced in the U.S. Senate and House of Representatives incudes language that would extend this access for patients. The Telehealth Expansion Act of 2021 (S. 1704) 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 before the end of this year, when existing access will end.
To read the full letter, click here or see below:
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Alliance Statement on the Primary and Virtual Care Affordability Act
STATEMENT ON THE PRIMARY AND VIRTUAL CARE AFFORDABILITY ACT
October 18, 2021
WASHINGTON DC – There are more than 35 million Americans with high-deductible health plans coupled with a Health Savings Account (HDHP-HSAs). More than 50 percent of individuals with HSAs live in zip codes where the median income is below $75,000 annually. Reaching the deductible threshold of $1,400 for an individual and $2,800 for a family is often a financial strain.
Allowing employers to subsidize access to telehealth for employees with HDHP-HSAs before the deductible is met, provides meaningful access to health care services. Through the CARES Act, Congress gave employers the ability to provide free or reduced telehealth services to their employees during the pandemic by creating a telehealth safe harbor from certain high deductible health plan rules. The safe harbor is not part of the flexibilities provided by the Public Health Emergency (PHE), and is set to expire on December 31, 2021 regardless of how long the PHE lasts.
The Alliance is pleased to support the introduction of the Primary and Virtual Care Affordability Act (H.R. 5541) and applauds Representatives Schneider (D-IL) and Wenstrup (R-OH) for their leadership in extending the CARES Act authority for employers and health plans to subsidize telehealth visits, and to expand this provision to primary care, for individuals with HDHP-HSAs through December 31, 2023.
A full statement can be found here and below:
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Alliance Statement for the Record to Senate Commerce Hearing on: “State of Telehealth: Removing Barriers to Access and Improving Patient Outcomes”
ALLIANCE FOR CONNECTED CARE STATEMENT FOR THE RECORD
“State of Telehealth: Removing Barriers to Access and Improving Patient Outcomes”
The Alliance submitted a letter to the Senate Commerce, Science, and Transportation Committee, Communications, Media, and Broadband Subcommittee on a hearing examining the importance of access to telehealth services, and the role that broadband plays in the public health response.
Our statement summarizes the following recommendations:
- Congress should invest in efforts that support broadband affordability for patients and providers.
- Congress must continue to coordinate with other federal agencies to ensure improvements are being made to our taxpayer-funded programs, and that all patients deserving of these benefits are being afforded access.
- Congress must make permanent the Emergency Broadband Benefit program.
- Congress must continue to address anticompetitive behaviors in all industries, and explore solutions that support patients.
- Congress should invest in efforts that support the deployment of broadband for all Americans, including those living in rural areas, on Tribal lands and to our nation’s health care providers and centers.
- Congress must maintain access to audio-only services for patients who, in the interim, continue to lack broadband access and/or affordability.
- Congress should pass the Data Mapping to Save Moms’ Live Act (S. 198/H.R. 1218) in the 2022 Consolidated Appropriations package.
- Congress should consider addressing antiquated licensure requirements that impeded access to care to address gaps in the delivery system and provide high-value care directly to consumers in rural or underserved areas.
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Alliance Joins Letter Calling on CMS to Address Critical Access Hospital Telehealth
The Alliance for Connected Care joined roughly 20 other groups in calling on CMS to address Critical Access Hospital (CAH) telehealth.
“We agree that telehealth payment should be addressed for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and also believe outpatient behavioral therapy services offered by Critical Access Hospitals (CAHs) are a key component of a comprehensive rural behavioral health strategy.”
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Alliance Joins Congressional Letter to Support Telehealth Resource Centers
The Alliance for Connected Care joined a letter this week to Senate HELP Chair Murray and Ranking Member Blunt requesting funding support for the Telehealth Resource Centers (TRC) program in the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services (HHS).
This increase in funding would provide a critical boost to the TRCs, which have experienced a high of an 800% increase in demand for telehealth assistance during the COVID-19 pandemic across the nation, yet have been level-funded since 2006.
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Comment Letter on CY 2022 Physician Fee Schedule Proposed Rule
The Alliance for Connected Care submitted comments on the Medicare Physician Fee Schedule (PFS) Proposed Rule for calendar year (CY) 2022, which includes several important reforms with respect to telehealth. The Alliance applauds the proposal to retain all Category 3 telehealth codes through the end of Calendar Year (CY) 2023 to provide an opportunity to collect and study data on the telehealth experience during the COVID-19 public health emergency.
In advance of our more detailed response the Alliance emphasized the following overarching priorities:
- A great deal of confusion continues to exist around the authority of the Administration to make longer-term telehealth changes. We encourage CMS to continue clearly communicating to Congress and stakeholders that there are statutory limitations curtailing CMS’ ability to allow continued access to telehealth for Medicare beneficiaries. Additionally, we urge you to continue collecting and publicly sharing data about telehealth utilization and inform a conversation with Congress around what statutory authorities CMS needs to make thoughtful, long-term policy.
- While we appreciate and support CMS’s effort to create temporary category 3 codes and its proposal to retain these codes through the end of the Calendar Year (CY) 2023, we continue to believe these codes are inadequate to the stability and predictability needed for health care providers to make necessary investments and plan for care/care systems in the longer term. Furthermore, and just as important, patients deserve and require predictability in their health care – and we urge CMS to consider patient expectations especially as patients have become more engaged in the delivery of health care services, and have become more ensconced in a hybrid model of health care delivery.
- While we recognize some statutory requirements exist, we remain very concerned with steps taken by CMS around in-person visit requirements. The Alliance and its members strongly believe that an in-person requirement constrains telehealth from helping individuals that are homebound, have transportation challenges, live in underserved areas, etc. It does not constrain those using telehealth for convenience. This creates a perversion of the Medicare payment system by reducing access for those who need it most, while allowing access for others.
- While we are supportive of CMS’ proposals to increase beneficiary participation and access in the Medicare Diabetes Prevention Program (MDPP) Expanded Model, we would like to highlight additional actions that would match CMS’ goals for the program. Specifically, the Alliance strongly feels that CMS should permit any CDC-recognized DPP suppliers to apply to become Medicare suppliers – including virtual DPP suppliers. Not only would permitting virtual suppliers to apply to become MDPP Expanded Model Suppliers increase the number of MDPP Suppliers participating in the program, but it would also broaden the reach of who can receive diabetes prevention services beyond brick-and-mortar locations, and provide convenient and timely access to a more diverse set of patients no longer burdened by needing to take time off everyday demands to complete the required curriculum.
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Summary: CY 2022 Proposed Physician Fee Schedule
On July 13, 2021, CMS released their proposed Calendar Year (CY) 2022 Medicare Physician Fee Schedule.Below is a summary of key payment and policy changes within the rule. Comments are due by September 13, 2021.
Physician Fee Schedule
Please find our summary of the PFS here.
Please find some topline elements and links below.
On July 13, 2021, CMS issued the proposed Calendar Year 2022 (CY2022) Physician Fee Schedule (PFS), which makes payment and policy changes under Medicare Part B.
CMS is proposing to retain all services added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023 – December 31, 2023 – to allow for time to collect more information regarding utilization of these services during the pandemic, and provide stakeholders the opportunity to continue to develop support for the permanent addition of appropriate services to the telehealth list through the regular consideration process, which includes notice-and-comment rulemaking.
In addition, CMS is proposing to amend the current regulatory requirement for interactive telecommunications systems to include audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. CMS is proposing to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology.
Finally, CMS is proposing to require an in-person visit be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter.
- CMS is seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology.
- CMS is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiary’s regular practitioner.
CMS is also soliciting comment on: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not CMS should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails CMS should consider putting in place in order to minimize program integrity and patient safety concerns.
Please see our detailed summary of the proposed rule below:
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430+ Organizations Urge Congress to Address ‘Telehealth Cliff’
430 Organizations Urge Congress to Address ‘Telehealth Cliff’
Letter to Congressional Leaders Highlights Telehealth Priorities
Washington, DC – July 26, 2021 – Today, more than 430 organizations sent a letter to Congress to urge policymakers to address the “telehealth cliff.” The letter was co-led by the Alliance for Connected Care, American Telemedicine Association, Consumer Technology Association, eHealth Initiative, HIMSS, Health Innovation Alliance, Partnership to Advance Virtual Care, and PCHAlliance.
If Congress does not act before the end of the COVID-19 public health emergency (PHE), Medicare beneficiaries will lose access to virtual care options which have become a lifeline to many. The letter calls for Congress to advance permanent telehealth reform focused on specific priorities:
- Removing arbitrary restrictions on where a patient must be located in order to utilize telehealth services;
- Ensuring federally qualified health centers, critical access hospitals, and rural health centers can furnish telehealth services;
- Authorizing the Secretary to allow additional telehealth practitioners, services, and modalities; and
- Removing restrictions on telemental health services.
Over the pandemic, telehealth has proven to be an efficient and popular tool to deliver high-quality care. Because of this, many providers and health systems have made substantial investments in telehealth. Congress must act now to pass legislation to ensure patients and providers are not left in the lurch with fewer options to address critical health needs.
The following quotes are from organizations co-leading the letter:
“The pandemic has introduced millions of seniors to telehealth and virtual care services, and has demonstrated a successful new way to access health care efficiently, effectively and as a substitute for in-person care. The time is now for Congress to eliminate outdated and ambiguous statutory barriers so that telehealth remains an option for Medicare beneficiaries moving forward and so that their care is not interrupted abruptly by the end of the public health emergency.” Krista Drobac, Executive Director, Alliance for Connected Care
- ACC MEDIA CONTACT: Crystal Wallace (crystal.wallace@connectwithcare.org)
“One acknowledged bright spot resulting from COVID-19 has been the extraordinary use of telehealth that has allowed patients to access quality care from the convenience of their homes. However, there is now much uncertainty around the future of telehealth, creating chaos and concern for patients and healthcare providers alike, as the ‘telehealth cliff’ threatens to abruptly cut off access to care, especially for our underserved and rural populations,” said Kyle Zebley, Vice President of Public Policy at the ATA. “With 430 stakeholders in lockstep, and unprecedented bipartisan support for these legislative priorities, we urge Congress to act swiftly to ensure that telehealth remains permanently available following expiration of the public health emergency. The ATA remains committed to working collaboratively to ensure Medicare beneficiaries can continue to access care when and where they need it.”
- ATA MEDIA CONTACT: Gina Cella (gcella@cellapr.com).
“It is far past time to update our telehealth laws. These are arbitrary restrictions that should be removed,” said Jen Covich Bordenick, Chief Executive Officer of eHealth Initiative. “The pandemic highlighted just how outdated our current law is. Congress needs to take immediate action to ensure millions of patients do not lose access to care delivered via telehealth.”
- eHI MEDIA CONTACT: Catherine Pugh (catherine@ehidc.org)
“Being able to call or video chat your doctor instead of driving into an office makes good, practical sense in many instances. But for millions of American seniors and the disabled, using a smart phone to get care will no longer be an option unless Congress acts to change the outdated Medicare statute before the end of the pandemic. Health Innovation Alliance urges Congress to stop waiting and permanently allow beneficiaries to receive care remotely and in their homes,” Brett Meeks, Vice President, Health Innovation Alliance.
- HIA MEDIA CONTACT: Greg Johnson (gjohnson@health-innovation.org)
“Evidence-based connected care has been at the core of our nation’s health resiliency throughout the COVID-19 pandemic and has established its important role in improving healthcare quality, access, and value for all Americans. HIMSS and PCHAlliance urge Congress to swiftly act to make the Medicare coverage changes permanent, to give patients and providers access to the tools they need and deserve,” Rob Havasy, Managing Director, Personal Connected Health Alliance.
- HIMSS and PCHALLIANCE MEDIA CONTACT: Morgan Searles (Searles@himss.org)
“The pandemic advanced telehealth policy by more than a decade overnight. Absent Congressional action, all of that substantial progress could be lost as quickly as it was gained. The Partnership to Advance Virtual Care urges Congress to provide certainty and stability for providers and patients who have gained access, convenience, and reliability from a wide array of virtual care services,” Mara McDermott, Executive Director, Partnership to Advance Virtual Care.
- PARTNERSHIP TO ADVANCE VIRTUAL CARE MEDIA CONTACT: Erin West (Eswest@mwe.com)
Read the letter to Congress, including the list of 400+ stakeholders, here and below:
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