Background

Section 3701 of the CARES Act created a temporary safe harbor that allowed employers and health plans to provide pre-deductible coverage of telehealth services for individuals with a high deductible health plan coupled with a health savings account (HDHP-HSA). The safe harbor allowed individuals with these plans to access telehealth services before their annual deductible was met, ensuring that employers and plans could support patients that were leveraging virtual care to access a range of critical health care services during the pandemic.

This provision has increased health care access for many individuals that otherwise would have avoided care due to out-of-pocket costs. Unfortunately, Congress did not anticipate that the COVID-19 public health emergency would last this long, and only provided for this access until December 31, 2021. New action is needed to ensure Americans do not lose access to these important telehealth benefits.

Recent Advocacy Highlights

More Than 125 Organizations Sent Letter Urging Congress to Reinstate CARES Act Provision Allowing Employees with HDHP-HSAs to Continue Receiving Pre-Deductible Coverage for Telehealth  

On Friday, January 21, more than 125 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. To read the full letter, click here.

Read Letter

More Than 125 Organizations Urge Congress to Reinstate Virtual Care Access for Individuals with HDHP-HSAs (1/21) – More than 125 organizations sent a letter to Congress urging policymakers to reinstate the telehealth safe harbor enacted in the CARES Act that allowed 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, which was sent to both Congressional leadership and Committee leadership, included a diverse mix of signers ranging from patient groups, clinician organizations, employer coalitions and digital health platforms. To read the letter to Congressional leadership, click here. To read the letter to Committee leadership, click here. For background information, click here.

More Than 70 Organizations Urge Congress to Extend Virtual Care Provisions in the CARES Act for Individuals with HDHP-HSAs (October 26, 2021) – 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. To read the full letter, click here.

Alliance Statement on the Telehealth Expansion Act of 2021 (November 17, 2021) – The Alliance for Connected Care is pleased to support the Telehealth Expansion Act of 2021 (S. 1704/H.R. 5981) and applauds Senators Steve Daines (R-MT) and Catherine Cortez Masto (D-NV) and Representatives Michelle Steel (R-CA) and Susie Lee (D-NV) for their leadership in introducing this bipartisan, bicameral bill. This legislation would permanently extend the CARES Act authority for employers and health plans to subsidize telehealth visits for individuals with HDHP-HSAs, which is currently set to expire on December 31, 2021. A full statement of support can be found here.

Alliance Statement on the Primary and Virtual Care Affordability Act (October 18, 2021) – 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 of support can be found here.

Inside Health Policy: Stakeholders to Lawmakers: Reinstate CARES Act Telehealth Policy for HDHP-HSAs (1/13) – The Alliance for Connected Care and over 100 organizations sent a letter to key lawmakers asking them to reinstate the CARES Act policy changes that allowed Americans with HDHP-HSAs to receive pre-deductible telehealth services. This flexibility expired on December 31, 2021. This letter builds on the advocacy done by the Alliance and several other stakeholders to ensure this provision does not lapse, including supporting efforts by bipartisan, bicameral lawmakers to request that the IRS waive enforcement of current law until lawmakers can act on this issue in 2022.

Congress: Letter to Treasury on the HDHP-HSA Telehealth Safe Harbor (12/22) – Senators Cortez Masto (D-NV) and Daines (R-MT) and Representatives Steel (R-CA) and Lee (D-NV), the co-sponsors of the Telehealth Expansion Act in the Senate and House, sent a letter to the US Department of the Treasury on an IRS non-enforcement strategy for the CARES Act provision that enabled employers and insurers to provide pre-deductible coverage of telehealth services for individuals with HDHP-HSAs. This provision expired on December 31, 2021. These Members of Congress sent this letter to Secretary Yellen, as well as to the White House and HHS, urging the Treasury to issue guidance ensuring that Americans with an HDHP-HSA will not be faced with unexpected out-of-pocket costs for telehealth services after this provision expired to allow Congress to act on this provision early in 2022.

Inside Health Policy: IRS Pressed to Waive Enforcement Until Congress Extends HSA Telehealth Policy (12/22) – Several stakeholders have asked the IRS to waive enforcement of the CARES Act provision that enabled employers and health plans to provide pre-deductible coverage of telehealth services to individuals with high-deductible health plans coupled with a health savings account (HDHP-HSAs) before it expired on December 31. A letter from the Alliance to Fight for Health Care urged the IRS to hold on enforcement until Congress is able to act in 2022, given it was not included in the Medicare extenders bill enacted in December. The Alliance for Connected Care has also been active on advocating around this issue, with Executive Director Krista Drobac stating “We are hopeful that the IRS will recognize congressional intent to continue telehealth flexibilities and provide a temporary delay in enforcement of HSA policy.”

Inside Health Policy: Congress Poised to Let CARES Pre-Deductible Telehealth Provision Expire (12/8) – The House failed to include an extension of a provision enacted through the CARES Act that has allowed employers to provide coverage for telehealth services pre-deductible for individuals with HDHP-HSAs in its newly passed provider relief measure. This provision is set to expire on December 31, 2021, as it is not tied to the public health emergency unlike other telehealth flexibilities. This policy was on the short list of provisions that the House and Senate was considering for this bill, but fell out during negotiations with the Ways & Means Committee due to lack of Democratic support. This policy has been widely adopted and is currently used by about 40 percent of employers, and groups including the Alliance for Connected Care continue to advocate for the policy’s extension.

Representative Steel: What They’re Saying: Healthcare Community Applauds Telehealth Expansion Act (11/30) – Reps. Steel (R-CA) and Lee (D-NV) recently introduced the Telehealth Expansion Act (H.R. 5981), which would make permanent a CARES Act provision that allowed pre-deductible coverage of telehealth services for individuals with HDHP-HSAs. This provision is set to expire on December 31, 2021 if Congress does not take action. Several groups were quoted in support of this legislation, including Alliance for Connected Care Executive Director Krista Drobac: “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. The bipartisan Telehealth Expansion Act of 2021 will ensure individuals with HDHP-HSAs continue to have ready access to virtual-care services while remaining eligible to make and receive contributions to an HSA.”

Fact Sheet

This document presents data on the use of the virtual care flexibility created in the CARES Act for individuals with HDHP-HSAs, and its impact on access to health care during the COVID-19 pandemic.

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