Unless Congress Acts, Telehealth Progress During Covid Will Be Lost
In response to the COVID-19 pandemic, federal policymakers enacted a series of legislative and regulatory measures to expand access to telehealth services. These changes allowed more patients to safely and conveniently receive medical care online, including those hoping to avoid virus transmission, in rural locations, with childcare or eldercare needs, with mobility issues, lacking transportation, and more. Congress recently extended many of these changes for two years in the Consolidated Appropriations Act of 2023 (H.R. 2617). However, policymakers should permanently extend these temporary measures to ensure that medical providers can continue to offer care to patients remotely after the extension ends.
At the start of the pandemic, President Trump and the Secretary of Health and Human Services (HHS) Alex Azar issued emergency declarations in response to COVID-19. Around the same time, President Trump signed into law the Telehealth Services During Certain Emergency Periods Act of 2020, as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (H.R. 6074). The law authorized the HHS Secretary to temporarily waive certain requirements for Medicare services, such as restrictions on where patients can receive care via telehealth, effectively allowing patients to access telehealth services from home.
Congress revisited the issue in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748) and granted the HHS Secretary authority to waive more requirements for Medicare services, such as changing requirements to allow patients without smartphones or similar devices to receive virtual care. The CARES Act also authorized employers and high-deductible health plans (HDHPs) to cover telehealth services before a patient meets their annual deductible until the end of 2021 and Congress extended this provision until the end of 2022 in the Consolidated Appropriations Act of 2022. As a result, patients with HDHPs can receive care via telehealth without facing an unnecessary financial burden.
Finally, HHS’s Office of Civil Rights (OCR) issued guidance allowing providers to offer telehealth services over common communications platforms, such as Zoom and Skype. Prior to their announcement, medical providers had to use specialized communications platforms that complied with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules. OCR’s new guidance dismissed parts of this requirement and expanded the number of providers who could offer telehealth services by allowing those who may not have had HIPAA-compliant telecommunications infrastructure in place to start hosting appointments over popular platforms.
Together, these measures removed many barriers to telehealth services. Far more patients utilized telehealth services during the COVID-19 pandemic than before. From 2019 to 2020, Medicare fee-for-service beneficiary telehealth visits increased from 840,000 to nearly 52.7 million. Patients with private insurance sought care at similar rates, with privately-billed claim lines increasing by over 8,300 percent from April 2019 to April 2020. Moreover, even though utilization of telehealth services has since leveled off, many patients have still chosen to receive medical care via telehealth in the later years of the pandemic. From July 27, 2022 to August 8, 2022, 22.8 percent of U.S. adults reported attending an appointment with a health professional over video or phone in the past four weeks.
In order to protect access to telehealth services and support their further development, Congress extended these COVID-19 telehealth flexibilities until the end of 2024 in the Consolidated Appropriations Act of 2023 (H.R. 2617). While the extension serves as a good first step, its temporary nature casts uncertainty on the future of telehealth services. As a result of this uncertainty, many patients who use telehealth services cannot adequately plan for future care or effectively build relationships with remote providers. Likewise, the regulatory uncertainty makes it harder for medical providers who have offered telehealth services over the course of the public health emergency, or who want to start now, to invest in telehealth technology for their practices.
Instead of repeatedly enacting temporary measures, policymakers should make the COVID-19 flexibilities supporting telehealth progress permanent and ensure that patients and medical providers alike can continue engaging in telehealth services without interruption. To that end, Congress should enact legislation that permanently removes geographic or site requirements, restrictions on the type of care that can be provided via telehealth, and prohibitions against audio-only services. The legislation should also repeal any provisions requiring patients to see a provider in person before receiving care via telehealth services.
Given that over 60 million beneficiaries have enrolled in Medicare, legislation to support the development of telehealth services for Medicare beneficiaries will likely affect the broader market and lead to more providers integrating telehealth into their practices. However, to further augment telehealth progress, Congress should similarly extend the provision allowing HDHPs to provide first-dollar coverage of telehealth services so patients with HDHPs can continue telehealth services without first meeting the burdens of a high deductible.
The COVID-19 pandemic has shown that telehealth can safely and effectively facilitate care for millions of patients. Congress should pass legislation permanently extending the flexibilities that enabled this care to ensure that patients can continue to receive virtual care from the comfort of their home.