WADA Advocacy Efforts Drive Permanent Advances in Telehealth
COVID-19 has led to a dramatic increase in the adoption of telehealth by physicians and patients. Policymakers should seize the opportunity to develop permanent policy that supports many of these advances beyond the pandemic.
On the March 15, 2022 episode of Moving Medicine, AMA Director of Experience Todd Unger discusses the importance of protecting the future of telehealth with Jason Marino, Director of Congressional Affairs of the AMA. ‘AMA.
At the start of the COVID-19 pandemic, with strong support from the AMA, restrictions on telehealth service coverage were lifted by Medicare and other health plans.
Unfortunately, many of the telehealth flexibilities that have dramatically improved patient access to care throughout the pandemic are set to expire five months after the national public health emergency ends. In a survey (PDF) conducted by the AMA on the use of telehealth, nearly 70% of physicians surveyed indicated an interest in continuing to provide telehealth services. However, much of this continued use and expansion of services will not be possible with a return to the previous lack of insurance coverage and payer reimbursement.
Obtaining permanent Medicare coverage of telehealth services for patients, including allowing them to continue to receive these services at home, is important for patient access to care. The AMA works to ensure physicians (PDF) have the tools, resources, and support needed to seamlessly integrate telehealth into their practices without financial risk or penalty.
Prior to March 2020, Medicare only paid for telehealth services in very limited circumstances:
- Patients had to reside in rural areas
- Patients could only receive telehealth services at a medical facility
- Two-way audio-video telecommunications equipment had to be used
- A limited number of services were on the Medicare Telehealth list
- Because payments were at facility rates, they were approximately 30% lower than in-office payment rates
During the nationwide COVID-19 public health emergency (PHE), the AMA successfully advocated for Medicare to pay for telehealth:
- In rural and non-rural areas throughout the country
- To patients at home or wherever they are without the need to travel to a medical facility
- Physicians providing telehealth services at home or wherever they are
- Use of audio-video telecommunications equipment, smartphones or audio-only telephones, including landlines
- At the same rates as in-office services
- For a vastly increased number of codes, including telephone visits, emergency room visits, home visits, home hospital services and many types of therapy
The AMA also strongly supports legislation enacted in March 2022 that will extend many of the telehealth policies put in place for PHE for an additional five months after PHE ends.
The biggest challenge now is to pass legislation that will permanently lift rural and home-site restrictions (PDF) on telehealth coverage for Medicare patients.
- The Telehealth Modernization Act of 2021 would lift the rural-only restriction and add any site where a patient is located as a potential source site.
- The CONNECT law for health lift the rural-only restriction, add home as an origin site, establish a process for the Secretary of the U.S. Department of Health and Human Services (HHS) to add origin sites, and give HHS the authority standing to waive the Section 1834(m) restriction.
- Telemental Health Care Access Act is a bipartisan bill that would repeal a new requirement that a patient must see a provider in person within six months of receiving a mental health telehealth service.
The AMA provides policy direction and recommendations at the state level to expand coverage, access, and payment for telehealth services.
At the state level, the AMA has worked to:
- Support telehealth coverage and payment
- Require insurers to allow all physicians under contract to provide care via telehealth
- Support hybrid models of care where physicians use both telehealth and in-person care
- Eliminate separate telehealth networks and policies that push patients to select telehealth providers instead of their regular physicians
- Prevent plans from using telehealth to meet network adequacy requirements
Additionally, the AMA supported the adoption of “The Appropriate Use of Telemedicine Technologies in the Practice of Medicine” by the Federation of State Medical Boards as an update to their 2014 guidelines. The new document provides guidance to state medical boards on the use of telemedicine in healthcare and can be used model policy for the permanent adoption of telemedicine at the state level.
The AMA has created a briefing note (PDF) outlining specific policy proposals to take important and necessary steps to promote and ensure equity in telehealth.
- Comment letter (PDF) to the Federation of State Medical Boards supporting their updated telemedicine policy.
- Signature letter (PDF) successfully urging congressional leaders to extend telehealth flexibilities for five months after the national public health emergency ends.
- Statement for the Record (PDF) to the U.S. House of Representatives Ways and Means Subcommittee on Health Supporting Continued Access to Telehealth Services for Medicare Beneficiaries.
AMA Advocacy Insights Webinar Series: The Future of Telemedicine
To cope with the dramatic increase in use of telemedicine following the COVID-19 pandemic, the Federation of State Medical Boards (FSMB) House of Delegates recently updated and adopted “The Appropriate Use of Telemedicine Technologies in Practice of medicine”. During this AMA Advocacy Insights webinar, experts from the FSMB provide an overview of updated policy, discuss current state licensing laws regarding telemedicine, and outline ongoing solutions that can be implemented at the coming.