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House OKs Extension of Medicare Telehealth Flexibilities Through 2024

Analysis  |  By Eric Wicklund  
   July 28, 2022

By a near unanimous vote, the US House of Representatives has passed a bill expanding telehealth access and coverage for Medicare services until the end of 2024, while making those flexibilities permanent for FQHCs and RHCs. The bill now goes to the Senate.

Congress is halfway toward extending telehealth flexibilities enacted during the pandemic until the end of 2024.

The US House of Representatives this week passed the Advancing Telehealth Beyond COVID-19 Act of 2021 (HR 4040) by a 416-12 vote, sending the issue on to the Senate. The bill, introduced more than a year ago by US Rep Liz Cheney (R-Wyoming), expands the definition of "originating site" to allow more locations to use telehealth, eliminates facility fees for new sites, expands the list of healthcare providers able to use telehealth, adds audio-only telehealth to the definition of "telecommunications system," and makes permanent the ability of federally-qualified health centers (FHQCs) and rural health clinics (RHCs) to use telehealth under the Medicare program.

These flexibilities were put into place by the Centers for Medicare & Medicaid Services (CMS) at the onset of the COVID-19 crisis to help healthcare organizations expand access to and coverage of telehealth services, with the caveat that they be terminated at the end of the public health emergency (PHE). The bill's goal is to give providers a better idea of how long they have to use those flexibilities before they either end or Congress takes more action.

The bill's passage drew immediate praise from the American Telemedicine Association (ATA) and its lobbying group, ATA Action.

“Today, we took a significant step forward in providing much needed stability in access to care for millions of Americans, with the US House vote to extend key telehealth flexibilities implemented during the COVID-19 Public Health Emergency (PHE) until the end of 2024," Kyle Zebley, the ATA's vice president of public policy and executive director of ATA Action, said in a press release. "We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent."

“Telehealth has long been a bipartisan healthcare issue and we now turn to the Senate to ensure this important piece of legislation makes it to President Biden’s desk so he can sign it into law,” he added.

The American Medical Association also weighed in on the issue.

“Increased Medicare-covered access to telehealth has been a lifeline to patients and physicians throughout the COVID-19 pandemic, and the American Medical Association (AMA) is pleased by today’s bipartisan vote in the House," AMA President Jack Resnick Jr., MD, said in a statement. "The COVID-19 public health emergency made plain that care via telehealth should be available to all Medicare patients, especially with their own physicians, regardless of where they live or how they access these services. From continuity of care, broadened access to care, and removing geographic and originating-site restrictions, our hope is that the flexibilities afforded during the public health emergency will be made permanent."

Passage of the bill is significant not only because of the margin of victory in the House – indicating strong bipartisan support for telehealth – but because Congress has taken action on the issue. Dozens, if not hundreds, of bills have been proposed in both the House and Senate these past few years aimed at expanding telehealth access and coverage, many seeking some or all of the flexibilities outlined in the Cheney bill, but very few have seen any votes.

Passage in the Senate is no done deal, even with the House's strong support. But Senator Joe Manchin's (D-West Virginia) recent shift to support the Inflation Reduction Act may hint at a willingness to move forward on other issues as well, including healthcare. And the bill does have the backing of the Biden Administration.

"It is important to continue the availability of expanded telehealth to meet the needs of Medicare beneficiaries and health care providers," the Executive Office wrote in a Statement of Administration Policy shortly before the House vote, noting that telehealth visits increased 63-fold in 2020, especially in rural areas and for behavioral health services. "As we emerge from the worst stages of the COVID-19 pandemic, H.R. 4040 will ensure that the Medicare program continually adapts to provide convenient, quality, accessible, and equitable healthcare."

The Senate can now vote on the House bill, vote on its own version of the bill, combine the two, or do nothing.

And while Senate passage of the bill is now top of mind, advocates will continue to push for permanent expansion for some or all of those flexibilities, arguing that telehealth has proven its value during the pandemic.

“We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent.”

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.


KEY TAKEAWAYS

HR 4040 extends several telehealth flexibilities enacted by the Centers for Medicare & Medicaid Services during the pandemic until the end of 2024, giving healthcare organizations a time frame during which to take advantage of expanded access and coverage for Medicare services.

Telehealth advocates are lobbying both Congress and the federal government to make those flexibilities permanent, saying telehealth has proven its value during the pandemic.

The bill is a rare example of bipartisan support for the expansion of healthcare services, though its approval by the Senate is not assured.


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