Telehealth finds receptive ear in Congress; $1.7T spending bill includes 2-year extension

It was a top priority for healthcare groups. Lawmakers agreed to continue telemedicine waivers through 2024, and advocates hope it’s a step toward permanent reforms.

Advocates for telehealth kept pressing Congress to ensure access for virtual care, and it appears lawmakers got the message.

Lawmakers are working on final approval of the $1.7 trillion federal spending bill before the government is slated to shut down at the end of the week. Senate leaders included a provision to extend telehealth waivers for healthcare providers through 2024.

The news was music to the ears of Kyle Zebley, senior vice president of public policy for the American Telemedicine Association.

With the possible exception of the federal government expanding virtual care shortly after the arrival of COVID-19, “This is the biggest federal success the telehealth community has had, arguably ever,” Zebley told Chief Healthcare Executive in an interview Wednesday morning.

“It’s a real bipartisan example of the stunning levels of support we have built up over the years,” Zebley said.

The Senate approved the omnibus spending package Thursday, and the House passed it Friday. President Biden is expected to sign it Friday.

Advocates are grateful for the two-year telehealth extension, and are looking for longer-lasting reforms down the road.

“It is a sign that we’re on the road to permanency,” Zebley said.

(In this video from an August interview with Chief Healthcare Executive, Kyle Zebley described the strong support for telehealth. The story continues below.)

Racing the clock

Healthcare groups emphasized that extending telehealth access was near the top of their list of priorities before Congress adjourns for the year. It wasn’t just an arbitrary deadline. 

A new Congress will take office in January. If lawmakers didn’t approve the telehealth measure, the legislative process would have to begin anew in 2023, with a new bill being introduced and requiring several steps to clear both the House and Senate, or get inserted into another spending package.

The House of Representatives overwhelmingly approved a bill in July to extend telehealth coverage through 2024. The House passed it with a 416-12 vote, an unusually wide margin in the highly charged partisan environment in Washington.

The measure also had strong support in the Senate, but health advocates said Senate passage wouldn’t be a lock because of the short amount of time left in the congressional session.

Health systems were given waivers to extend telehealth services early in the COVID-19 pandemic, which was a necessity since many providers had curbed in-person services in the first few months of the pandemic.

Advocates expected the telehealth legislation would have to be included in a broader spending package, and healthcare groups sought to get it into the omnibus bill, even as the end of the year rapidly approaches.

“For something like this, everybody that’s been fighting to get something included in a massive package like this ... It’s a race against time,” Zebley said.

The telehealth waivers are largely tied to the federal government’s COVID-19 public health emergency, generating uncertainty as to how long those waivers would be in effect. The emergency looks to stay in place through the early months of 2023, healthcare advocates say, but it’s difficult to predict how long it will last. Health systems warned of an impending cliff for telehealth.

Congress and President Biden approved a safety net early last year by allowing telehealth waivers to continue for about five months after the end of the emergency designation.

But health systems pressed lawmakers for a longer period to continue telehealth, which has become a valuable service for providers and for patients, particularly those who don’t live near a practice or hospital.

Key provisions

The spending package includes a two-year delay in implementing the Medicare telemental health in-person requirement, a key issue for behavioral health providers. Healthcare leaders have said telemedicine is a critical way to expand mental health services, particularly with the shortage of clinicians.

It also includes a two-year extension to offer telehealth in High Deductible Health Plans, the American Telemedicine Association said.

The spending package would also provide a two-year extension for hospital-at-home programs, another top issue for health systems. More hospitals have been launching home-based acute care programs. Across the nation, 259 hospitals in 37 states are offering acute care at home, according to federal data.

Home hospital programs are “one of the most innovative test programs that has come out during the pandemic,” Zebley said. “That's included and it’s a huge victory.”

In addition, audio-only telehealth services would be covered, which Zebley said is important in communities where video telehealth services aren’t widely available.

However, the spending package didn’t include a provision healthcare advocates had sought.

Telemedicine advocates had pushed for an extension of the waiver for the remote prescription of certain controlled substances, including some medications for substance use disorder. But that provision didn’t make the final cut.

The remote prescription waiver is tied to the public health emergency, so that waiver could end shortly after the emergency designation is phased out.

“There’s a big outlier … I’m very concerned about what happens when the public health emergency ends for that community,” Zebley said.

The spending package directs the Drug Enforcement Administration to develop regulations specifying when telemedicine may be used for remote prescriptions of certain substances. And health groups will continue pushing for a more permanent solution, Zebley said.

Looking ahead

Assuming Congress gets the spending package done, health groups are looking forward to pressing ahead with permanent telehealth reforms.

There will be a new Congress, with Republicans holding a narrow majority in the House and Democrats holding a slim edge in the Senate. Zebley said he’s optimistic that there will continue to be strong support for telehealth across party lines, and healthcare groups will be pushing for legislation to craft lasting coverage for telehealth.

“We’re one of those rare issues that had extraordinary support in the Trump administration, which carried over into the Biden administration,” Zebley said.

This wasn’t a new, last-minute effort to wedge telehealth expansion into a big spending package, Zebley said. Telehealth advocates have been pressing Congress for years, building credibility and support with lawmakers. Health groups spoke “with one voice in support of telehealth … which is no small thing,” Zebley said.

“Getting everyone on the same page is also important,” Zebley said.

Telehealth usage soared early in the COVID-19 pandemic, and while use of telehealth has dipped from peak levels, many patients like having virtual options. More than one in three Americans (37%) used telehealth at some point in 2021, according to the Centers for Disease Control and Prevention.

With broad usage of virtual care, strong legislative support and a two-year extension, Zebley said advocates can work with lawmakers on crafting thoughtful legislation to continue telehealth services.

“Even in a divided Congress, even during a divided time, even as we gear up for the 2024 election, this continues to be an issue that garners bipartisan support,” Zebley said.

“I think the vast majority of these programs are on the road to permanency,” he said. “I’m very optimistic.”