The new year is poised to be consequential for online health care as several pandemic-era telemedicine measures are set to phase out, leaving many in the industry anxious over which will be kept, telehealth policy watchers said.
Congress’s legislative agenda for 2024 will include industry-backed bills aiming to permanently extend flexibilities that patients and providers came to rely on during the Covid-19 public health emergency.
Flexibilities on the line include provisions that address the scope of Medicare reimbursement to telemedicine providers, telehealth access for underinsured Americans, and online controlled substance prescribing, along with several other policies that were instrumental in growing telehealth to an industry of over 81 million visits in 2022.
“We have made tremendous progress to date in advancing telehealth and in improving health care in America. I think what we have now is hard work ahead of us to keep the momentum of all the progress that we’ve made,” Sree Chaguturu, executive vice president and chief medical officer at CVS Health, said at a recent panel discussion with telehealth industry leaders.
Here’s a look at three areas where lawmakers will be looking to step in.
Medicare Overhauls
Spurred by the Covid-19 lockdown and the need to transition millions of Americans to online care, the Centers for Medicare & Medicaid Services introduced several emergency waivers relaxing administrative barriers to virtual care reimbursement.
The new flexibilities opened the door for doctors to receive Medicare payments for appointments irrespective of location, expanded the list of providers eligible to bill Medicare, and allowed beneficiaries to access care online or through the phone without an in-person consultation.
The flexibilities also ensured that doctors would get paid at parity regardless of whether they chose to conduct their appointments in an office or virtually. After the introduction of these relaxed policies, telemedicine visits under Medicare exploded, growing from 860,000 in 2019 to over 53 million a year later.
For telehealth policy watchers like Mei Wa Kwong, executive director of the Center for Connected Health Policy, a telemedicine public policy think tank, maintaining the coverage gains realized during the pandemic will be a top issue for lawmakers in 2024.
Kwong sees Sen.
The bill, which has 61 cosponsors, would remove geographic restrictions on telehealth services, eliminate in-person requirements for mental health services, and expand the list of providers eligible to bill Medicare to include practitioners like occupational therapists and speech-language pathologists.
The bill will likely be tacked onto an appropriations package to get the best chance at making it to the finish line, she said.
Expanding Coverage
The pandemic also led to several flexibilities that expanded online health-care access to underinsured Americans, particularly seasonal workers, and those covered under high-deductible health plans.
Nearly 29% of Americans were covered under high-deductible plans in 2022, with those with single coverage plans contending with yearly deductibles of over $2,900 on average, according to health research firm KFF.
Flexibilities implemented in Section 3701 of the Coronavirus Aid, Relief, and Economic Security Act (CARES) temporarily lifted this burden from high-deductible policyholders by allowing them access to online coverage previously out of reach due to up-front costs.
Now nearly a year removed from the pandemic, Rep.
Their bill, the Telehealth Expansion Act (H.R. 5981), which passed through the Ways and Means Committee in June, would amend the Internal Revenue Code to remove the restrictions on allowing high-deductible plans to furnish telehealth services before a deductible is met.
Similarly, lawmakers and telehealth advocates like Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, are eying the possibility of permanently offering telehealth services as a standalone employee insurance benefit.
“During the pandemic, part-time or seasonal employees that wouldn’t have had access to care otherwise were given the ability to receive telehealth care, and that provision is going away now that the public health emergencies are over,” Zebley said. “What we want to do is have that brought back to life.”
The Telehealth Benefit Expansion for Workers Act of 2023 (H.R. 824), spearheaded by Reps.
Controlled Substance Prescribing
The year is also likely to see a push to bring about a permanent policy over the online prescribing of controlled substances.
In 2020, the Trump administration temporarily relaxed restrictions on online controlled substance prescribing, allowing doctors the discretion to dispense drugs like Adderall and buprenorphine without in-person examination or monthly supply limitations.
With those flexibilities set to expire in 2024, telehealth industry leaders are looking for policymakers to keep in them in place, either through lawmaking or by using existing regulatory pathways.
“Congress granted DEA the authority to come up with a rule that would allow something like a TSA PreCheck for providers to prescribe controlled substances without prior in-person requirements. We’re now 15 years into Congress asking the DEA to do this, and they still haven’t done so,” Zebley said.
Deepa Patel, senior health policy adviser to Rep.
The bill originally expanded prescribing access to the majority of Schedule II-V controlled substances but was later amended to target only opioid use disorder drugs after lawmakers raised concerns about the possibility of increased abuse and diversion, Patel said.
Trone will look toward any avenue available to move the bill as quickly as possible, Patel said.
“We’re pushing through Senate HELP as an amendment, we are looking at the Support Act, and we’re also looking at potentially adding it to a different substance use disorder legislation called CARA 4.0,” Patel said. “Given that we have an appropriations deadline in January, there’s potential to add it into an omnibus.” CARA 4.0 is the latest iteration of the Comprehensive Addiction and Recovery Act.