A consortium of 336 healthcare providers and industry organizations have written to U.S. congressional leaders to expand temporary regulatory flexibilities allowing for more widespread use of telehealth during the COVID-19 public health emergency. Groups including the National Hospice & Palliative Care Organization and the American Academy of Hospice and Palliative Medicine are ultimately seeking to make these temporary arrangements permanent.
Better access to telehealth has been essential for healthcare providers, patients and families during the pandemic, helping to reduce person-to-person contact to avoid spreading the virus. For many providers, telehealth has become an integral part of their clinical operations over the past two years. The temporary measures are due to expire with the end of the public health emergency, which the federal government must renew every 90 days.
Signatories to the letter called for an extension of the waivers until December 31, 2024 as well as legislation to make them permanent for implementation the same year.
“Many of the telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of COVID-19. [public health emergency] — and impact both public health programs and private health coverage…,” the groups wrote in the letter. “As things stand, providers must weigh the costs of investing in the technology and clinical infrastructure needed to keep telehealth programs at scale against the possibility that Congress ultimately decides not to support a permanently expanded telehealth coverage.”
To inform the legislative process they seek, the groups have called on Congress to demand that the US Department of Health and Human Services (HHS) complete waiver assessments by fall 2023 and provide lawmakers with relevant data and recommendations. Prior to the pandemic, available data was apparently too limited to allow further federal action. Today, according to the signatories, this is no longer the case.
In 2020, the United States Centers for Medicare & Medicaid Services (CMS) temporarily extended a number of telehealth flexibilities during the national COVID-19 emergency to reduce the likelihood that patients, families, or clinicians can spread the virus. Later, President Trump issued an executive order directing HHS to review these waivers to determine which ones could be made permanent. These measures taken by CMS, coupled with the need to maintain social distancing, have skyrocketed the demand for telehealth throughout the pandemic.
During times of national disaster, HHS has the authority to waive regulatory requirements under Section 1135 of the Social Security Act, allowing CMS to issue waivers relaxing the conditions of participation (CoP) for hospices and health care providers.
During the pandemic, hospices have been able to provide interdisciplinary services via telemedicine or audio as long as the patient receives the level of routine care at home and telemedicine services that are audio-only services are able to meet the needs of the patient and caregiver.
The $2.2 trillion CARES Act, designed to help the economy and essential industries cope with the impact of the pandemic, also contained provisions for telehealth in palliative care, including allowing practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters.
In May 2021, a bipartisan group of senators reintroduced the Creating Opportunities for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. temporarily during the COVID-19 pandemic. To date, the bill has not advanced.
“Congress has an opportunity to bring the American healthcare system into the 21st century and a responsibility to ensure that the innovative delivery models implemented to combat COVID-19 are used to effectively modernize healthcare delivery. health care in the United States,” the letter read. “Telehealth has enormous potential to expand access to high-quality virtual care for all Americans.”