Medical Industry Makes Push to Enshrine Telehealth Provisions

Medical providers are pushing Congress to help them make permanent telehealth provisions they came to rely on during the Covid-19 pandemic.

Bills backed by dozens of lawmakers aim to permanently enshrine pandemic-era flexibilities around digital health-care services.

Some of the flexibilities offered by the bills include removing in-person examination requirements for online health-care services, allowing employers to offer standalone telehealth benefits to their employees, and removing the requirement that patients pay a deductible for health care administered via telehealth.

Telehealth use soared during the pandemic, bringing in-demand services like mental health treatment to remote areas and disadvantaged communities, while at the same time alleviating some old concerns.

Before Covid-19, online telemedicine faced stringent regulation largely due to concerns over privacy issues and the medium’s potential for fraud and abuse.

Regulations like in-person exam requirements and geographic restrictions for physicians were established to make sure telehealth services were being used appropriately and didn’t compromise patients’ quality of care. Numerous privacy and data security rules were also put in place, at the expense of telehealth ease of use and convenience, to ensure that private health information was safe from security vulnerabilities.

But the Trump administration temporarily relaxed these restrictions at the height of the pandemic in response to the pressing need for remote health care.

Last December’s Consolidated Appropriations Act extended many of these flexibilities until 2025, but outcries from telehealth advocates are putting pressure on Congress to make these provisions permanent.

Several of the bills have been passed out of committee but none has seen floor action.

Kyle Zebley, vice president of the American Telemedicine Association, said much of the momentum for permanent telehealth flexibilities came after recent data showed the extent of abusive billing among telemedicine providers was not higher than that of traditional in-person care.

A 2022 audit from the Department of Health and Human Services’ Office of Inspector General found that slightly more than 300 providers nationwide billed telehealth services at the most expensive level every time. The nationwide loss due to such “upcoding” amounted to $5.2 million of the nearly $5.1 billion in telehealth services billed to Medicare.

“The OIG audit showed that the level of fraud from telehealth providers was less than 0.1%, which is no more prone to fraud than what can occur with in-person care,” Zebley said.

Eliminating the In-Person Requirement

Several telehealth bills have been making the rounds of Congress, each seeking to permanently enshrine specific emergency provisions introduced during the Covid-19 public health emergency.

The Telemental Health Care Access Act (H.R. 3432), introduced by Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio), would eliminate the requirement that mental health clinicians see Medicare beneficiaries in person within six months of receiving virtual treatment.

The bill also would broaden existing Medicare coverage benefits specific to mental health care to also include behavioral health care. This would clarify that both mental health and substance abuse disorder treatments are covered.

Arthur C. Evans, CEO of the American Psychological Association, said the bill will go a long way in reducing costs for behavioral health for insurance companies, providers, and patients.

“When people have access to timely outpatient behavioral health services, as they would through telehealth, it reduces the need for more costly crisis or inpatient services,” Evans said in a statement to Bloomberg Law.

The bill has four additional cosponsors. A markup has not been scheduled.

Similar to H.R. 3432, the Connect for Health Act of 2023, introduced this month with 60 cosponsors from the Senate, also would eliminate geographical restrictions and in-person visitation requirements. However, the bill would go a step further by providing additional resources to the HHS to improve beneficiary engagement in telehealth.

The bill would provide resources and training for health professionals offering virtual care and would require the Centers for Medicare & Medicaid Services to publish detailed information quarterly on the use of telehealth services.

The Connect for Health Act has proved popular with patients and medical providers. The legislation has been endorsed by over 150 organizations, including AARP, the American Medical Association, and the American Psychiatric Association.

The American Psychiatric Association said in a statement to Bloomberg Law that the legislation would do a lot to assuage anxiety over continuity of care disruptions for people receiving mental health services online.

Standalone Insurance Benefit

Lawmakers are also looking to overhaul restrictions around offering telehealth services as a standalone employee insurance benefit. The Telehealth Benefit Expansion for Workers Act of 2023 (H.R. 824), spearheaded by Suzan DelBene (D-Wash.), Tim Walberg (R-Mich.), and four other lawmakers, would enable employers to offer standalone telehealth benefits to their part-time or seasonal employees ineligible for standard group health insurance coverage.

In a February press release, DelBene said “under [the] legislation, stand-alone telehealth benefits would remain separate from traditional health care plans and would not serve as a replacement. Instead, [the] bill would fill a much-needed gap for certain members of the American workforce who lack affordable access to quality health care.”

But critics of H.R. 824 argue that separating telehealth from other health benefits could fragment care delivery and make care coordination difficult.

“While doing almost nothing to expand access to telehealth services, the legislation promotes the marketing of products exempt from mental health parity, pre-existing condition protections, and other critical benefit standards,” Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, said.

“These telehealth-only products are also likely to fracture care delivery and increase the administrative complexity that consumers have to deal with,” she said.

Rep. Frank Pallone Jr. (D-N.J.) echoed similar sentiments in a subcommittee hearing in June. “I believe this bill is a solution in search of a problem. Employers already have the flexibility to offer telehealth to their employees. I’m worried that if we expand these plans, American families will be left with inadequate coverage,” he said.

The bill was voted out of the House Education and the Workforce Committee on June 13 by voice vote.

High-Deductible Health Plans

Meanwhile, the House Ways and Means Committee this month voted to the Telehealth Expansion Act (H.R. 1843) to the House floor.

The bill, introduced by Michelle Steel (R-Calif.) would permit individuals with high-deductible health plans, funded by health spending accounts, to access telehealth services before reaching their plan’s minimum deductible of $1,500 for individuals and $3,000 for families.

Steel told the committee her bill would “modern[ize] HDHP plans by removing cost sharing for many scenarios where families want to talk to a provider but can’t afford the cost.”

But lawmakers like Rep. Lloyd Doggett (D-Texas) question the potential repercussions of the legislation, noting it could operate as a “backdoor advantage” for wealthy individuals due to the tax advantages offered by health savings accounts.

According to the IRS, HSA contributions are tax-deductible and any interest accrued by the account is also tax-free. Withdrawals for nonmedical expenses after the age of 65 are also tax-free.

“You can shelter your health savings account money for as long as you want. And you get to retirement and you can spend it any way you want it,” said Doggett at a House Ways and Means subcommittee hearing in June.