June 29, 2020
| The Honorable Mitch McConnell Majority Leader United States Senate Washington, DC 20510 | The Honorable Nancy Pelosi Speaker United States House of Representatives Washington, DC 20515 |
| The Honorable Charles Schumer Minority Leader United States Senate Washington, DC 20510 | The Honorable Kevin McCarthy Minority Leader United States House of Representatives Washington, DC 20515 |
Dear Congressional Leaders:
Thank you for acting to expand access to telehealth services during the COVID-19 public health emergency (PHE) by providing the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) the authority to waive longstanding restrictions on Medicare telehealth services and ensuring that additional types of health care providers can furnish telehealth services during the pandemic.
Providers across the country have utilized these flexibilities to scale delivery and provide older Americans, many for the first time, access to high quality virtual care, resulting in 11.3 million beneficiaries accessing telehealth services in mid-April alone.1 Medicare Advantage plans have driven a similar expansion with 91 percent of seniors reporting a favorable telehealth experience and 78 percent likely to use telehealth again in the future, figures that closely track with similar patient satisfaction data from health systems nationwide.2 Additional flexibility has also allowed Federally Qualified Health Centers (FQHC) to deliver safe and effective care to underserved patient populations that have rated the service they received highly.3
Private health plans have also followed suit, and in response, telehealth adoption has soared – resulting in a 4,300 percent year-over-year increase in claims for March 2020.4 Taken as a whole, these temporary policy changes have allowed 46 percent of Americans to replace a cancelled healthcare visit with a telehealth service during the pandemic. With so many patients accessing care virtually, expectations for the future of our healthcare system have shifted significantly and 76 percent of Americans now report having a strong interest in using telehealth moving forward.5
Driven by swift action from Congress and new patient demand, healthcare organizations are dramatically transforming and investing in new technologies to meet the needs of many Americans. Unfortunately, much of this transformation is dependent on temporary flexibilities extended to health systems and providers that are limited to the duration of the COVID-19 public health emergency declaration. Absent additional action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth services when the emergency declaration ends.
Virtual care has provided unprecedented access for patients, but it has become clear that uncertainty as to the future of telehealth under Medicare will halt or reverse further adoption and utilization – to the detriment of both patients and providers.
Given the statutory restrictions in Section 1834(m) of the Social Security Act and that the authorities granted to HHS and CMS through recent coronavirus legislation are limited to the COVID-19 public health emergency period, Congress must act to ensure that the Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services. Congress not only has the opportunity to finally bring the US healthcare system into the 21st century, but the responsibility to ensure that billions of dollars in COVID-focused investments made during the pandemic are not wasted and instead used to support the transformation of care delivery and ultimately, expand access to high quality virtual care to all Americans.
With these critical issues in mind, we ask that Congress advance permanent telehealth reform focused on the following priorities:
- Remove Obsolete Restrictions on the Location of the Patient: Congress should permanently remove the current section 1834(m) geographic and originating site restrictions to ensure that all patients can access care at home, and other appropriate locations. The response to COVID-19 has shown the importance of making telehealth services available in rural and urban areas alike. In order to bring clarity and provide certainty to patients and providers, we strongly urge Congress to address these restrictions in statute by striking the section 1834(m) geographic limitation on originating sites and allow beneficiaries across the country to receive virtual care in their homes, or location of their choosing, where clinically appropriate and with beneficiary protections and guardrails in place.
- Maintain and Enhance HHS Authority to Determine Appropriate Providers and Services for Telehealth: Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, HHS and CMS should maintain the authority to add or remove eligible telehealth services – as supported by data and demonstrated to be safe, effective, and clinically appropriate – through a predictable regulatory process that gives patients and providers transparency and clarity.
- Ensure Federally Qualified Health Centers and Rural Health Clinics Can Furnish Telehealth Services after the PHE: FQHCs and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act. Congress should ensure that FQHCs and RHCs can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers.
- Make Permanent HHS Temporary Waiver Authority During Emergencies: Congress has given HHS authority under Section 1135 of the Social Security Act to waive restrictions during the COVID-19 pandemic. However, the waiver authority is specific to this particular PHE. Congress should ensure HHS and CMS can act quickly during future pandemics and natural disasters.
We encourage you and your colleagues to consider legislation centered on these priorities before the public health emergency expires, which would end beneficiaries’ access to virtual care. These priorities ensure HHS and CMS have the necessary authority to maintain oversight of telehealth services, guaranteeing access to safe, effective, and appropriate care while targeting clearly outdated statutory restrictions that discriminate based on geography and patient location. Swift congressional action will provide a clear signal to patients, who are concerned about the future of their telehealth benefits, as well as providers and health systems, which are hesitant to make investments in critical healthcare infrastructure without certainty from policymakers.
We need your support in ensuring that seniors and providers do not go over the telehealth “cliff” – losing access to these critical services when they are still needed by so many. We look forward to working with you to build on the temporary reforms included in the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act to ensure Medicare beneficiaries can continue to access care when and where they need it.
Sincerely,
| Adirondacks ACO | HIMSS Washington Chapter |
| Advanced ICU Care, Inc. | Hospice Palliative Nurses Association |
| Advanced Medical Technology Association (AdvaMed) | HSA Coalition |
| Adventist Health | IHE USA |
| Air Visits | Immune Deficiency Foundation |
| Allergy & Asthma Network | IncludeHealth, Inc. |
| Alliance for Aging Research | Indiana University Health |
| Alliance for Connected Care | Indie Health |
| Alliance of Community Health Plans | Infectious Diseases Society of America |
| Allscripts | Inovalon |
| Alpha Medical | InSight + Regroup |
| ALS Association | Intel Corporation |
| Altheia Predictive Health | Intermountain Healthcare |
| Alzheimer’s Foundation of America | International OCD Foundation |
| AMD Global Telemedicine | InTouch Health |
| Amen Clinics, Inc | K4Connect |
| America Pharmacists Association | Keck Medicine of USC |
| American Academy of Allergy, Asthma & Immunology | Lanai Community Health Center |
| American Academy of Ambulatory Care Nurses | LeadHealth |
| American Academy of Audiology | LeadingAge |
| American Academy of Family Physicians | Leidos |
| American Academy of Hospice and Palliative Medicine | Leon Concierge Medicine |
| American Academy of Neurology | Less Government |
| American Academy of PAs | Lewy Body Dementia Association |
| American Association of Colleges of Nursing | Life365 |
| American Association of Nurse Anesthetists | LifePoint Health |
| American Association of Nurse Practitioners | LifeWIRE Corp. |
| American Cancer Society Cancer Action Network | Lincare |
| American Chiropractic Association (ACA) | LiveWell Alliance, Inc. |
| American Clinical Neurophysiology Society | Livongo |
| American College of Obstetricians and Gynecologists | Locumtenens.com |
| American College of Physicians | Marshfield Clinic Health System |
| American Consumer Institute Center for Citizen Research | Mass General Brigham |
| American Diabetes Association | Massachusetts General Hospital |
| American Geriatrics Society | Medical Group Management Association |
| American Heart Association | Medisante’ Group |
| American Lung Association | MedStar Health |
| American Medical Rehabilitation Providers Association | MedWand Solutions, Inc. |
| American Nurses Association | Mend VIP, Inc. |
| American Occupational Therapy Association | Mental Health America |
| American Organization for Nursing Leadership (AONL) | MiCare Path |
| American Osteopathic Association | Michigan Medicine |
| American Physical Therapy Association | Muscular Dystrophy Association |
| American Psychoanalytic Association | MyndYou |
| American Psychological Association | NACBHDD and NARMH |
| American Society of Nephrology | National Association for Healthcare Quality |
| American Society of Pediatric Nephrology | National Association for Home Care and Hospice |
| American Speech-Language-Hearing Association | National Association of ACOs |
| American Teledentistry Association | National Association of Community Health Centers |
| American Telemedicine Association (ATA) | National Association of Health Underwriters |
| American Urological Association | National Association of Pediatric Nurse Practitioners |
| Americans for Prosperity | National Association of Rural Health Clinics |
| America’s Essential Hospitals | National Association of Social Workers |
| AMGA | National Athletic Trainers’ Association |
| Amwell | National Council for Behavioral Health |
| Ascension | National Council of State Boards of Nursing |
| Association for Behavioral Health and Wellness | National Diabetes Volunteer Leadership Council |
| Association of Asian Pacific Community Health Organizations (AAPCHO) | National League for Nursing |
| Association of Departments of Family Medicine | National Nurse-Led Care Consortium |
| Association of Diabetes Care & Education Specialists | National Organization for Rare Disorders |
| Association of Family Medicine Residency Directors | National Partnership for Healthcare and Hospice Innovation (NPHI) |
| Association of Oncology Social Work | National Partnership for Women & Families |
| Association of periOperative Registered Nurses | National Patient Advocate Foundation |
| Association of Public Health Nurses | National Psoriasis Foundation |
| athenahealth | National Taxpayers Union |
| Avera Health | Nemours Children’s Health System |
| Beacon Medical Group, Inc. | NextGen Healthcare |
| Better Medicare Alliance | Nonin Medical |
| Biofourmis, Inc. | North American Primary Care Research Group |
| BioscienceLA | Northfield Hospital + Clinics |
| BJC HealthCare | OCHIN |
| Bright.md | Ochsner Health |
| California Association of Public Hospitals and Health Systems | Omron Healthcare Inc. |
| California Health Information Association | Oncology Nursing Society |
| California Health Information Services & Partnership Organization | Onduo LLC |
| California Primary Care Association | One Medical |
| California Psychological Association | Optimize Health |
| California Telehealth Policy Coalition | Orion Behavioral Health Network |
| CaliforniaHealth+ Advocates | OrthoVirginia |
| Cancer Support Community | Parent Project Muscular Dystrophy |
| Caregility | Parkview Health |
| CareSpan USA, Inc. | Partnership for AI, Telehealth & Robotics in Healthcare |
| Center for a Free Economy | PAs in Virtual Medicine and Telemedicine |
| Center for Freedom and Prosperity | Personal Connected Health Alliance |
| Center to Advance Palliative Care | Physician Assistants in Hospice and Palliative Medicine |
| Centering Healthcare Institute | Pillsy Inc. |
| Centerstone | Pine Rest Christian Mental Health Services |
| Central Logic | Planted Recovery Inc |
| Cerner | Point-of-Care Partners |
| Change Healthcare | Primary Care Collaborative |
| Chesapeake Urology Associates | Primary Care Development Corporation |
| CHI Franciscan | Providence St. Joseph Health |
| Children’s Health Fund | PursueCare |
| Chimes International Inc | Qualtrics |
| ChristianaCare | Quio Technologies |
| Clinical Informatics, Inc. | Rebel Labs Inc. |
| Coalition for Compassionate Care of California | Recovr Inc. |
| Coalition For Headache And Migraine Patients (CHAMP) | Reflexion Healthcare |
| Cohen Veterans Network | ResMed, Inc. |
| College of Healthcare Information Management Executives (CHIME) | ResolutionCare Network, LLC |
| College of Psychiatric and Neurologic Pharmacists (CPNP) | Roman Health Ventures Inc. |
| Columbia University Irving Medical Center | Royal Philips |
| CommonWell Health Alliance | Rural Hospital Coalition |
| Compassion & Choices | San Francisco Tech Council |
| Connected Home Living | Saunders Medical Center |
| Consumer Choice Center | Scripps Health |
| Consumer Technology Association | Shriners Hospitals for Children |
| Convenient Care Association | Small Business & Entrepreneurship Council |
| Cosan Group | SOC Telemed |
| CoverMyMeds | Society of Hospital Medicine |
| Curve Health | Society of Pediatric Nurses |
| Cystic Fibrosis Foundation | Society of Teachers of Family Medicine |
| DestinyWell | Spectrum Health |
| Devoted Health Inc. | Spina Bifida Association |
| Diabetes Patient Advocacy Coalition (DPAC) | Stanford Health Care |
| Digital Medicine Society (DiMe) | Strategic Health Information Exchange Collaborative (SHIEC) |
| Digital Therapeutics Alliance (DTA) | Strategic Interests, LLC |
| Doctor On Demand | Summit Healthcare Regional Medical Center |
| Duke Health | Supportive Care Coalition |
| eHealth Initiative | Sutter Health |
| EHR Association | SYNERGIA Integrated teleBehavioral Health, Inc. |
| emids | TapestryHealth |
| Encounter Telehealth, LLC | Taxpayers Protection Alliance |
| Endocrine Society | Teladoc Health |
| Envision Healthcare | TeleMed2U |
| Epic Systems Corporation | Texas e-Health Alliance |
| Epilepsy Foundation | Texas Health Information Management Association |
| EveryLife Foundation for Rare Diseases | The Center for Telehealth & eHealth Law |
| ExamMed | The Commons Project Foundation |
| Excalibur Healthcare | The ERISA Industry Committee |
| Federation of American Hospitals | The Gerontological Advanced Practice Nurses Association |
| Fight Colorectal Cancer | The Headache and Migraine Policy Forum |
| Foothold Technology | The Jewish Federations of North America |
| Forefront Telecare, Inc | The Johns Hopkins Health System |
| Frederick Health | The Joint Commission |
| FreedomWorks | The Learning Corporation |
| Friends of the National Institute of Nursing Research | The Michael J. Fox Foundation for Parkinson’s Research |
| Global Partnership for Telehealth, Inc. | The University of Texas at Austin, UT Health Austin |
| GlobalMedia Group, LLC, DBA GlobalMed | Third Eye Health, Inc. |
| GlyCare | Tourette Association of America |
| GO2 Foundation for Lung Cancer | Treatment Communities of America |
| Trinity Health | |
| Grace Initiative Foundation Tree | TytoCare |
| Grapevine Health | United Spinal Association |
| Greenway Health | United Urology |
| HCA Healthcare | University of California Health |
| Health Data & Management Solutions (An Aetna company) | University of California, Davis Health |
| Health Innovation Alliance | University of Hawaii System |
| Healthcare Leadership Council | University of Mississippi Medical Center |
| Heart Failure Society of America | University of Pittsburgh Medical Center (UPMC) |
| HIAI-TOUCH (Telehealth Outreach for Unified Community Health) Non-profit | University of Pittsburgh Medical Center, Pinnacle |
| Hillrom | Updox |
| Hims & Hers Health, Inc. | URAC |
| HIMSS | UsAgainstAlzheimer’s |
| HIMSS Central Pennsylvania Chapter | Validic, Inc. |
| HIMSS Central/North Florida Chapter | Verato |
| HIMSS Delaware Valley Chapter | VeruStat Inc. |
| HIMSS Greater Illinois Chapter | Virtual Medical Group |
| HIMSS Indiana Chapter | VirtuSense Technologies LLC |
| HIMSS Kentucky Bluegrass Chapter | ViTel Net |
| HIMSS Louisiana Chapter | Vodafone |
| HIMSS Maryland Chapter | Washington State Society for Post-Acute and Long-Term Care Medicine |
| HIMSS Minnesota Chapter | Welcome Home Health, Inc |
| HIMSS Montana Chapter | Wellbox |
| HIMSS Nebraska Chapter | Wisconsin Hospital Association |
| HIMSS New England Chapter | Wound Ostomy and Continence Nurses Society (WOCN®) |
| HIMSS Northern California Chapter | Yale New Haven Health System |
| HIMSS Oregon Chapter | Ziegler |
| HIMSS South Carolina Chapter | Zipnosis |
| HIMSS Tennessee Chapter | Zocdoc |
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