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June 29, 2020

The Honorable Mitch McConnell
Majority Leader
United States Senate
Washington, DC 20510

The Honorable Nancy Pelosi
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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.


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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
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 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
Google 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
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HIMSS Central/North Florida Chapter Verato
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HIMSS Greater Illinois Chapter Virtual Medical Group
HIMSS Indiana Chapter VirtuSense Technologies LLC
HIMSS Kentucky Bluegrass Chapter ViTel Net
HIMSS Louisiana Chapter Vodafone
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