LAS VEGAS — HHS Secretary Xavier Becerra told Inside TeleHealth in a backstage interview at the HLTH Conference that he wants Congress to take legislative action to permanently expand access to telehealth by enabling HHS to reach rural communities with quality broadband access, working with states to expand interstate telehealth and including behavioral health provisions within telehealth legislation. Becerra’s remarks come two weeks after he said he supports congressional action to permanently extend some pandemic telehealth waivers as the administration “is strapped because of the statute.”
Becerra also told Inside TeleHealth that HHS is looking closely at ways to allow audio-only telehealth, especially in areas where that might be patients’ only option.
When asked why he supports a permanent extension of pandemic Medicare telehealth waivers rather than a temporary one, Becerra responded that the flexibilities are “saving lives.”
Telehealth lobbyists are scrambling to get lawmakers to quickly pass a permanent or temporary extension of COVID-19 pandemic waivers. The administration last week signaled the public health emergency declaration will likely extend beyond mid-January, providing lobbyist a little more wiggle room.
House Republicans — who are poised to take over the House — hope to pass a permanent telehealth extension bill in the new Congress, a key GOP staffer recently told Inside TeleHealth. A temporary extension could also pass in the lame-duck session. Democrats are likely to be on board given the bipartisan nature of virtual care.
When asked what congressional action should be taken to expand access to telehealth, Becerra said it is essential that Congress let HHS reach out to rural communities and make sure broadband is available everywhere in the country.
“I don’t mean rinky-dink broadband, I mean real, legitimate broadband communication,” Becerra told Inside TeleHealth.
The bipartisan Infrastructure Investment and Jobs Act’s allocation of $42 billion towards closing the digital divide will increase access to telehealth, according to stakeholders, because more patients will have access to audio-video appointments. The National Telecommunications and Information Administration said it will use the Federal Communication Commission’s updated broadband maps to allocate funds to areas that have no access to broadband.
While some lawmakers are confident that the new FCC maps will be higher quality than third-party maps, other lawmakers and stakeholders worry the vast inaccuracies in prior FCC maps that had hindered broadband expansion could still be apparent in the new maps.
The Government Accountability Office previously called for the White House to synchronize the over 100 federal programs that aim to expand broadband access to rural areas and other locations with limited or no access to internet, and to ask for congressional help if necessary. Without a national plan, GAO said, the federal government could miss the chance to expand internet and increase access to essential services, like telehealth.
Becerra told Inside TeleHealth that Congress must act to facilitate cross-state telehealth “to the satisfaction of the different states because there are different standards.”
Stakeholders are divided on how to approach interstate telehealth without overstepping state medical boards and ensuring patient safety.
While some stakeholders continue to support existing interstate licensing compacts that expedite licensing accreditation for providers that wish to practice in multiple states, other stakeholders and industry lobbyists support encouraging states to join a registration system like the Uniform Law Commission’s model telehealth legislation, which would register providers with a state medical board without mandating they obtain an additional license.
The White House was said to be exploring multiple pathways to accomplish interstate licensing for mental health practitioners in May, lobbyists said, including plans the administration could enact on its own and others that would be in conjunction with Congress.
Becerra emphasized to Inside TeleHealth that it is essential to make sure “we do not leave out behavioral health as we talk about telehealth.”
The finalized Medicare physician fee schedule implements coverage in alignment with the Consolidated Appropriations Act, which covers telehealth services for behavioral health treatments, via CMS program instruction or other subregulatory guidance in anticipation of the public health emergency’s end.
Becerra told Inside TeleHealth that HHS is “looking closely at” audio-only telehealth.
“I wouldn’t pass judgment on it by itself,” Becerra said. “It is an important component, especially in areas where that may be the only alternative. But that is something we are looking into.”
Telehealth stakeholders say CMS’ decision not to extend audio-only telehealth codes on a temporary basis until the end of 2023 in the final physician fee schedule will exacerbate health disparities for patients of lower socio-economic classes that lack broadband access and have poor digital literacy.
But CMS said that since audio-only telehealth is not face-to-face telehealth and not in-person care it cannot be reimbursed like other types of care. CMS also concluded in the physician rule that it is not appropriate to temporarily expand access to audio-only services because audio-only telehealth is not analogous to in-person care. — Cara Smith (email@example.com)