A Senate hearing took place earlier this week, providing an update the future of telehealth in the United States. The hearing, held on November 14, 2023, was convened by the Senate Committee on Finance’s Subcommittee on Health Care. It aimed to address the question of whether the regulatory flexibilities that enabled expanded telehealth access during the COVID-19 pandemic should be made permanent, with anticipated policy updates in 2024.
Senators Benjamin L. Cardin and Ron Wyden chaired the subcommittee, joined by Steve Daines and Mike Crapo. The healthcare leaders who testified provided valuable insights into the telehealth landscape and its potential permanence. One of the pressing concerns highlighted by Senator Cardin was the need for clarity regarding the future of telehealth regulations, which are set to expire on December 31, 2024. The testimonies gathered during this hearing are expected to play a role in Congress’s decision-making process on this issue. The healthcare leaders who testified unanimously emphasized the importance of making permanent various waivers and flexibilities that played a role in the remarkable surge of telehealth adoption during the pandemic. Dr. Chad Ellimoottil, the Medical Director of Virtual Care at the University of Michigan, cautioned against the potential decline of telehealth services, referring to both a “fast death” due to reinstated restrictions and a “slow death” caused by regulatory complexities and unexpected bills. A consensus emerged among the healthcare leaders on key flexibilities that should become permanent fixtures of telehealth policy. These include eliminating geographical requirements for originating sites, preserving coverage of audio-only telehealth visits, expanding the range of healthcare providers permitted to offer telehealth services, allowing telehealth prescriptions of select controlled substances, and instituting a narrow exception to state licensure for physicians with established prior patient relationships.
While there was alignment on many fronts, payment emerged as a point of contention. Some leaders stressed the importance of ensuring that telehealth visit payments remain on par with in-person care reimbursement. They argued that dropping reimbursement rates below parity could hinder providers from offering telehealth services, ultimately disadvantaging patients who rely on this technology for care access. Dr. Ateev Mehrotra, a professor of health policy and medicine at Harvard Medical School, offered a different perspective. He expressed concerns that maintaining payment parity could provide virtual-only companies with a competitive edge, potentially leading traditional clinicians to shift exclusively to virtual practice. Instead, he urged Congress to base telehealth policy decisions on principles that prioritize high-value telehealth applications, avoid one-size-fits-all approaches, and reduce administrative burdens for clinicians and patients.
Questions raised during the hearing show the urgency of reaching decisions on telehealth flexibilities. Dr. Ellimoottil pointed out that the uncertainty surrounding telehealth policy is harmful to strategic planning for healthcare provider organizations, hindering their ability to determine the direction of telehealth investments. There is a substantial amount of research supporting the continuation of telehealth, emphasizing its benefits in terms of healthcare access and quality without runaway spending. As discussions around the future of telehealth continue, it is evident that the decisions made will significantly impact the accessibility and delivery of healthcare services in the United States. The hearing suggests policy developments will be implemented in the coming year, with the goal of ensuring that the benefits of telehealth are permanently integrated into the healthcare industry. In addition to the Senate proceedings, telehealth regulations have seen shifts following the end of the COVID-19 public health emergency (PHE). Certain telehealth flexibilities within the Medicare program have been extended through December 31, 2024. These include waivers allowing patients to engage in telehealth visits from their homes and the coverage of audio-only visits.
The HHS Office for Civil Rights will no longer enforce HIPAA noncompliance penalties against covered healthcare providers who used remote monitoring technology. This shift coincides with the end of the PHE, and there will be a 90-day transition period for providers to ensure HIPAA compliance, ending on August 9. Similarly, telehealth flexibilities related to HIPAA and behavioral healthcare are undergoing adjustments. The flexibility that permitted opioid treatment programs to evaluate patients via telehealth, rather than in person, has been extended until May 11, 2024. While Medicaid, CHIP, and private health insurers will continue to provide telehealth coverage, specifics will vary depending on the plan. Telebehavioral health licensure will also see variations, with compacts formed during the PHE allowing providers to practice across state lines. To support these developments, the HHS has increased its support for organizations facilitating licensure compacts.