As Congress approaches the December 31st deadline to extend Medicare telehealth flexibilities, key committees in Congress have advanced differing pieces of legislation that will dictate federal telehealth policy in the years ahead. Since 2020, the use of telehealth has become widely popular among the general public, as well as policymakers on both sides of the aisle. The widespread consensus is that telehealth is here to stay, but instead of passing permanent Medicare coverage of telehealth, in recent weeks members of Congress have coalesced around a two-year extension. The idea behind this is two-fold: a short-term extension is less expensive on paper than outright permanency, making it easier to pass, and by making it temporary it gives policymakers a chance to revisit some of the open-ended questions about the long-term future of telehealth.
However, for the Rural Health Clinics (RHCs) program, the main issue at stake is not the length of a telehealth extension but rather the lack of medical telehealth reimbursement parity. Since 2020, NARHC has been advocating for “normal” telehealth reimbursement and against the so-called special payment rule which pays RHCs a flat fee for telehealth visits that is significantly less than in-person visits. On this issue, two of the key committees of jurisdiction in the House have advanced opposing bill text, one retaining the special payment rule and another bill that would result in payment parity. This means that while we still have our work cut out for us, the possibility of truly fixing this policy later this year remains viable.
Unfortunately, on May 8th, the Ways & Means Committee unanimously advanced the Preserving Telehealth, Hospital, and Ambulance Access Act, H.R.8261, which includes a two-year extension of the current telehealth flexibilities and keeps the “special payment rule” in place for RHCs. NARHC was disappointed to see this development, as the bill was introduced only days before the May 8th markup and ignores the significant support built around the majority of other telehealth bills that do fix the reimbursement issue for safety-net providers.
Encouragingly, just over a week later on May 16th , the Energy & Commerce Health Subcommittee advanced the Telehealth Modernization Act, H.R.7623, which includes a two-year extension of telehealth flexibilities and most importantly replaces the “special payment rule” with reimbursement parity. NARHC was pleased to see this bill receive unanimous support and we plan to continue our advocacy for parity, in order to ensure that rural providers have the same incentives to invest in telehealth as their Fee-For-Service peers.
“We were very happy to see that the Energy & Commerce Health Subcommittee opted not to pass the hastily introduced Ways and Means committee telehealth solution,” said Nathan Baugh, Executive Director of NARHC. “If both committees of jurisdiction had passed the special payment rule as a part of their telehealth extension, we would have had only a very small chance of solving this issue. However, since the Energy & Commerce committee appears poised to pass telehealth payment parity for safety-net providers, we have a realistic chance at reversing this harmful policy for the RHC community during the lame duck.”
Of course, the House represents only one side of Capitol Hill. Over on the Senate side (my old stomping grounds) the Senate Finance Committee held a rural health hearing on May 16th. The Senators heard from a panel of experts about rural health issues, including the importance of extending telehealth—importantly for the RHC community, Sen. Marsha Blackburn (R-TN) asked the panel about the impact of not having reimbursement parity for telehealth. One of the witnesses, Jeremy Davis, President and CEO of the Grande Ronde Hospital, highlighted before the full committee the financial and administrative burdens associated with the “special payment rule”.
“We have seen Congress gloss over safety-net provider nuances when extending telehealth in years past,” said Baugh. “So, the fact that Senator Blackburn highlighted the nuances of the special payment rule, gives us hope that in this upcoming extension Congress will not simply extend status quo and pretend like it is a win for RHCs and FQHCs.”
All of these developments simply lay the groundwork for the telehealth extension that will likely be packaged with government funding legislation in November or December. Eventually, the three committees of jurisdiction (Ways & Means, Energy & Commerce, and Finance) will need to agree on the exact text of the telehealth legislation. Ultimately, it will come down to the decisions of the leadership from those key committees, as to whether or not they will fix telehealth for safety-net providers or continue the status quo.
Until these key policymakers come to agreement on bill text, RHCs are faced with continued uncertainty about what the future of telehealth will hold. As Congress appears poised to pass a two-year extension, NARHC remains engaged with members to build further support for reimbursement parity and ensure rural providers are not left behind in the future.
If you are interested in getting involved and sharing your support for reimbursement parity with your members of Congress, you can do so here. The most impactful voice a Representative or Senator can hear is that of their constituents, so it’s important that you share how the policies Congress makes impact you and your clinic.
Written by Jeffrey Burke, NARHC Deputy Director of Government Affairs.