The U.S. House of Representatives Committee on Energy & Commerce held a hearing on March 2 on “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care.” Opening statements by Committee Chairman Frank Pallone, Jr. (D-NJ) and chair of the Health Subcommittee Anna G. Eschoo (D-CA) noted that access to telehealth for Medicare beneficiaries had been greatly expanded during the COVID-19 pandemic, raising the question of whether Medicare coverage should be extended permanently. Chairman Pallone commented that in considering a permanent expansion of Medicare coverage for telehealth, essential considerations will include how to encourage the use of high-value care while discouraging low-value care and overutilization; strengthening program integrity to combat fraud; and ensuring equitable access to telehealth across the digital divide that affects many Americans. Representative Eschoo suggested that telehealth can help address shortages of some medical specialties and racial disparities in health outcomes.
The memorandum prepared for the Committee highlights limitations on Medicare payment for telehealth prior to the additional flexibilities approved during the pandemic. Medicare generally paid for telehealth only to beneficiaries in rural areas, and at eligible originating sites (which usually did not include a patient’s home). Medicare paid for telehealth visits only if the visit included both audio and visual capabilities, except for virtual check-ins for established patients and certain remote patient monitoring. Also, payment was made only for services provided by specified types of practitioners and only for services on the telehealth coverage list.
During the public health emergency (PHE) of the COVID-19 pandemic, Congress authorized the Department of Health & Human Services (HHS) to waive statutory limitations on telehealth, and allowed Federally Qualified Health Centers and Rural Health Clinics to bill Medicare for telehealth services. The Centers for Medicare and Medicaid Services (CMS) authorized coverage for some audio-only services, expanded the categories of practitioners eligible to bill for telehealth services, and added 144 new covered telehealth services (60 of which will continue to be covered after the end of the PHE). CMS temporarily waived the requirement that physicians and practitioners be licensed in the state where they are providing services, but the waiver remains subject to state licensing laws. CMS also permitted insurers in the individual and group market to amend plan benefits during the 2020 plan year to expand telehealth coverage.
These changes substantially increased usage of telehealth: from 13,000 visits per week to 1.7 million per week, for Medicare fee for service beneficiaries. A warning sign accompanying this increase is the threat to program integrity: a 2020 report by the HHS Office of Inspector General noted that $4.5 billion in telehealth related fraud has been uncovered.