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Lawmakers Resubmit Telehealth Bills Targeting Kids’ Health, COVID-19 Effects

By News

By Eric Wicklund

Two more telehealth bills have returned to Capitol Hill after failing to make it through last year’s session. One takes on kids’ health and other calls for an HHS study of how telehealth has effected care delivery.

– Two more telehealth bills have resurfaced on Capitol Hill, joining a growing package of legislation aimed at improving connected health coverage and access after the coronavirus pandemic.

US Reps. Lisa Blunt Rochester (D-DE) and Michael Burgess, MD (R-TX) last week reintroduced the Telehealth Improvement for Kids’ Essential Services (TIKES) Act (HR 1397), which aims to boost telehealth coverage through state Medicaid and Children’s Health Insurance Program (CHIP) services.

While no text is available for this bill, Rochester and Burgess, who first submitted the bill last October, said last year that it would “provide guidance and strategies” to help states integrate telehealth in Medicaid and CHIP programs and mandate telehealth studies from both the Government Accountability Office (GAO) and the Medicaid and CHIP Payment and Access Commission (MACPAC). It would build upon a 25-page CMS toolkit unveiled in April 2020 that’s designed to help states expand telehealth coverage under Medicaid and CHIP to deal with the pandemic.

“Amidst the pain and suffering that our nation has endured throughout the COVID-19 pandemic, a major takeaway has been the advantage of telehealth,” Burgess said then. “There is a convenience factor to not having to take time to physically transport yourself to the doctor’s office and have your child sit in a waiting room with other potentially sick patients. This bipartisan legislation will improve utilization of telehealth by requiring the Centers for Medicare and Medicaid Services (CMS) to provide guidance to states on how to make the most of telehealth options in their Medicaid and CHIP programs. Additionally, it directs studies to gather data that can help inform future telehealth policy.”

Also making a return appearance in Washington is the COVID-19 Emergency Telehealth Impact Reporting Act (HR 1406), which would have the Health and Human Services Department collect data on telehealth use during the pandemic and analyze how these technology platforms have affected care delivery.

“Telehealth is undoubtedly the future of health care, especially for the rural communities that I am privileged to represent,” US Rep. John Curtis (R-UT), who co-sponsored the bill submitted last July and this year’s version with US Reps. Peter Welch (D-VT) and Doris Matsui (D-CA), said in a press release last year. “Ultimately, Congress’ objective should be to make many – if not at all – of these regulatory changes permanent. Our bill is a significant step in that direction because it will ensure we are keeping patients’ health and reducing the costs of care through value-based medicine as our top priorities as we consider expanding telehealth services throughout the country.”

With the COVID-19 pandemic in full force last year, Congress saw several bills aimed at improving coverage for and access to telehealth services both during the after the public health emergency, but none of those bills made it out to a vote. With a new administration and Congress in place this year, the hope is that some – if not all – of these bills making a return will be approved, either individually or in some sort of package.

Just last week, the Senate saw the reintroduction of the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (S 340) and the Telehealth Modernization Act (S 368 and HB 1332).

Primary Care Needs Telehealth Reimbursement, Targeted Relief

By News

From continued telehealth reimbursement to more targeted federal relief, primary care practices need payment reform to survive the second year of the COVID-19 pandemic.

 By Jacqueline LaPointe


– Better-targeted federal relief, continued telehealth reimbursement, and help acquiring personal protective equipment are some ways primary care providers can maintain financial stability as the country enters the second year of the COVID-19 pandemic, industry experts are saying.

An already underfunded area of medicine, primary care has faced significant financial challenges throughout the first year of the pandemic, explained experts from the Robert Wood Johnson Foundation and Urban Institute in a new brief.

Funds from the federal government and telehealth reimbursement parity were key to surviving empty waiting rooms, higher PPE costs, and other changes in operations during the pandemic. However, experts found that policymakers still have much to learn from these sources of support.

“COVID-19 has created enormous challenges for primary care providers that could result in long term changes in the delivery of care,” Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an emailed statement. “We need to find out what practices need to succeed in this environment, and devise policies to help support this foundational part of our health care system.”

The Provider Relief Fund, for example, did little to help independent primary care practices, the brief explained.

Established by the Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020, the Provider Relief Fund (PRF) has given hundreds of billions of dollars in grants to healthcare providers. But the government’s distribution methods have favored large hospitals and health systems, leaving most practices with relatively small payments from the initial, automatic distribution.

Instead, primary care practices relied more on Paycheck Protection Program funding and advanced Medicare reimbursements, the brief found. But again, hospitals received more upfront Medicare reimbursements, which were essentially zero-interest loans if repaid in time, compared to physicians.

“Future outlays from the PRF should ideally be better targeted than past payments, in order to support those providers most in need,” the brief stated.

Additionally, federal support is likely needed to ensure primary care practices can access sufficient PPE and meet the demand for increased telehealth and audio-only services.

The brief found that practices shifted rapidly to telehealth and other modes of care delivery when delivering in-person care was not feasible or safe, and that transition was relatively seamless according to the practice leaders interviewed for the brief.

But practices could not have been successful with telehealth implementation if not for federal support for reimbursement from the CARES Act.

“Respondents generally felt that their shift to telehealth as a significant portion of their interaction with patients was only viable because of altered payment rules and increased reimbursement for telehealth services,” the brief stated.

However, the reimbursement policies are only temporary and private payers who jumped on the bandwagon can pull the plug on telehealth reimbursement parity at any time in most states. Additionally, only one state has required payers to waive cost-sharing requirements for telehealth visits during the emergency period although many payers have elected to adopt the policy internally.

The latter policy has particularly supported practices, according to a Massachusetts respondent, who described deductibles as “killing” practices financially even before the pandemic.

Primary care practices are already planning the future of telehealth now that they have implemented the technology to facilitate visits and have a better understanding of how telehealth can fit into appropriate care delivery.

Patients have also taken to virtual care and many have started to demand telehealth appointments, even too much in some cases according to some practice leaders.

However, respondents reported that some private payers are already scaling back telehealth reimbursement rates and reinstating cost-sharing requirements. This is leading to concerns among practice leaders that telehealth will not be financially stable.

Practice leaders also voiced concerns about payers encouraging patient use of telehealth-only providers even though these providers may not be invested in the long-term health of a patient and can result in overutilization.

Continued support for telehealth reimbursement would help struggling practices maintain patient volumes in the event of more COVID-19 waves as well as with sustaining care transformations beyond the pandemic.

Additionally, policymakers should address increasing levels of clinician and staff burnout to strengthen primary care, experts stated.

These policy considerations could help to support vaccination efforts.

A new survey from the Primary Care Collaborative, Larry A. Green Center, and 3rd Conversation found that primary care continues to be untapped as the government struggles to administer COVID-19 vaccines. In fact, eight in ten primary care practice leaders surveyed said their organization is ready and willing to assist with vaccine distribution despite ongoing staffing shortages.

However, 44 percent of respondents also reported that local health systems are getting the vaccine, while smaller and independent practices are not.

“Primary care can play a major role in targeting and encouraging their patients to get vaccinated, particularly people with chronic conditions, the elderly, and people who are hesitant to get vaccinated,” Ann Greiner, President and CEO of the Primary Care Collaborative, said in an announcement. “Patients trust primary care, and trust is a major factor in our ability to help patients overcome vaccine concerns.”