Collins, King Call for Permanent Expansion of Telehealth Coverage in End of Year Legislation

WASHINGTON, D.C. – U.S. Senators Susan Collins (R-Maine) and Angus King (I-Maine) joined a bipartisan, bicameral group of 49 lawmakers in calling for the expansion of access to telehealth services during the COVID-19 pandemic to be made permanent. Provisions from the Collins and King-sponsored CONNECT for Health Act that have allowed Medicare beneficiaries in all areas of the country to utilize telehealth services from their homes, as well as more types of health care providers to provide telehealth, were included in previous COVID-19 legislation but will expire following the pandemic unless congressional leaders act now to make those measures permanent.

“Telehealth has been a critical tool during the COVID-19 pandemic in ensuring that patients can continue to receive the health care services that they need while minimizing the spread of the virus and keeping health care providers and patients healthy and safe,” the lawmakers wrote in their letter to Senate Majority Leader Mitch McConnell (R-Ky.), Senate Minority Leader Chuck Schumer (D-N.Y.), House Speaker Nancy Pelosi (D-Calif.), and House Minority Leader Kevin McCarthy (R-Calif.). “We continue to hear from our constituents and health care providers that the uncertainty about the long-term future of Medicare telehealth coverage is a barrier to organizations investing fully in telehealth.  Congress needs to act now to better serve patients and health care providers during the pandemic, and to ensure that telehealth remains an option after the pandemic is over.”

In their letter, the lawmakers highlight the growing use and benefits of telehealth during the ongoing coronavirus pandemic, as patients seek to avoid traveling to hospitals and other providers and instead receive care at home. New data shows that the number of Medicare beneficiaries using telehealth services increased by nearly 13,000 percent in just a month and a half during the pandemic.

The bipartisan and bicameral Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act was first introduced in 2016. The bill, which is cosponsored by 47 senators including Senators Collins and King, is considered the most comprehensive telehealth legislation in Congress.

In addition to Senators Collins and King, the letter was also signed by U.S. Senators Brian Schatz (D-Hawaii), Roger Wicker (R-Miss.), Ben Cardin (D-Md.), Mark Warner (D-Va.), Cindy Hyde-Smith (R-Miss.), Thom Tillis (R-N.C.), Jacky Rosen (D-Nev.), Chris Van Hollen (D-Md.), Tim Kaine (D-Va.), Kevin Cramer (R-N.D.), Kyrsten Sinema (D-Ariz.), Tina Smith (D-Minn.), Jeanne Shaheen (D-N.H.), John Boozman (R-Ark.), Tim Scott (R-S.C.), Rand Paul (R-Ky.), Shelley Moore Capito (R-W.Va.), Mike Rounds (R-S.D.), Chris Murphy (D-Conn.), Lisa Murkowski (R-Alaska), Chris Coons (D-Del.), Jon Tester (D-Mont.), Lamar Alexander (R-Tenn.), Elizabeth Warren (D-Mass.), Richard Blumenthal (D-Conn.), Martin Heinrich (D-N.M.), and Steve Daines (R-Mont.) and U.S. Representatives Mike Thompson (D-Calif.), Peter Welch (D-Vt.), Doris Matsui (D-Calif.), Bill Johnson (R-Ohio), David Schweikert (R-Ariz.), David McKinley (R-W.Va.), Bruce Westerman (R-Ark.), Greg Stanton (D-Ariz.), David N. Cicilline (D-R.I.), Joyce Beatty (D-Ohio), Michael Guest (R-Miss.), Brendan F. Boyle (D-Pa.), Tom O’Halleran (D-Ariz.), Tom Cole (R-Okla.), Trent Kelly (R-Miss.), Chrissy Houlahan (D-Pa.), Elise M. Stefanik (R-N.Y.), Jeff Van Drew (R-N.J.), and Ron Kind (D-Wis.).

The full text of the letter is below and available here.

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Dear Majority Leader McConnell, Minority Leader Schumer, Speaker Pelosi, and Minority Leader McCarthy:

As we near the end of the year and the 116th Congress, we urge you to include provisions in end of the year legislation to make permanent expanded coverage of Medicare telehealth services. Specifically, immediate action to permanently waive geographic restrictions for originating sites, authorize health centers in rural and underserved areas to provide telehealth, and allow beneficiaries to use telehealth in their homes would be key steps to ensure much-needed certainty about Medicare telehealth coverage for health care providers and to improve access to care for patients.

Telehealth has been a critical tool during the COVID-19 pandemic in ensuring that patients can continue to receive the health care services that they need while minimizing the spread of the virus and keeping health care providers and patients healthy and safe.  Telehealth is also important in increasing capacity at health care facilities and reducing health care providers’ use of scarce personal protective equipment.  For these reasons, the Centers for Disease Control and Prevention issued guidance at the beginning of the pandemic advising individuals and health care providers to optimize the use of telehealth services.

The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 and the Coronavirus Aid, Relief, and Economic Security Act included provisions from our bipartisan CONNECT for Health Act to increase access to telehealth services for Medicare beneficiaries during the COVID-19 pandemic.  As a result, waivers of statutory geographic and originating site restrictions have allowed Medicare beneficiaries to use telehealth services in all areas of the country, as well as in their homes.  In addition, more types of health care providers including health centers in rural and underserved areas, are authorized to provide distant site telehealth services, among other important flexibilities.  

This new authority resulted in a rapid increase in telehealth utilization.  An early analysis of the expansion of Medicare telehealth coverage during the pandemic shows that before the public health emergency, about 13,000 beneficiaries in fee-for-service Medicare received telehealth services in a week, but by the last week of April, nearly 1.7 million beneficiaries received telehealth services.  The Centers for Medicare & Medicaid Services (CMS) also found that beneficiaries are getting care through telehealth at similar rates across demographics.  In response to these findings, CMS stated that, “The rapid adoption of telemedicine among providers and patients has shown that telehealth is here to stay.”

However, the authority for this expanded coverage of Medicare telehealth services is temporary and tied to the COVID-19 public health emergency declaration, which is renewed in three-month increments.  We continue to hear from our constituents and health care providers that the uncertainty about the long-term future of Medicare telehealth coverage is a barrier to organizations investing fully in telehealth—even now during the pandemic.  Ramping up telehealth requires significant costs—including the purchase of equipment such as tablets and webcams, telehealth platforms, additional staff, provider training, and changes to electronic health records, billing, and patient engagement processes.  Without more certainty about the future of Medicare coverage, many organizations are not investing in all of these areas to optimize the use and availability of telehealth.

Therefore, Congress needs to act now to better serve patients and health care providers during the pandemic, and to ensure that telehealth remains an option after the pandemic is over.  We understand that further data analysis is underway to assess the impact of the telehealth changes that have been available during the public health emergency.  However, to fully benefit from telehealth during the pandemic, there are steps Congress should take before the end of the year to expand access to telehealth with appropriate guardrails and beneficiary protections.

In particular, Congress should immediately provide permanent authority to waive or remove the geographic restrictions on originating sites in section 1834(m) of the Social Security Act so that a beneficiary’s ability to receive telehealth services is no longer based on where he or she lives.  Services that CMS has determined to be clinically appropriate to be delivered through telehealth should be available to all beneficiaries, not just some.  CMS concurs, stating that “The data have shown that telehealth can be an important source of care across the country, not just for those living in rural areas.”

We also urge action to permanently authorize Federally Qualified Health Centers and Rural Health Clinics to provide distant site telehealth services and to allow patients to receive clinically appropriate telehealth services in their homes.  These actions would address the restrictions on originating sites that CMS has stated are the greatest barriers to the expansion of Medicare telehealth services as well as ensure that health centers can continue their pivotal role in providing health care in rural and underserved areas.   

Telehealth is an area of strong bipartisan support, and Congress can, and should, act now to lead the way in ensuring expanded access to telehealth.  We appreciate your collaboration on this important issue.

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