Congress Expands Telehealth Access in the Fiscal Year 2023 Omnibus Spending Package

With little time to spare before the Christmas holiday, Congress adopted the fiscal year (FY) 2023 omnibus spending package to fund the government. Along with government funding, the package expanded certain telehealth policies and invested in telehealth programs.

With certain Medicare telehealth flexibilities set to expire 151 days after the conclusion of the public health emergency, Congress took the opportunity to provide an additional extension of certain Medicare telehealth policies through December 31, 2024:

  • The removal of the originating site and geographic restrictions, which allows any location where a patient is located at the time of a Medicare service to be considered an originating site without geographic restriction;
  • Continued coverage and payment of audio-only services;
  • A designation that qualified physical therapists, speech-language pathologists, and audiologists to be eligible practitioners to deliver telehealth services;
  • Expansion of telehealth services for federally qualified health centers and rural health clinics;
  • A delay of the in-person requirements for mental health services delivered through telehealth and telecommunications technology until January 1, 2025;
  • Continuation of virtual recertification of hospice care; and
  • A requirement for the Secretary of the Department of Health and Human Services (HHS) to conduct a study using medical record review of telehealth services delivered from January 1, 2022 through December 31, 2024 on program integrity related to Medicare Part B telehealth services. The study will review and analyze the duration, type, and impact of telehealth services furnished on the future utilization of health services by Medicare beneficiaries. An interim report will be due to Congress on October 1, 2024 and the final report will be due by April 1, 2026.

Elimination of the originating site and geographic restrictions and coverage and payment of audio-only services are two of AUA’s top telehealth priorities. The extension of these policies will provide continued flexibility to our members and their patients.

Two other Medicare provisions of interest were included in the package:

  • An extension of the Acute Hospital Care at Home initiative, which provides for a patient’s home or temporary residence to be considered an originating site, for the provision of certain hospital services through December 31, 2024; and
  • An extension of the policy that allows employers and plans to provide coverage of telehealth services per-deductible for individuals with a high-deductible health plan coupled with a health savings account through December 31, 2024.

AUA had requested the inclusion of the following report language in the report that accompanied the Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) bill:

Telehealth Data—The Committee recognizes that demand for telemedicine increased in 2020 in response to the COVID–19 pandemic. In addition, the Committee notes disparities in telehealth exist between and within racial and ethnic groups, rural and urban locations, and geographic regions as detailed in a December 2021 report by the Assistant Secretary for Planning and Evaluation. The Committee urges the Secretary, working with CMS and HRSA, to categorize telehealth usage data, including for audio-only services, by Health Professional Shortage Areas. The Committee further urges the Secretary to work across agencies to ensure that improvements to broadband availability are prioritized in those areas with lowest telehealth usage, highest audio-only usage, and a known health professional shortage. The Committee requests an update within 120 days of the date of enactment of this Act on this categorization and broadband availability.

The language was included in the House’s Labor-HHS report, which was adopted as final as part of the omnibus package, and represents another win for AUA and its members. We will look forward to seeing the final report once it is available.

The omnibus report also included the following report language related to telehealth:

Broadband Deployment Locations MapThe agreement directs the Department to submit a report to the Committees not less than 120 days after the date of enactment of this Act detailing the steps it has taken to coordinate with the Federal Communications Commission and carry out its responsibilities to implement the Deployment Locations Map pursuant to Section 60105 of the Infrastructure Investment and Jobs Act (P.L. 117-58).

Additionally, the omnibus invested in other HHS agencies with significant investments made in Health Resources and Services Administration’s (HRSA) programs:

  • The Medicare Rural Hospital Flexibility Grants Program received $64,277,000 with $1,000,000 allocated for the Providing Mental Health Services and Other Services to Veterans and Other Residents of Rural Areas to support the purchase and implementation of telehealth services and other efforts to improve health care coordination for rural veterans between rural providers and the Department of Veterans Affairs.
  • The Office for the Advancement of Telehealth received $38,050,000 to support grants, contracts, and cooperative agreements.
  • The Telehealth Centers of Excellence sites received $8,500,000.
  • The omnibus report also included the following language:
    • Rural Telehealth Initiative—The Committee supports the Memorandum of Understanding entered into on August 31, 2020, establishing a Rural Telehealth Initiative among HHS, the Federal Communications Commission, and the Department of Agriculture. Together, this important initiative can leverage expertise of each respective agency and improve collaboration amongst entities tasked with addressing rural telehealth access. This initiative recognizes the unique problems facing rural Americans that need access to critical care services through telehealth platforms. The Committee encourages agencies involved in this initiative to prioritize opportunities to continue the expansion of telehealth services, close the digital divide, and not leave rural communities behind.

CMS was directed to do the following in the omnibus report:

Telehealth and Health Care Access—The Committee requests a report in the fiscal year 2024 Congressional Budget Justification on the impact of telehealth on health care access, utilization, cost, and outcomes, broken down by race, ethnicity, sex, age, disability status, and zip code under the Medicaid program and CHIP.

Outside of HHS, the Department of Veterans Affairs was directed to develop a strategic plan to ensure the effectiveness of telehealth technologies and modalities delivered to veterans with the requirement that this plan be updated at least once every three years. Congress also directed the Government Accountability Office to submit a report to Congress on telehealth services delivered by the Department, including information on telehealth and virtual care programs; the challenges VA faced delivering virtual care to veterans living in rural areas; mitigation strategies used to overcome connectivity barriers; partnerships entered into by the Department’s Office of Connected Care to bolster telehealth services; the extent to which the Department has examined the effectiveness of telehealth services compared to in-person treatment; and veterans’ satisfaction with health care services.