Letter to Leadership - Scott Joins Bipartisan, Bicameral Group of Lawmakers in Calling for the Permanent Expansion of Telehealth Coverage

Letter

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.1
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.

1 https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-hcf.html.
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."
2
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."
3
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.4

2 https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/.
3 https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/.
4 https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Information-on-Medicare-TelehealthReport.pdf.
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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