Advancing Telehealth Beyond Covid-19 Act of 2021
Floor Speech
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Mr. SMITH of Nebraska. Madam Speaker, may I inquire how much time is remaining?
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Mr. SMITH of Nebraska. Madam Speaker, I yield 2 minutes to the gentlewoman from Iowa (Mrs. Miller-Meeks).
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Mr. SMITH of Nebraska. Madam Speaker, I yield 2 minutes to the gentleman from North Carolina (Mr. Murphy).
Mr. MURPHY of North Carolina. Madam Speaker, I rise today in support of H.R. 4040. There have been a few silver linings that we have seen in the pandemic, and definitely telehealth has been one of them.
I will submit, I am personally thankful for this bill because I will say, maybe, perhaps I am the only sitting Member of Congress who, as a physician, has actually used telehealth.
In my surgical practice, I see patients from 2 hours north, 2 hours south, and sometimes 5 hours east out on the eastern North Carolina coast. So many of my patients who come from rural eastern North Carolina can't even afford gas in the inflationary environment we have to even travel these distances, much less sometimes across town.
While this bill is a good start, it is a very, very good start, it does not go far enough, and that is why I, with Dr. Burgess and Congresswoman Herrell, introduced a bill to permanently extend telehealth for federally qualified health centers and rural health centers. These are the medical practices that take care of our poorest and the most at-risk patients. These individuals need to be able to access telehealth because they have to travel long distances and don't have the resources that they need to be able to access physician care.
I subsequently urge my colleagues to support this initiative and urge them that we can do much more.
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Mr. SMITH of Nebraska. Madam Speaker, I yield myself such time as I may consume. I will be brief in my remarks here.
I know that you have heard several concerns expressed about this entire process, and I would certainly share those concerns.
I do think that this is a great opportunity to address a bipartisan issue that is important across America. But it appears this bill was negotiated quickly, in secret, and outside the committees of jurisdiction. Neither outside stakeholders nor Members who have worked extensively on telehealth policy were consulted, as far as I can tell, and the closed rule under which this is being considered has precluded any opportunity to improve or amend the bill.
An issue this important deserves an open and transparent process that follows regular order, allowing Members to offer input and highlight important needs which might otherwise have been overlooked. We call this legislating.
If we had worked together on the Ways and Means Committee with our Energy and Commerce friends and had included the various ideas and innovations, this would have been a true and real bipartisan bill. I am confident that the telehealth extension we are considering today would be even better, as has been mentioned by my colleagues.
In fact, back in May, I introduced a bipartisan bill almost identical to this one called the Connecting Rural Telehealth to the Future Act. That bill extended all the provisions included in the FY22 omnibus through at least 2024 and also included provisions to ensure critical access hospitals can continue to provide telehealth services to their patients. It also corrects a flaw in the CARES Act which shortchanges federally qualified health centers and rural health clinics which offer telehealth services.
Madam Speaker, I include in the Record two letters from the National Rural Health Association and the National Association of Rural Health Clinics expressing their support for both the aims of H.R. 4040 as well as the need to extend critical rural health provisions from the Connecting Rural Telehealth to the Future bill. National Rural Health Association, July 26, 2022. Hon. Nancy Pelosi, Speaker, House of Representatives. Hon. Kevin McCarthy, Minority Leader, House of Representatives.
Dear Speaker Pelosi and Minority Leader McCarthy: The National Rural Health Association (NRHA) applauds the House of Representatives for prioritizing telehealth flexibilities by scheduling a vote on H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2022. This legislation will extend important telehealth flexibilities enacted in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and extended for 151 days post-public health emergency in the Consolidated Appropriations Act (CAA), 2022, until December 31, 2024. NRHA supports the extension of telehealth flexibilities to show providers that telehealth is here to stay but urges rural friendly tweaks to the legislation.
NRHA is a non-profit membership organization with more than 21,000 members nationwide that provides leadership on rural health issues. Our membership includes every component of rural America's health care, including rural community hospitals, critical access hospitals, doctors, nurses, and patients. We provide leadership on rural health issues through advocacy, communications, education, and research.
As the text is currently written, H.R. 4040 includes the extension of distant-site status for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) at their current reimbursement level. While continuation of this flexibility is necessary, the reimbursement level for virtual services is significantly lower than in-person services under current statute. Should reimbursement remain as it is currently written, by 2028 there will be nearly a $100 discrepancy between services provided in-person and virtually at RHCs. NRHA believes this will cause rural communities to utilize these important services less often than their urban and suburban counterparts moving forward and will cause harm to an already fragile rural safety net.
To remedy this discrepancy, NRHA urges this text be amended to incorporate reimbursement updates as reflected in Section 9 of H.R. 7876, the Connecting Rural Telehealth into the Future Act, introduced by Representatives Adrian Smith (R-NE) and Terri Sewell (D-AL). Incorporating this legislative text will bring payment parity between in-person and virtual care at RHCs and FQHCs and ensure that rural communities have access to the same health care delivery methods as their urban and suburban counterparts.
NRHA applauds the House of Representatives for acting on telehealth to show providers long-term stability. However, to ensure that rural providers, and their patients, can properly utilize these services tweaks are needed. Sincerely, Alan Morgan, Chief Executive Officer. ____ National Association of Rural Health Clinics, July 26, 2022. Hon. Nancy Pelosi, Speaker, House of Representatives, Washington, DC. Hon. Kevin McCarthy, Republican Leader, House of Representatives, Washington, DC.
Dear Speaker Pelosi and Leader McCarthy: The National Association of Rural Health Clinics (NARHC) is grateful that the House of Representatives is considering extending Medicare coverage of telehealth through 2024 but we are concerned that the current language in H.R. 4040 will perpetuate inequitable payment policies for safety-net providers.
Presently, our peers in traditional office settings are able to bill for telehealth services as if the service was provided physically in the office. In other words, they have coding and reimbursement parity between telehealth services and in-person services.
On the other hand, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) do not use their normal coding and reimbursement rules for telehealth. RHCs and FQHCs instead have a ``special payment rule'' that requires them to bill a single code, G2025, for all telehealth services which is then reimbursed at a single nationwide rate (currently $97.24).
We are concerned with this ``special payment rule'' methodology for a whole host of reasons. First and foremost, the payment is significantly less than what most RHCs and FQHCs would receive for providing the same service in person, disincentivizing safety-net providers from offering the service via telehealth. Second, the current rules require RHCs and FQHCs to ``carve-out'' all telehealth costs from their cost report, which adds significant administrative burden to the cost-reporting process. Third, the use of a single telehealth code, G2025, has prevented RHCs from tracking annual wellness visits and other services provided via telehealth severely hindering their ability to properly participate in ACOs and other quality programs.
Complicating matters is the fact that for mental health services provided via telehealth, RHCs and FQHCs do use their normal coding and reimbursement mechanisms. This policy is working well, and we believe that is should work this way for all services, not just mental health services.
NARHC strongly believes that the best way to encourage telehealth usage in underserved communities is to create parity between in-person and telehealth policies. We strongly encourage Congress to amend H.R. 4040 to include the payment policy enumerated in Section 9 of H.R. 7876, the Connecting Rural Telehealth to the Future Act introduced by Representative Adrian Smith and Representative Terri Sewell.
Please feel free to contact me if you would like to discuss this issue further. Sincerely, Nathan Baugh, Executive Director, National Association of Rural Health Clinics.
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Mr. SMITH of Nebraska. Madam Speaker, these organizations fully understand the vital role that rural health clinics and FQHCs and critical access hospitals play in ensuring access to care for those in rural and underserved areas.
Even with the passage of this bill, the future of telehealth after the government-designated public health emergency is uncertain. More work needs to be done to assess what has worked well over the last 2 years, what can be improved, and what can safely be left behind.
While I do encourage Members to vote ``yes'' on this bill, I hope in the future we can work in a true bipartisan fashion under regular order to address the gaps that we know exist in policy and set a long-term, sustainable course for telehealth well beyond 2024.
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Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the gentleman from Oklahoma (Mr. Hern), a member of the Ways and Means Committee.
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Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the gentlewoman from New Mexico (Ms. Herrell).
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Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the gentlewoman from California (Mrs. Steel).
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Mr. SMITH of Nebraska. Madam Speaker, I yield 1 minute to the gentleman from California (Mr. Obernolte).
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Mr. SMITH of Nebraska. Madam Speaker, I yield 3 minutes to the gentleman from Arizona (Mr. Schweikert).
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Mr. SMITH of Nebraska. Madam Speaker, I yield myself the balance of my time.
I think we have had a good discussion here today. I think we have laid out that we are acting in good faith, supporting an issue, moving it forward, but also posing the scenario that there are so many other things we can do to address the very matter that we are taking up here today.
The surrounding details about how this bill came up and everything, I think it is problematic for the institution. But the fact of the matter is, we have an issue here that we need to address. I hope that we can work to continue to make it permanent in the future so that we can encourage investment, as was outlined previously, and encourage bending of the cost curve, ultimately, on healthcare, which is lacking at this point in time.
Madam Speaker, I urge a ``yes'' vote on this bill, and I urge a different kind of cooperation moving forward.
Madam Speaker, I yield back the balance of my time.
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