Advancing Telehealth Beyond Covid-19 Act of 2021
Floor Speech
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Mr. PALLONE. Madam Speaker, pursuant to House Resolution 1256, I call up the bill (H.R. 4040) to amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program, and for other purposes, and ask for its immediate consideration in the House.
The Clerk read the title of the bill.
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Mr. PALLONE. 4040.
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Mr. PALLONE. Madam, I yield myself such time as I may consume.
I rise in support of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act, bipartisan legislation, introduced by Representatives Cheney and Dingell.
Over the course of this pandemic, telehealth has served as an important tool for staying connected to care without increasing the risk of exposure to COVID-19. And in the Medicare program, millions have utilized telehealth for the first time during the pandemic, thanks to actions taken early on by Congress and the administration.
When the pandemic was beginning to take hold in America, Congress moved quickly to significantly expand access to telehealth for Medicaid beneficiaries. And this was critically important because Medicare beneficiaries are some of the most vulnerable to COVID-19.
The waiver of Medicare's originating site and geographic restrictions during the public health emergency has allowed millions of Medicare beneficiaries nationwide to receive telehealth services, including audio-only services, without ever having to leave their homes.
Now, the Energy and Commerce Committee has a long history of working to expand access to telehealth services in the Medicare program. For example, the SUPPORT Act expanded access to substance use disorder services delivered via telehealth.
The Consolidated Appropriations Act of 2021 permanently expanded access to telemental health services and Medicare. And most recently, the Consolidated Appropriations Act of 2020 extended key telehealth flexibilities for an additional 5 months after the end of the public health emergency.
So H.R. 4040 builds on the bipartisan telehealth extension included in the Consolidated Appropriations Act of 2022. The bill extends the same key telehealth flexibilities as the previous legislation, but now would extend them until December 31, 2024, essentially 2 more years. And this longer-term extension will provide beneficiaries and stakeholders with more certainty.
It will also give policymakers time to assess the impact expanded telehealth services have had on the Medicare program and on beneficiaries' health and well-being, and the quality of care that they are receiving.
So I thank the many Energy and Commerce Committee members who have been leaders on this issue over the years, such as Representatives Dingell, Eshoo, Matsui, Welch, Blunt-Rochester, Kelly, and many more.
And I also commend Representative Cheney and Dingell for their bipartisan leadership on this legislation today.
I look forward to working with all Members on a permanent solution to address telehealth coverage under Medicare but, in the meantime, this multi-year extension is critical for preserving access to telehealth services.
The language included in the bill is the same bipartisan language previously negotiated by the House and Senate committees and the bill-- and I stress, Madam Speaker, that the bill is fully paid for.
So I hope we can, once again, extend these flexibilities with strong bipartisan support.
I urge all my colleagues to support this bill, and I reserve the balance of my time.
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Mr. PALLONE. Madam Speaker, I yield 3 minutes to the gentlewoman from Michigan (Mrs. Dingell).
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Mr. PALLONE. Madam Speaker, I yield 3 minutes to the gentlewoman from California (Ms. Matsui), a member of the Energy and Commerce Committee.
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Mr. PALLONE. Madam Speaker, I yield such time as she may consume to the gentlewoman from Wyoming (Ms. Cheney).
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Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Doggett).
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Mr. PALLONE. Madam Speaker, I yield the gentleman an additional 1 minute.
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Mr. PALLONE. Madam Speaker, I have no additional speakers at this time. We may have one more, but not at this time. I reserve the balance of my time.
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Mr. PALLONE. Madam Speaker, I am prepared to close, but I think Republicans may have additional speakers.
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Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my time.
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Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my time.
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Mr. PALLONE. Madam Speaker, I continue to reserve the balance of my time.
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Mr. PALLONE. Madam Speaker, I yield myself the balance of my time.
Since I heard every Republican who spoke say that they support the bill, I was certainly reluctant to suggest that we would have any kind of significant debate about the bill. I generally feel that if I have both sides of the aisle saying it is a good bill, I should leave well enough alone.
But I do want to say this in response to some of the comments that were made by the Republican Members. We were reluctant in the committee to move to have permanent authorization of the telehealth flexibility expansion for several reasons.
First of all, it is expensive. In other words, the Congressional Budget Office scored this bill. As I said, the bill for the 2 years is paid for. If you wanted to go permanent, I think they would have said that we needed another $20 billion. I feel very strongly that the bill should be paid for. That is part of what we believe as Democrats. We were able to get agreement with the Republicans on a pay-for for the 2 years, so that was a factor as to why it is for 2 years instead of permanent.
Beyond that, and more importantly, really, is the fact that a permanent expansion is a major change. I think it needs a lot of study, a lot of oversight and investigation. One of the things that I mentioned in Rules is that both HHS and the inspector general have been tasked to report back to us this spring with a report on a lot of the things that were mentioned here today, integrity issues, in terms of fraud and abuse, that were mentioned by both sides of the aisle.
I think the feeling of the committee was that this was something that needed more study before we went ahead and made this permanent. That is what we do. In other words, right now, the concern is that because the omnibus appropriations bill basically expanded the telehealth program until 5 months after the public health emergency for COVID ends, that would take us to the end of this year. But we don't have a lot of legislative days left. We figured the best thing was to at least extend it for another 2 years. We can pay for it, as was mentioned by Ms. Cheney.
This, I think, is the best way to resolve this: Do a 2-year extend, pay for it, and let's spend the time between now and next spring having some more hearings and opportunities to talk about a further extension or possibly making it permanent.
Again, I appreciate the fact that everyone on the Republican side supports the bill, but I do want to address some of the things that you mentioned.
Madam Speaker, I yield back the balance of my time.
Ms. JACKSON LEE. Madam Speaker, I rise in support of H.R. 4040 the Advancing Telehealth Beyond COVID-19 Act of 2021, which would make permanent several telehealth flexibilities under Medicare that were initially authorized during the COVID-19 public health emergency.
This bill would extend the life-saving measures put in place by Congress during the COVID-19 pandemic that allowed millions of American people to access telehealth-care.
Specifically, H.R. 4040 would:
permanently remove originating site and geographical restrictions that limited telehealth services to designated clinics in the event of a physician shortage,
give rural providers the ability to serve patients remotely while being properly compensated for their work,
empower providers to provide access to smart devices and innovative digital technology to their patients for monitoring purposes, and
provide coverage for audio-only evaluation, management, and behavioral health services.
H.R. 4040 would codify critical telehealth policies implemented during the pandemic for the continued benefit of all, but especially those in isolated communities, people with disabilities, and seniors.
Telehealth has dramatically improved the medical industry by making healthcare more accessible to people in rural areas, those with mobility concerns, and individuals whose work or family schedules may not accommodate an appointment at a physical location.
During the height of the pandemic, while more than 3,000 people were dying per day of the virus, telehealth served as an invaluable weapon against the spread of infectious disease.
Remote screening and care prevented undue burden on our already exhausted medical professionals and allowed patients to get the care they needed without putting themselves or their families at risk.
What began as emergency protocol then, has now emerged as best practice.
Currently, 76 percent of hospitals in the U.S. connect doctors and patients remotely via telehealth.
This is up from 35 percent a decade ago.
Remote healthcare allows for greater flexibility for patients, enables certain physicians like allergists or occupational therapists to access an individual's environmental needs, and streamlines the scheduling process to prevent long wait times and wasted time.
Telehealth has allowed doctors to monitor their patients' chronic conditions more closely, like heart or lung disease.
Better monitoring can improve patients' quality-of life and reduce hospital admissions and deaths from chronic diseases.
Additionally, telehealth is a good way to deliver care quickly in an emergency, such as a stroke or heart attack.
Telehealth has also played a significant role in expanding pediatric mental healthcare access.
As of April 2019, there were only 8,300 practicing child and adolescent psychiatrists in the U.S.
This number is dwarfed by the more than 15 million kids and teens in need of a psychiatric provider.
For over a decade, The University of Texas Medical Branch has offered telehealth services for rural patients.
After initially partnering with community mental health clinics in fringe counties, the program has since been able to expand adolescent mental health services directly to school districts.
This means children without access to a local psychiatrist can receive the care they need without being pulled from school or traveling long distances.
It also means psychiatrists can observe children in their natural setting at home or in school, rather than in an inorganic hospital environment.
Telehealth allows children to be where they ought to be--in the classroom getting an education.
These are just some of the many examples of how telehealth has aided our healthcare system in providing the quality medical services that our constituents deserve.
The passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, would ensure that these positive developments continue to benefit communities across the country.
It is important to note, however, that telehealth has not always served all people equally.
Historical data shows that People of Color have long faced obstacles to getting the critical health care services they need.
Unfortunately, the rapid implementation of telemedicine hasn't bridged the equality divide as much as one would have hoped.
A study led by the University of Houston College of Medicine found that African Americans were 35 percent less likely to use telemedicine compared to White Americans, and those in Hispanic communities were 51 percent less likely to use it.
Only 66 percent of African American and 61 percent of Hispanic households have access to broadband internet compared to 79 percent of white households.
Additionally, only a quarter of families earning $30,000 or less have smart devices, such as a phone, tablet, or laptop at home, limiting their access to telehealth services.
So, while telehealth has reduced many barriers to adequate healthcare, we must stay vigilant to the needs of our most disadvantaged community members.
We are a long way from full medical equality in this country, however, I believe that the Advancing Telehealth Beyond COVID-19 Act of 2021 is an important step in bringing us closer to that goal.
H.R. 4040 is an opportunity to connect our healthcare providers with patients who might otherwise go without the medical care they so desperately need.
It is an opportunity to lift our nation's healthcare into the 21st century and to utilize technology as a medical equalizer.
I urge all my colleagues to support H.R. 4040 the Advancing Telehealth Beyond COVID-19 Act of 2021.
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