House Passes Bill to Extend Hospice Telehealth Flexibilities Through 2024

The U.S. House of Representatives has approved a bill that would extend telehealth waivers until the end of 2024, whether or not the COVID-19 public health emergency is extended. This includes the ability to re-certify patients for hospice through virtual visits.

The bill, dubbed the Advancing Telehealth Beyond COVID-19 Act, cleared the House with an almost unanimous vote, but must now go to the Senate for consideration.

“Through telehealth, Americans are able to take care of immediate and necessary health needs at home without the costs or health risks associated with in-person appointments,” said Rep. Michael C. Burgess (R-Tex.), who is a physician as well as a legislator. “Telehealth is the start of future innovation in technology that will further influence how we deliver care to American patients.”

In addition to extending most of the waivers through 2024, the bill would make permanent the ability of federally-qualified health centers (FHQCs) and rural health clinics (RHCs) to use telehealth.

The long-term outlook of these flexibilities has been a top concern among hospices and other health care organizations. What began as an emergency stopgap measure has become an integral part of care delivery during the past two years, and providers have invested heavily in expanding their telehealth capabilities.

A consortium of industry stakeholders noted these concerns in a letter to Congressional leaders earlier this year urging legislators to make the waiver permanent, including the National Hospice and Palliative Care Organization (NHPCO) and the American Academy of Hospice and Palliative Medicine.

“Many of the telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of the COVID-19 [public health emergency] – and impact both public health programs and private health coverage …,” the organizations wrote in the letter. “As it stands today, providers must weigh the costs of investing in the technological and clinical infrastructure required to maintain telehealth programs at scale against the possibility that Congress may ultimately decide not to support permanently expanded telehealth coverage.”

Between March 2020 and February 2021, more than 28 million Medicare beneficiaries used telehealth services, according to research from the Kaiser Family Foundation.

The U.S. Centers for Medicare & Medicaid Services (CMS) issued these waivers in 2020 to help limit the spread of COVID-19. Congress subsequently instituted further flexibilities, including the recertification requirement, that were instituted through the CARES Act. 

Later, former President Trump issued an executive order instructing the U.S. Department of Health & Human Services to review these waivers to determine which could be made permanent, but the agency has yet to announce any determination on the rules pertaining to hospice and many other providers. CMS in 2021 did make permanent some telehealth provisions for mental health services.

But expanded access to telehealth has transcended its original objective of reducing infections. These services have allowed providers to add new touchpoints for patients, reduce unnecessary in-person visits and associated costs, and ease some of the burden on over-extended staff.

Rapid deployment of telemedicine during the COVID-19 public health emergency also has created “a new pathway” for bringing palliative and hospice care specialists to rural areas, according to authors of a recent report published in the JAMA Health Forum. Additional studies further support the claim that changes to telehealth policy improved access.

Stakeholders in the hospice community applauded the House vote.

“The passing of the Advancing Telehealth Beyond COVID-19 Act of 2021 in the House of Representatives is a win for our hospice community partners who will continue to have flexibility to care for more Americans during this ongoing Public Health Emergency,” said NHPCO interim CEO Ben Marcantonio. “NHPCO and our affiliate Hospice Action Network are continuing to monitor the progress of this bill as it advances to the Senate and remain engaged with key members of Congress and partner organizations on telehealth issues impacting the industry.”