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House committee advances bill to extend telehealth rules

20 May 2024 12:00 PM | Matt Zavadsky (Administrator)

Continuation of telehealth reimbursement models available through the current CMS waivers will be beneficial to EMS because they help facilitate protocols that include a telehealth consult as part of an EMS Treatment in Place (TIP) protocol by allowing providers to be reimbursed for telehealth services originating at the patient’s residence, and without an established patient:provider relationship.

And because the current waivers allow telehealth providers to reimburse ambulance agencies for the facilitation of provider requested telehealth services.

Salient waiver language, with links, included at the end of the article.


House committee advances bill to extend telehealth rules


May 08, 2024


Congress took the first step Wednesday to extend expiring telehealth rules, hospital at home services and other programs aimed at rural hospitals.

The House Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act of 2024 by a vote of 31-0, setting it up for passage by the full House later this year.

The bill would extend for two years telehealth rules adopted during the pandemic that are due to expire at the end of the year, as well as extend similar rules for Medicare's hospital at home program for five years.

The measure also expands the practitioners eligible to bill Medicare for telehealth services to physical therapists, occupational therapists, audiologists and speech language pathologists. And it allows federally qualified health centers and rural health clinics bill Medicare for telehealth services, and delays in-person visit requirements for remote mental healthcare.

"One of our top priorities on this committee is helping every American access healthcare in the community where they live, work and raise a family. In rural America, in small towns, families often struggle to get healthcare," Ways and Means Committee Chair Jason Smith (R-Mo.) said. "Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home, starting at the end of this year."

While the bill received broad bipartisan support, many of the Democrats on the committee complained that Republicans failed to include significant fraud prevention measures.

"it's difficult to view this bill as progress with regard to fraud since it gives [the Centers for Medicare and Medicaid Services] no new authority, and no new enforcement tools," said Rep. Lloyd Doggett (D-Texas).

"There's much more to do here to protect consumers," said the ranking Democrat on the committee, Rep. Richard Neal (Mass.)

Republicans agreed that more should be done to target fraud, but suggested it should be addressed in a different, broader bill.

One potentially controversial provision in the bill requires pharmacy benefit managers that work with Medicare Part D plans to de-link the compensation they pay themselves from the rebates they secure based on drugs' high list prices. Rep. Brad Schneider (D-Ill.) said the provision will save the government about $500 million, although official estimates were not yet available. The provision does not apply to the broader commercial market, though Schneider and Rep. Nicole Malliotakis (R-N.Y.) both called for expansion of the provision to the commercial market. Large PBMs oppose such provisions.

Other extensions in the bill cover Medicare’s Low Volume Adjustment and the Medicare-Dependent Hospital Program, which give rural hospitals bonus payments, and are due to expire at the end of 2024. The payments would be extended until September 2025. The bill includes a nine-month extension for Medicare add-on payments for ambulance services in areas with poor access. Republicans opposed amendments to add more time to the extensions, saying they were not paid for.

The committee is still considering several other bills designed to ease stresses on rural hospitals. Among them:

  • ·         The Preserving Emergency Access in Key Sites Act of 2024, which would boost ambulance payments for hospitals in locations that are hard to reach.
  • ·         The Rural Hospital Stabilization Act of 2024 to boost grants to rural hospitals.
  • ·         The Rural Physician Workforce Preservation Act of 2024 to require that 10% of 1,200 recently approved Medicare graduate medical education training slots go to rural hospitals.
  • ·         The Second Chances for Rural Hospitals Act of 2024, which would allow rural hospitals that closed as long ago as 2017 to reopen as Rural Emergency Hospitals, which receive $276,000 monthly payments from Medicare to support 24-hour emergency services.

Democrats suggested that because of objections they raised, the bills would not pass in the Democratic-controlled Senate. Republicans argued that the House should not worry what the Senate might do.

Whether the Senate ever takes up the specific bills, passing them through the committee and likely through the full House makes them available for negotiations that are likely to begin once the November elections are over and Congress grapples with unfinished business.

"Many of these bills won't become law," Neal said. "There's much more we could have done and likely we will do, post-election time."

Waiver Language:

 EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. Prior to this waiver Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.




RIN 0938-AU31

Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Interim final rule with comment period.

“….. We note that in specifying that direct supervision includes virtual presence through audio/video real-time communications technology during the PHE for the COVID-19 pandemic, this can include instances where the physician enters into a contractual arrangement for auxiliary personnel as defined in § 410.26(a)(1), to leverage additional staff and technology necessary to provide care that would ordinarily be provided incident to a physicians’ service (including  services that are allowed to be performed via telehealth). For example, physicians may enter into contractual arrangements with a home health agency (defined under section 1861(o) of the Act), a qualified infusion therapy supplier (defined under section 1861(iii)(3)(D) of the Act), or entities that furnish ambulance services in order to utilize their nurses or other clinical staff as auxiliary personnel under leased employment (§ 410.26(a)(5)). In such instances, the provider/supplier would seek payment for any services they provided from the billing practitioner and would not submit claims to Medicare for such services. For telehealth services that need to be personally provided by a physician, such as an E/M visit, the physician would need to personally perform the E/M visit and report that service as a Medicare telehealth service.”


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