Telehealth Reform: US Congress Heeds Public Outcry

Telehealth reform

Telehealth Reform: US Congress Heeds Public Outcry

Continued public outcry for telehealth reform has led to a remarkable display of bipartisanship, with representatives of the US House and Senate working on several efforts to support the permanent expansion of telehealth. Introduced in the House, the Advancing Telehealth Beyond COVID-19 Act, H.R.7338, would allow many telehealth regulations implemented through the CARES Act during the pandemic to remain permanent. For example, the proposed legislation will allow the HHS to waive geographical limitations for Medicare beneficiaries using telehealth or remote patient monitoring services; establish permanent telehealth coverage at Rural Health Clinics (RHC) and would advance telehealth access to emerging technology for seniors, especially in rural areas.

Several other key bills of interest to behavioral health professionals are briefly described below:

Mental and Behavioral Health Connectivity Act

U.S. Senators Angus King (I-Maine) and Todd Young (R-Ind.) recently introduced the Mental and Behavioral Health Connectivity Act, known as S. 3998, which would allow Medicare beneficiaries to extend telehealth access for mental and behavior health services. The Act is supported by the American Counseling Association, American Psychiatric Association, American Psychological Association, Mental Health for America, National Association of Social Workers, National Association of State Mental Health Program Directors, and the National Suicide Prevention Foundation.

If passed, the bill would permanently change a number of key pieces of legislation to:

  • Allow Medicare beneficiaries to keep receiving care in their home
  • Continue eligibility of care to the currently  expanded list of non-physician providers, which allows for many types of professionals to be reimbursed for delivering Medicare services, and
  • Allow Medicare to cover audio-only (telephone) delivery of telehealth services.

Telehealth Addiction Services: TREATS ACT

U.S. Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS Act) to address substance abuse. The bill has support from American Society for Addiction Medicine, American College of Medical Toxicology, Kennedy Forum, National Association of Addiction Treatment Providers, National Association of Behavioral Health, National Safety Council, Shatterproof, and Well Being Trust.

The argument is that existing temporary waivers on e-prescriptions are time-bound and will expire after the COVID-19 Public Health Emergency. The TREATS ACT aims to make permanent key waivers for e-prescribing such as the permission to prescribe Medication Assisted Therapies (MAT) and other essential drugs without requiring in-person visits. Of particular note is that the TREATS Act includes support for Medicare reimbursement for audio-only telehealth services (telephone). As pointed out by Portman, the bill is essential for augmenting addiction treatment, where no-show rates are high, even if access to care is offered. 

Increased Broadband for Telehealth Reform

On another front in the fight for telehealth reform, Senate Bill 4201 or known as The Rural Broadband Acceleration Act,  addresses access to broadband, the most significant structural barrier in making telehealth work for the underserved. The bill will boost efforts in making rural broadband more accessible across the country. If passed, rural America will have the same level of broadband service experienced by the cities and suburbs. Simultaneously, identical legislation was also introduced in the house of representatives by Fred Upton (R-MI) and House Majority Whip Jim Clyburn (D-SC). The authors of the bill have highlighted telehealth as one of the essential reasons for its legislation. “Millions of Americans still lack access to high-speed broadband, which means they don’t have access to online learning, teleworking, and telemedicine at the very moment they’re most needed during the COVID-19 pandemic,” said Senator Bennet. Senator Brown also commented on the self-protection aspects of strong internet connections, “The better your internet connection, the better you’re able to protect yourself – you need broadband to apply for unemployment, or to order groceries, or to have a telemedicine appointment.” House Majority Whip Clyburn, described the need for  telehealth reform in South Carolina stating, “Telework, telemedicine, and distance learning are impossible without broadband access. Nearly 1 in 10 South Carolina households lack access to a reliable broadband connection.” 

Other Legislative Action toward Telehealth Reform

As outlined in TBHI’s Telehealth Newsletter last week, legislative action is surfacing in a number of areas, particularly after the American Telemedicine Association, Alliance for Connected Care and NCQA spearheaded a task force to lobby Congress to keep the momentum going. They include:

  • S. 3988 Amends the Public Health Service Act with respect to telehealth enhancements for emergency response. It supports the federal tracking, maintenance and improvement of the country’s ability to provide health care through telehealth systems. 
  • H.R. 7233 calls for federal officials to report to Congress on efforts to expand access to telehealth services, through Medicare, Medicaid and the Children’s Health Insurance Program, during the COVID-19 emergency.

What Can You Do to Support Telehealth Reform?

Not only have 340 healthcare organizations urged congress to legislate permanent telehealth reforms on four key issues, but the Taskforce on Telehealth Policy  is seeking public input  as it develops policy recommendations to advance quality and patient experience while establishing a stable, long-term environment that fosters the growth and integration of remote services within the healthcare system. The public comment period has been extended to Monday, July 13, 2020. You may also want to contact your state representatives to encourage their support of the many telehealth reform bills currently being introduced. Please post updates and new legislation below.

Deepening your own understanding of telehealth may also be warranted to assure compliance with published competencies. Courses offered at the Telebehavioral Health Institute include Telehealth Certifications, a 4-hour live, interactive COVID update and Telehealth Clinical Best Practices Workshop as well as a newly scheduled Minimizing Zoom Fatigue webinar.

Your TBHI Professional Training Options

TBHI specializes in teaching you how to relax when delivering telehealth.  It offers you a step-by-step learning path of online training that helps you be legally and ethically compliant, clinically proficient, and able to handle even the most difficult of clinical scenarios. Take advantage of COVID discount pricing to learn how to sit back and enjoy your telehealth experiences, rather than struggling with ZOOM fatigue and clinical uncertainty. All courses are evidence-based, available 24/7 through any device and most count toward legal and ethical requirements for licensure. Two micro certifications are also available.

    1. Telehealth Group Therapy  — Exciting, highly interactive telehealth learning experience designed to get answers to your questions about legally and ethically managing telehealth group therapy. Digital class will allow you to connect with colleagues ahead of time to ask questions and share answers. Distinguished faculty will lead you through telehealth group therapy theory and exercises.
    2. Telehealth Clinical Best Practices Workshop — Live, interactive webinar, w/ 4 CME or CE hours to discuss preventing and handling complex clinical issues.
    3. Course Catalog
    4. Micro Certifications to give you a broader range of legal and ethical grounding, and allow you to distinguish yourself as a TBHI-credentialed professional on your websites, in social media, directories and other areas.

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11 comments on “Telehealth Reform: US Congress Heeds Public Outcry

  1. Brendahiebner01@gmail.com
    Brenda Hiebner LIMHP
    I believe we should continue Telehealth therapy it has allowed my very high risk clients to do therapy during this COVID-19. They are house bound and have no ability to get help outside of their homes. I have clients that if they got Covid-19 they could die. Please make this a permanent change!

  2. Thank you for your timely and comprehensive coverage of all things telehealth! I look forward to these updates eagerly and always read them even as I regularly bypass many other incoming emails.

  3. Thirty years ago my analyst referred me someone whom he was unable to treat. I treated this person on the telephone and never met him in person. Through our work together for one year he stopped drinking, improved his relationship with his girlfriend and his relationship with himself. He stopped attacking himself. I was able to help him with his relationship with his father because I understood my conflicts with my father through my personal psychoanalysis. And I understood potential countertransference issues with this patient. I didn’t have any specific training with telephone therapy. But I learned to be a good listener. My chief concern is about the potential building of big business around telephone therapy. I am concerned about the establishment of bureaucracies and regulations that demand trainings in telephone therapy and supervisors who supervise people in telephone therapy. So it becomes a big business which has some advantages but as many problems.

    • Mark,

      Thank you for your comments. I have to agree about the downside to bureaucracies and regulations that demand trainings in telephone therapy, and yet, exactly how painful is a little training, anyway? Besides, we are trainers here at TBHI. The perspective we take is that most of us are well-intentioned professionals but uninformed. Most of our colleagues don’t know what they don’t know because they don’t stop long enough to look at the repercussions of their actions in the larger picture.

      Without some formal training in healthcare, the promise of an easy-to-give and easy-to-get cure for the ills of our world’s most vulnerable people can be considered low hanging fruit. Anyone could quickly make a fistful of easy cash for sitting around, dolling out advice in person, on the phone or their computers.

      Speeding laws don’t exist for the sheer pleasure of inconveniencing the cautious, thoughtful driver. Rather, they exist to teach us important things like how far to break ahead of a stop sign and what to do when we hear an ambulance siren. Laws and the bureaucracies needed to enforce them have many of their own problems, but they also exist to control the thoughtless, careless, impulsive driver who could easily kill innocent people after having a bottle of vodka.

      Thank you for commenting. I invite you to respond and other readers to share their thoughts as well.

    • Natalie,

      Non-Medicare/Medicaid services can include a variety of types, but if you are referencing third party carriers, they are their own beasts. They are regulated by states, and your state’s insurance commissioner is appointed to make sure they follow those regulations. In short, then, you have to stay in touch with the payors who reimburse you through their newsletters or announcements, stay in touch with your insurance commissioner and your governor’s office. To shortcut some of that, you might join your state professional association and follow their local legislative efforts.

      No one really knows for sure where all this will lead, but on our end at TBHI, we’ll let you know as soon as we find out. If you haven’t yet registered for our free weekly telehealth community newsletter, you may want to sign up for the TBHI News today. That’s where we give you an overview of the latest news of relevance to telehealth with a special focus on telebehavioral health.

    • Natalie,

      The immediate and long-term fate of telehealth is dependent on many factors, including your state, profession and third-party carriers. Given the lack of helpful leadership that we are seeing from Washington regarding COVID, each state is deciding its own fate. Given that insurance companies are state-based, each company in each state is trying to make sense of COVID as well. All we can do is write to our local state elected officials and ask for what we and our clients/patients need.

      I hope you and everyone reading this will take an hour to write a letter outlining a sample composite case and example why telehealth coverage needs to continue. (Of course, please protect the identity of any real clients/patients that you describe.) Be the pebble in the shoe of your elected officials everywhere, as well as your state board, insurers and your national and state associations. One letter can be used for all parties.

  4. I am in total support of making Telemental health revisions made since Covid-19 permanent.
    The following revisions since Covid-19 are:
    1. a face to face in person assessment is not required.
    2. a Medicare in person at a Medicare designated site is not required.
    3. telephone therapy is permitted.
    These rules allow patients and practitioners to provide and receive services in the safety and comfort of their homes. If the rules are put back in place it would defeat the purpose of safety as well as limit those in need of services. Respectfully, Bonnie Eidens, MSSA, CEAP

    • Bonnie, The best action to take is to write a letter stating your views and send it to your governor and state representatives. This action will take you about an hour and can make all the difference.

  5. telehealth is dependent on people understanding the technology and the need for privacy both by the therapist and an encrypted platform. please pass the word.

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