Unprecedented Telehealth Support through Omnibus Appropriations & Coronavirus Relief Spending Bills

On Monday evening of 12/21/2020, the US Congress passed a $2.3 trillion appropriation bill that delivers $900 billion in new COVID-19 relief and $1.4 trillion to fund the federal government through September 30, 2021. The Omnibus Appropriations and Coronavirus Relief Package includes spending bills that are of direct relevance to the telehealth and general behavioral communities, and are detailed below. (Bolding added for emphasis by Telehealth.org.)

An appropriation of $4.25 billion for mental health and substance use programs, whose funding are beyond the regular FY 2021 spending. These 2021 spending bills have now allocated:

• $1.65 billion for the Substance Abuse Prevention and Treatment Block Grant.
• $1.65 billion for the Community Mental Health Services Block Grant, with no less than 50% of funds directed to behavioral health providers.
• $600 million for Certified Community Behavioral Health Clinic (CCBHC) Expansion Grants to be allocated by the Substance Abuse and Mental Health Services Administration (SAMHSA).
• $50 million for suicide prevention programs.
• $50 million for Project AWARE.
• $240 million in emergency grants to states.
• $125 million of these allocations should be in funding to tribes.

Never before have we seen a bill that changed the face of telehealth to this degree. After millions of people have experienced the benefits of telehealth, the US Congress has voted to make telehealth permanently available to Medicare beneficiaries without prior restrictions with regard to location. The appropriation bill includes the following provisions:

• Telehealth. The bill includes the Mental Health Telemedicine Expansion Act, H. R. 1301, which permanently expands access to telehealth services in Medicare to allow beneficiaries to receive mental health services via telehealth, including from the beneficiary’s home.
  • To be eligible to receive these services via telehealth, the beneficiary must have been seen in person at least once by the physician or non-physician practitioner during the six month period prior to the first telehealth service, with additional face-to-face requirements determined by the Secretary.
  • The final text of the spending bill also calls for a study of the effectiveness of telehealth during the COVID-19 pandemic. The current Drug Enforcement Agency flexibilities to prescribe controlled substances via telemedicine are still allowed per the Public Health Emergency declaration.
• Telehealth Grants and Broadband Access. The final package appropriates funding for three programs for funding telehealth and greater broadband connectivity.
  • The first appropriates an additional $250 to the Federal Communications Commission for the COVID-19 Telehealth reimbursement program authorized by the CARES Act in March, 2020.
  • The second establishes the Emergency Broadband Benefit Program at the FCC, under which eligible households may receive a discount of up to $50 ($75 on tribal lands) off the cost of internet service and a subsidy for low-cost devices such as computers and tablets.
  • The third establishes grant programs at the National Telecommunications and Information Administration to bolster broadband connectivity on tribal lands and in state and local governments across the country.
• Additional Relief. The act provides for a one-time, one-year increase in the Medicare physician fee schedule of 3.75% to support physicians and other professionals adjusting to changes in the Medicare physician fee schedule during 2021 and provides relief during the COVID-19 public health emergency.

Other Omnibus Appropriations and Coronavirus Relief Spending Bills

These other provisions of the allocation bill are offered to the reader as a convenience:

• Certified Community Behavioral Health Clinics. The bill extends a series of programs funded by the Centers for Medicare and Medicaid Services (CMS), including the CCBHC Medicaid demonstration, to September 30, 2023. This extension applies to existing Prospective Payment System (PPS)-receiving CCBHC states. The package also extends the enhanced Federal Medical Assistance Percentages (FMAP) payment through September 30, 2023, for these states. Visit the CCBHC Success Center page for details on the demonstration states.
• Small Businesses. $325 billion for the Small Business Administration is allocated for a second round of Paycheck Protection Program (PPP) loans. This includes eligibility for 501(c)(6) nonprofit organizations with as many as 300 employees.
• Provider Relief Fund. The final package provides an additional $9 billion in support for health care providers including $3 billion in grants for hospital and health care providers to be reimbursed for healthcare-related expenses or lost revenue directly attributable to the public health emergency resulting from coronavirus, along with direction to allocate not less than 85% of unobligated funds in the Provider Relief Fund through an application-based portal to reimburse health care providers for financial losses incurred in 2020.
• Parity. The package includes provisions of the Strengthening Behavioral Health Parity Act of 2020 (H.R. 7539) which authorizes and requires the Departments of Labor, Treasury, and Health and Human Services to conduct random audits and comparative analyses of at least 20 insurance plans per year to ensure proper and full enforcement of existing parity laws. The act also appropriates $2.5 million in grants to each state to establish all-payer claims databases. This is an important step that will help move states toward parity with greater access and transparency into claims data.
• Provider Relief Fund. The final package provides an additional $9 billion in support for health care providers including $3 billion in grants for hospital and health care providers to be reimbursed for healthcare-related expenses or lost revenue directly attributable to the public health emergency resulting from coronavirus, along with direction to allocate not less than 85% of unobligated funds in the Provider Relief Fund through an application-based portal to reimburse health care providers for financial losses incurred in 2020.
• Coronavirus Relief Fund Extension. Extends the date by which state and local governments must make expenditures with CARES Act Coronavirus Relief Fund awards from December 30, 2020, to December 31, 2021.

FY 2021 SAMHSA Appropriation Bill

The $1.4 trillion omnibus appropriation bills allocated to the federal government include annual funding for health-related agencies and priorities for FY 2020 in addition to the COVID-19 relief provisions above. The spending allotments for SAMHSA are as follows:

• Substance Abuse and Mental Health Services Administration (SAMHSA) — The appropriation bill funds SAMHSA at $6 billion, an increase of $133 million above the 2020 enacted level. SAMHSA funding contains increased support for mental health services, including a new $35 million crisis care initiative within the Mental Health Block Grant, expanded services and support for mental health for children and youth including $107 million for Project AWARE, an increase of $5 million, and $72 million for the National Child Traumatic Stress Initiative, an increase of $3 million. The allocation bill includes $3.8 billion for substance abuse treatment and $208 million for substance abuse prevention. Finally, the bill includes $250 million for Certified Community Behavioral Health Clinics.

Ryan Haight Act

Proponents of permanently waiving the Ryan Haight Act (DEA – HHS.gov) are disappointed today, as the Drug Enforcement Agency was not required by the bipartisan COVID compromise package to permanently waive the act.

• Assuming that the public health emergency (PHE) will remain in effect at least for 2021, the current Ryan Haight waiver should remain in effect as long the PHE is in place.
• The final appropriations report directed at the Department of Justice did include language directing DEA to issue the Special Registration regulations.

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