Telemedicine Reimbursement, Telehealth Expansion Act of 2023, HDHP-HSA

Legislation to Remove the In-Person Requirement for Telehealth & Telemedicine Reimbursement


June 20, 2023 | Reading Time: 5 Minutes

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Since 2011, I have been writing the blog to inform behavioral health professionals of telehealth advocacy to support the permanent approval of telehealth and telemedicine reimbursement at state and federal levels. This week’s exciting update briefs you on the structure of two pivotal pieces of legislation that, if approved, will permanently alter the nature of telehealth and telemedicine reimbursement in the United States. It also outlines how you can help to ensure the passage of these crucial bills. As you read about them below, you will undoubtedly see the bigger picture – how they are positioning telehealth and telemedicine reimbursement to steadily become a cornerstone of advancing 21st-century healthcare for US citizens, starting with additional Medicare revisions. The first bill of note is the 2023 update to the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, which, among other telehealth expansions, will permanently remove the in-person requirement for behavioral health clients and patients receiving Medicare.* The second bill was recently advanced by the Alliance for Connected Care, which led 188 organizations urging House Ways & Means Committee leaders to advance the Telehealth Expansion Act of 2023. The following article briefly outlines both bills.

Updated CONNECT Act

Although many behavioral health practitioners have been distraught about Medicare’s requirement for an in-person visit for behavioral healthcare, current legislation will negate that possibility.

Spearheaded by a physician, US Senator Bill Cassidy, MD (R-LA), the updated Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act was filed on June 16, 2023, along with Senators Brian Schatz (D-HI), Roger Wicker (R-MS), Ben Cardin (D-MD), John Thune (R-SD), Mark Warner (D-VA), Cindy Hyde-Smith (R-MS), and a bipartisan group of 60 senators. According to a press release issued through the Bill Cassidy MD legislative website, the Act will expand coverage of telehealth services through Medicare, make permanent COVID-19 telehealth flexibilities, improve health outcomes, and make it easier for patients to connect with their practitioners.

The original CONNECT for Health Act was introduced in 2016 and represented the most far-reach telehealth and telemedicine reimbursement legislation proposed to Congress. Based on this seminal legislation, numerous bill provisions have since been enacted or adopted by the Centers for Medicare & Medicaid Services. These include provisions to remove restrictions on telehealth services for mental health, stroke care, and home dialysis.

The 2023 version of the CONNECT for Health Act builds on that progress and includes new and revised provisions to help more people access telehealth services. 

The newly proposed legislation aims to (bolding added by

  • Permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites.
  • Permanently allow health centers and rural health clinics to provide telehealth services.
  • Allow more eligible healthcare professionals to utilize telehealth services.
  • Remove unnecessary in-person visit requirements for telemental health services.
  • Allow for the waiver of telehealth restrictions during public health emergencies and
  • Require more published data to learn more about how telehealth is used, its impacts on quality of care, and how it can be improved to support patients and health care providers.

Companion legislation is being introduced in the House of Representatives by US Representatives Mike Thompson (D-CA-04), Doris Matsui (D-CA-07), David Schweikert (R-AZ-01), and Bill Johnson (R-OH-06). The CONNECT for Health Act also has the broad-based support of more than 150 organizations. See the press release for details. Click here to download a summary of the bill and the complete list of endorsing organizations. 

Telehealth Law and Ethical Issues

Telehealth Expansion Act of 2023

This week’s second bill of note, advanced by the Alliance for Connected Care, is the Telehealth Expansion Act of 2023, which has been fast-tracked to the full House of Representatives for consideration. The newly proposed Act (H.R. 1843/S. 1001) is a bold initiative to amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from specific high deductible health plan rules. The following article briefly outlines both bills. Proposed by representatives Steel (R-CA), Lee (D-NV), Smith (R-NE), Schneider (D-IL), and Senators Daines (R-MT) and Cortez Masto (D-NV), the cross-party, two-chamber legislation aims to indefinitely authorize the power vested by the CARES Act that permits employers and health plans to facilitate telehealth-based services. More specifically, the Act builds on the earlier version of this Act, which allowed people enrolled in high-deductible health plans paired with a health savings account (HDHP-HSA) to receive telehealth service before reaching their health-plan deductible. This concession has proved essential to ensuring that American families could afford and access various virtual healthcare services on a pre-deductible basis amidst the COVID-19 pandemic. The planned expiration date for the existing Consolidated Appropriations Act of 2023 is December 31, 2024.

Why the Consolidated Appropriations Act of 2023 Needs to Be Extended

Over 32 million Americans are covered by HDHP-HSAs. More than half of these individuals reside in regions with a median annual income below $75,000. For these people, fulfilling the deductible limit of $1,400 for an individual and $2,800 for a family is often a significant financial challenge. This makes the provision that allows employers to offer pre-deductible coverage of telehealth services for HDHP-HSA subscribers a crucial step towards affordable healthcare.

The Popularity of HDHP-HSAs

HDHP-HSA policies also enjoy significant support among patients and plan sponsors in the commercial market. As demonstrated by a 2021 survey of health plans, the services most likely to boost patient satisfaction if covered pre-deductible for HDHP-HSA subscribers are primary care visits (81%) and the permanent provision of telehealth services (64%).

As Krista Drobac, Executive Director of the Alliance for Connected Care, noted, “Many Americans have to bear the burden of paying thousands of dollars out of pocket for medical services before their insurance steps in. Despite the advantage of tax exclusion, high deductibles remain a significant struggle for numerous individuals and families. Isn’t it essential to allow employers to cover telehealth services, including primary care and mental health, irrespective of the deductible status? It’s all about improving access to healthcare.” The Alliance is proud to endorse the Telehealth Expansion Act, which ensures permanent access to virtual healthcare services for individuals with HDHP-HSAs.

The Alliance led in drafting a letter of support for this bill, which garnered the backing of more than 185 organizations. The letter was instrumental in securing the favorable reporting of the bill from the House Ways & Means Committee during their review on June 7, 2023.

Why Your Advocacy Is Needed Now

Without widescale support from practitioners, these bills may face undue delays. Please take 10-15 minutes to write to your elected officials about casting their votes in favor of the above two proposed pieces of legislation. Write a simple, 1-page letter 1) identifying them as your elected official and 2) yourself as a citizen of their jurisdiction, 3) naming the bills outlined above, and 4) why you think it is important for the citizens of your state that they advocate for the passing of this legislation. You may also want to 5) give an example of a client or patient (without identifying information) and how they need such legislation to benefit from your reimbursed services.

Stay tuned to’s Telehealth and Technology Updates for more breaking now about telehealth reimbursement and associated legislation.

  • * If you do not serve Medicare beneficiaries, you may want to consider reading my earlier blogs about the many long-term advantages of offering Medicare telehealth services to assure yourself of continued income.
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