Telehealth use climbed early in the COVID-19 pandemic, particularly as rules on use for Medicare patients loosened. However, providers and patients now face a dilemma — some temporary telehealth policies set during the pandemic are set to expire at the end of the year unless Congress makes them permanent.
Before COVID, only Medicare patients in certain locations and with specific circumstances could use telehealth. During the pandemic, the CMS increased payments that providers could receive for audio-only telehealth visits. Meanwhile, regulators relaxed some rules on telehealth use across state lines.
Mei Kwong is the executive director at the Center for Connected Health Policy (CCHP), a national telehealth policy center partially funded by the federal government. CCHP provides guidance to the White House, state legislators, health plans, providers and national organizations about telehealth policy.
Healthcare Dive spoke with Kwong about what policy changes to expect as a crucial end-of-year deadline looms for telehealth.
This interview has been edited for clarity and length.
HEALTHCARE DIVE: How has telehealth changed since the height of the COVID-19 pandemic?
MEI KWONG: Before the pandemic, I would have categorized it as very slow and steady, but still very much like a niche area in providing healthcare. It probably wasn’t until the pandemic that family members and friends actually understood what I did for a living, simply because they just were not exposed, or telehealth just was not in the realm of knowledge. And that's probably a good representation of most people out there.
Telehealth became this really great tool to combat [the spread of COVID] because you're keeping people separated, but still providing those healthcare services. However, policies from all those years before really kept telehealth boxed in and siloed in a lot of ways.
During the pandemic, telehealth was used more actively and out of necessity, and when things started opening up again, it was all based on temporary policies, temporary exceptions.
After the first year of the pandemic, states made some policies permanent. It was still in that temporary phase on the federal level. They have to make some type of decision this year.
The National Law Review described the end of 2024 as a "telehealth cliff." Is this true? What changes can we expect to see toward the end of 2024 and into 2025?
It’s a cliff if [lawmakers] don’t do anything by Dec. 31 at 11:59 p.m. ET.
There are two main areas of federal policy that impact telehealth. The majority of temporary policies are in what Medicare covers. The other area would be in prescribing controlled substances.
With Medicare, if nothing's done and we revert back to pre-COVID policy, there's a location limitation on where the patient can be both geographically and in the type of building they're in.
So the permanent policy for Medicare is that you have to be in a rural location. There's a specific definition for what rural means. For example, under that definition, about 97% of the state of California would not qualify because it doesn't meet their definition of rural.
What type of impact would that have on prescriptions of controlled substances?
There are very narrow exceptions on where you can use telehealth to prescribe if that provider has not performed an in-person exam of the patient.
Narrow exceptions essentially require the patient to have that physical exam with a telehealth prescriber, or the patient has to be in a specific type of location, like a [Drug Enforcement Administration]-registered facility at the time that telehealth interaction takes place, or they're with a DEA-licensed provider.
Section 4113 of the 2023 Consolidated Appropriations Act states that people may have to move their location to access telehealth after December 2024. Is this true?
They would not necessarily move, but their location under the waivers would no longer be eligible. For example, if they were receiving telehealth services in the home and no policies changed, they would have to go into a clinic or a doctor's office.
If you're a Medicaid patient, it's going to depend on what state you're in, and you're going to have to look at their Medicaid policies. If you're a commercial payer, it depends on what state you're in, and perhaps what the state law may require of those commercial health plans, and then look at the health plan policies.
Let's say I was being treated by a dermatologist for a skin condition during the pandemic, and I've been doing my telehealth consultations from home. Nothing happens. It's Jan. 1 2025, and I can't do those at home anymore if my services are covered by Medicare. I would have to go into a doctor's office for the telehealth consultation, or a hospital, a clinic, skilled nursing facility or a critical-access hospital.
If a lot of states have settled on telehealth policies, will things change much for people not on Medicare?
Not really. The unknown is Medicare. There are a couple of states that have a temporary extension: Maryland and Connecticut. They are wait and see.
If you’re not a Medicare provider, you’re probably settled on what you’re doing. But one thing to keep in mind is that there's a trickle-down effect sometimes. So when Medicare has a policy on something, you sometimes see states duplicate it on the state level.
If you're not a Medicare patient, you're not going to have that immediate direct impact on Jan. 1, 2025. However, even if you’re not on Medicare or Medicaid, if you're being prescribed a controlled substance and your prescriber has been doing this over telehealth, you will be impacted if the DEA doesn’t move.
