On August 3, 2020, President Trump announced that he was signing an executive order (EO) to further expand telehealth services, specifically for rural health providers. The executive order builds on actions taken during the public health emergency (PHE) by the Centers for Medicare and Medicaid Services (CMS). The EO directs the Department of Health and Human Services (HHS) to create a new payment model for rural providers, improve both the physical and communications healthcare rural infrastructure, prepare a report on rural health policy initiatives, and expand telehealth flexibilities to rural healthcare providers beyond the public health emergency.
The White House also held a briefing on the executive order, where CMS Administrator Seema Verma stated that the Administration is looking to extend some telehealth services to rural providers permanently such as prolonged office visits, mental health services, neuro-behavioral exams, and other types of visits in addition to the Administration’s previous action to make telehealth for home health services permanently available. Meanwhile, some services will be extended through the end of the calendar year in which the PHE ends , to study their impacts under more normal circumstances and minimize disruption to providers and patients who currently rely on flexibilities such as lower-level emergency department visits, psychological testing services, and nursing facility discharge visits provided via telemedicine. Following the White House briefing on August 3, CMS released the CY 2020 Physician Fee Schedule (PFS) rule, which includes these proposals to extend telehealth services and requests public comments on services that should be made permanent beyond the PHE.
Administrator Verma also stated that making telehealth permanent outside of rural areas and expanding the list of providers authorized to provide telehealth services cannot be done through regulatory action. Extending the removal of restrictions on site-of-care for providers in non-rural areas requires Congress to change statute. If Congress fails to act, telehealth will revert to a rural benefit that can only be utilized from a healthcare facility rather than from one’s home.
New Payment Model for Rural Providers
Within 30 days the Secretary of Health and Human Services (HHS) will launch a new, innovative payment model giving rural providers flexibilities from existing Medicare rules, establishing predictable financial payments, and encouraging value-based care to ensure they are able to provide patients the necessary level and quality of care.
Improving Rural Infrastructure
In addition, the order directs the Secretary of HHS and the Secretary of Agriculture to work in coordination with the Federal Communications Commission to develop a strategy for improving the physical and communications infrastructure in rural America.
Report on Policy Initiatives to Increase Rural Access to Healthcare
The order calls for a report within the next 30 days on the following existing and upcoming policy initiatives to: increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals, prevent disease and mortality by developing rural specific efforts to drive improved health outcomes, reduce maternal mortality and morbidity, and improve mental health in rural communities.
Expanding Telehealth Flexibilities to Rural Healthcare Providers
The order also addresses expanding telehealth flexibilities and services, reporting, staffing, and supervision flexibilities to rural health care providers beyond the public health emergency. The order directs the Secretary of HHS to propose a regulation to extend these measures beyond the public health emergency within 60 days of the order.