On Jan. 31, the Alexandria, Va.-based AMGA (American Medical Group Association) posted the following press release to its website:
“Alexandria, VA—AMGA recommends Congress permanently extend the current telehealth flexibilities and ensure continued payment parity of telehealth services. The recommendations were submitted yesterday in response to a request for information (RFI) from the Congressional Telehealth Caucus to update the CONNECT for Health Act of 2021 (CONNECT Act) for the 118th Congress. AMGA also recommends the continuation of payment parity of audio-only services and removing state licensing restrictions for telehealth services. ‘AMGA appreciates Congress' willingness to extend telehealth flexibilities with the Medicare program until the end of 2024 through the passage of the Consolidated Appropriations Act of 2023,’ said Jerry Penso, M.D., MBA, AMGA president and CEO. ‘To ensure that patients have access to their providers where they want it and how they want it. We urge Congress to permanently codify the current telehealth flexibilities.’
A recent AMGA telehealth survey confirms the need for permanent telehealth expansion. Ninety-two percent of survey participants stated a reduction in payments would result in decline in telehealth access. ‘During the COVID-19 pandemic, our members dedicated considerable resources to create a telehealth infrastructure that ensured continuity of care and access for their communities,’ Penso said. ‘Providers must have consistent reimbursement to maintain quality and patient access.’
AMGA applauds the Congressional Telehealth Caucus on its release of the CONNECT Act RFI and will continue to advocate for its policy priorities as the bill is developed this Congress. The letter is available on AMGA’s website.”
Meanwhile, the members of the Congressional Telehealth Caucus are as follows:
Co-Chair: Rep. Bill Johnson (R-Oh.) Co-Chair: Rep. David Schweikert (R-Az.) Co-Chair: Rep. Mike Thompson (D-Calif.) Co- Chair: Rep. Doris Matsui (D-Calif.)
Members:
Rep. Jake Auchincloss (D-Mass.)
Rep. Troy Balderson (R-Oh.) Sen. Ben Cardin (D-Md.) Rep. Diana Harshbarger (R-Tenn.) Sen. Peter Welch (D-Vt.) Sen. Cindy Hyde-Smith (R-Miss.) Rep. Bob Latta (R-Oh.) Rep. Kathy Manning (D-N.C.) Rep. Mariannette Miller-Meeks (R-Ia.) Rep. Joe Morelle (D-N.Y.) Sen. Brian Schatz (D-Hi.) Sen. John Thune (R-S.D.) Sen. Mark Warner (D-Va.) Sen. Roger Wicker (R-Miss.)
And this week, Lauren Lattany, director of government relations at AMGA, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland about developments in this area, and the prospects for permanentizing flexibilities created by the Centers for Medicare & Medicaid Services (CMS) during the first months of the COVID-19 pandemic, under the Public Health Emergency (scheduled to end on May 11), and the potential for the permanent extension of payment parity for telehealth-delivered patient care. Below are excerpts from that interview.
With regard to the extension of the flexibilities created at the beginning of the pandemic, where is that process in Congress, at this moment?
Last December, Congress passed the Consolidated Appropriations Act, to keep funding the government, extending the current flexibilities through December 31, 2024.
And the flexibilities that were extended are around originating site and geographic limitation?
Yes, prior to the Public Health Emergency, telehealth-based care could only be paid for if as a patient you lived in a rural area or you went to facility to receive care; with the flexibilities, you can receive care anywhere, and it is authorized for reimbursement. Meanwhile, telehealth as a concept remains extremely popular; some 400 bills were introduced in Congress around telehealth last year. And extending those waivers also allows MedPAC [the Medicare Payment Advisory Commission] to continue tracking the data around telehealth-delivered care and analyzing it.
And the extension of those flexibilities through December 31, 2024, was created in December?
Yes, that’s correct.
What’s the likelihood that those two flexibilities will be permanentized?
It’s a strong possibility, but there’s a cost in the billions of dollars involved. There were a lot of things paid for in the Medicare Improvement Fund last year, so they had a limited pot of money. So it will continue to be extended in limited ways, until they can identify longer-term funding for this. They’re also waiting for MedPAC to make their recommendations. MedPAC might change payment rules. Right now, providers are getting paid at a higher rate for doing these services in their offices, and that ends at the end of this year.
And so, to be clear, right now, telehealth-delivered care paid at the same rate as in-person care, correct?
Yes, it is. They elevated it to account for the fact that you have to pay for your staff, etc., so in-office providers are getting paid the same rates as for care delivered in hospitals.
There has been some discussion in the industry around the idea that not all providers support the permanentization of payment parity. What are your thoughts?
Our members are saying that this is important to them. And the general sentiment is that this would be harmful if the rates were lowered once again. W asked members what the impact would be on the services in the organization, and 92 percent of members surveyed said they would decline access to telehealth. They basically are telling us that there is no difference in costs involved—staff time, prep, in order to engage in these telehealth services.
What is your sense of the overall feeling on the Hill that there will be a permanentization of payment parity?
Members of Congress are waiting to hear back from MedPAC on this. And because they extended most of the waivers until next year gives them some time. So I don’t it’s top of mind right now. They feel they have the time to wait on MedPAC.
AMGA’s members would like the waivers and payment parity permanentized, then? And is that desire pervasive across the industry?
I can’t speak for the entire multiverse of the entire healthcare system; but in general, most are for it. And then there are commercial services that provide telehealth-delivered care. There is a concern that those commercial services might get conflated in the minds of lawmakers with what regular providers do, providing both in-person and telehealth-delivered services; and that’s a determination that MedPAC has to address in their report.
When will the next MedPAC report that might address this, come out?
I believe it will be addressed in their June report, or later this year.
Is there anything else you’d like to add on this subject for now?
We recently submitted our response to the RFI [request for information] to the House and Senate Telehealth Working Group in order to continue to amplify this issue. If an issue like this has to be addressed within two years, you have to keep it moving forward. And we really like the work being done in the Working Group.
