This new momentum was driven by Americans' quick acceptance of remote care during lockdowns, cementing a permanent role in what had been a niche sector. The Senate bill, S.1512 (117), which would permanently enshrine many aspects of Trump Medicare coverage as well as payment rules, has attracted 59 cosponsors. Private insurers have begun to expand or offer virtual visits.Schatz stated that they have moved beyond the point where talking about telehealth would cause someone's eyes to glaze over. Their heads nod vigorously as I talk about telehealth.Skeptics warn that telehealth's rapid expansion could lead to a surge in health spending. The Congressional Budget Office has long opposed plans to increase payments for the technology. They fear the financial burden it might place on payers. MedPAC, the Medicare advisory committee, recommended a cautious approach. This would cover some telehealth services temporarily for all beneficiaries. However, it would revert back to lower reimbursement rates for virtual appointments post-crisis. A rapid expansion of telehealth services could lead to more fraudulent billings. The HHS Office of Inspector General estimated $4.5 billion in telehealth-related fraud in the last year.Last month, Government Accountability Office officials from the health department warned the Senate Finance Committee of possible fraud and higher spending. They also said that it was unclear how the policy extension would impact quality of care. Last year, the Congressional Budget Office found that a plan to remove Medicare's geographic restrictions on mental health care via telehealth would increase spending by $1.65 billion between 2021-2030.CBO last year found that H.R. 5201 (116) would remove Medicare's geographic restrictions on mental health care via Telehealth. This would increase spending by $1.65 billion between 2021-2030.Tom Leary, senior vice-president of government relations at the Healthcare Information and Management Systems Society, said that we are still fighting with [congressional scorekeepers]. The biggest problem is possible overutilization.The Schatz plan would eliminate all restrictions on telehealth based on location for Medicare beneficiaries, allow patients to initiate care from home, and allow rural health clinics and centers that provide care to underserved communities to use telehealth permanent. Prior to the pandemic, Medicare did not cover telehealth beyond certain rural areas. Patients had to travel to qualified health care facilities in order to get telehealth services.It would allow the Secretary for Health and Human Services, to permanently lift telehealth restrictions and require a study of telehealth usage during and after the Covid-19 pandemic. HHS Secretary Xavier Becerra supports lifting the restrictions.Over half of the states have lifted telehealth restrictions this year. Others are considering legislation to increase access. Congress has also introduced several other proposals regarding telehealth.Advocates claim the legislation will be a win in patient access and medical care. They also point to the support of many provider groups, such as the American Medical Association.It avoids what we refer to as the telehealth-cliff," said Kyle Zebley (director of public policy, American Telemedicine Association). If Congress fails to act, and the public emergency in health is declared over within the near future, then all these regulatory flexibilities that made telehealth available to all Medicare beneficiaries will end.To avoid any rollback in access, backers of the legislation believe they will write at most an extension of telehealth flexibilities into legislation this year. HHS informed governors in a letter that the public emergency declaration lifting restrictions on telehealth will likely continue through 2021.Schatz plans to attach Schatz's legislation to a must pass bill. This could include a year end spending agreement. In the event that that fails, legislators could seek a temporary extension to allow them more time to gather data about virtual care as a result of the pandemic. This would be in line with MedPAC's recommendations which call for a one or two-year extension once the public health emergency is over.Sen. Ron Wyden, D-Ore., and Lloyd Doggett, D-Texas, House Ways and Means chair (both Democrats) are two of the influential lawmakers who haven’t signed on. Their tax-writing panels have authority over Medicare. Doggett, who has expressed concern over a permanent scale for telehealth before more research is done, said that he would introduce legislation to allow waivers for telehealth data collection.Telehealth advocates argue that there is already sufficient data to show that there are fewer appointments missed and that certain virtual services are just as effective as in-person care.Sarah-Lloyd Stevenson, Faegre Drinker, stated that Congress will always request more data. Even if we extend for two years, I fear they will continue to ask for more data.
