Bill Overview
Title: Advancing Telehealth Beyond COVID–19 Act of 2021
Description: 2022 This bill modifies the extension of certain Medicare telehealth flexibilities after the end of the COVID-19 public health emergency. Specifically, the bill provides that certain flexibilities continue to apply until December 31, 2024, if the emergency period ends before that date. The bill allows beneficiaries to continue to receive telehealth services at any site, regardless of type or location (e.g., the beneficiary's home); occupational therapists, physical therapists, speech-language pathologists, and audiologists to continue to furnish telehealth services; federally qualified health centers and rural health clinics to continue to serve as the distant site (i.e., the location of the health care practitioner); evaluation and management and behavioral health services to continue to be provided via audio-only technology; and hospice physicians and nurse practitioners to continue to complete certain requirements relating to patient recertifications via telehealth. The bill also delays implementation of certain in-person evaluation requirements for mental health telehealth services until January 1, 2025, or the first day after the end of the emergency period, whichever is later.
Sponsors: Rep. Cheney, Liz [R-WY-At Large]
Target Audience
Population: Medicare beneficiaries utilizing telehealth services
Estimated Size: 63000000
- The bill extends telehealth flexibility under Medicare beyond the COVID-19 emergency, affecting people who rely on Medicare for healthcare services.
- Individuals who use telehealth services from occupational therapists, physical therapists, speech-language pathologists, and audiologists will be impacted.
- Patients receiving care from federally qualified health centers and rural health clinics will also be affected due to the continuation of these facilities as distant sites.
- The legislation impacts patients who require behavioral health services via audio-only technology, as these provisions are continued.
- Rural populations could be significantly affected as telehealth access could mitigate the challenge of accessing in-person care.
- Beneficiaries living in remote areas or those who face mobility challenges will benefit from continued telehealth services.
Reasoning
- The policy primarily targets Medicare beneficiaries who rely on telehealth services, and is estimated to affect around 63 million Americans. Those particularly impacted are individuals who have adapted to telehealth during the COVID-19 pandemic, including those living in rural areas, those with mobility issues, and those needing specialized care such as occupational or speech therapy. The extension of telehealth services can greatly influence the self-reported wellbeing of these individuals, as it can improve accessibility to healthcare services.
- Given the budget constraints of $75,000,000 for the first year and $857,000,000 over ten years, the policy must be efficiently implemented to ensure significant impact on the target population. The interviews reflect a range of perspectives, including those who strongly benefit from the policy extension and those who might see minimal change due to already having access to in-person healthcare options.
- By simulating a diverse group of interviews, I considered different demographics including age, health condition, and geographical location to accurately reflect the population distribution. I included individuals whose access to specific health services would be significantly enhanced by telehealth continuation, as well as those who may not experience any considerable change.
Simulated Interviews
Retired farmer (Rural Texas)
Age: 75 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 8/20
Statement of Opinion:
- Telehealth helped me a lot during COVID times; it allowed me not to worry about traveling far for my appointments.
- If the policy continues telehealth, it will be a big help for someone like me living alone and with mobility challenges.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 1 |
Retired teacher (Urban New York)
Age: 80 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- I'm quite accustomed to using telehealth now, the continuation until 2025 makes perfect sense.
- These sessions have been crucial in managing my diabetes and blood pressure without leaving the facility.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
Part-time librarian (Suburban California)
Age: 67 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 9/20
Statement of Opinion:
- I appreciate how telehealth has made accessing mental health services easier for me.
- Removing the travel barrier lets me attend sessions more regularly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 4 |
| Year 5 | 4 | 3 |
| Year 10 | 3 | 2 |
| Year 20 | 3 | 2 |
Retired miner (Rural Arkansas)
Age: 72 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 2.0 years
Commonness: 7/20
Statement of Opinion:
- Telehealth physical therapy was a lifesaver; the continuation is crucial for my recovery.
- I'd otherwise struggle with constant travel to the nearest clinic.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 4 | 2 |
| Year 10 | 3 | 1 |
| Year 20 | 2 | 1 |
Retired nurse (Urban Chicago)
Age: 78 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- While I can visit my doctor easily, telehealth still offers convenience for my routine checks.
- It's nice to have the option without it being absolutely necessary for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Retired mechanic (Remote Idaho)
Age: 69 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 2.0 years
Commonness: 5/20
Statement of Opinion:
- Audio-only telehealth calls are essential since video calls aren't feasible here.
- If the policy keeps this service, it really helps someone living off the grid like me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 4 | 2 |
| Year 10 | 3 | 1 |
| Year 20 | 2 | 1 |
Retired bank employee (Rural Ohio)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 8/20
Statement of Opinion:
- Continuing telehealth means consistent access to hearing tests without needing lengthy drives.
- It's been key to maintaining my quality of life post-COVID.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 1 |
Retired engineer (Suburban Georgia)
Age: 65 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 1.5 years
Commonness: 6/20
Statement of Opinion:
- Telehealth helped maintain low exposure risk post-surgery.
- The policy's continuance reduces the need to travel for routine follow-ups.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
Retired coal miner (Rural Kentucky)
Age: 85 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 7/20
Statement of Opinion:
- Reducing travel for healthcare is crucial due to my physical pain; telehealth plays a big role.
- Continuing this service benefits not just my health but also my finances.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 1 |
Retired accountant (Urban San Francisco)
Age: 74 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- The policy supports broader healthcare access; while I don't use telehealth much, many in my community benefit greatly.
- It's a modern necessity that reflects the times; great for managing mental health.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Cost Estimates
Year 1: $75000000 (Low: $60000000, High: $90000000)
Year 2: $78000000 (Low: $62000000, High: $94000000)
Year 3: $81000000 (Low: $65000000, High: $97000000)
Year 5: $85000000 (Low: $68000000, High: $102000000)
Year 10: $95000000 (Low: $76000000, High: $114000000)
Year 100: $150000000 (Low: $120000000, High: $180000000)
Key Considerations
- Shifting healthcare delivery models might require regulatory and infrastructure investments.
- The transition period after the pandemic requires close monitoring to assess if permanent policy adjustments are necessary.