Bill Overview
Title: Telehealth Extension and Evaluation Act
Description: and Evaluation Act This bill expands and otherwise modifies coverage of telehealth services under Medicare until two years after the end of the COVID-19 public health emergency. Specifically, the bill (1) allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner), (2) allows for Medicare payment of certain audio-only services and of outpatient critical access hospital services consisting of telehealth behavioral therapy, (3) conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding 12-month period, and (4) allows Schedule II through V controlled substances to be prescribed online if a practitioner has conducted a telehealth evaluation with video. The bill also generally extends any Medicare telehealth flexibilities that were granted during the COVID-19 public health emergency until two years after the emergency ends. The Centers for Medicare & Medicaid Services (CMS) must report on the effects of changes that were made during the emergency period with respect to the provision or availability of telehealth services under Medicare. The CMS must also award grants to state Medicaid programs to allow them to report on similar information.
Sponsors: Rep. Axne, Cynthia [D-IA-3]
Target Audience
Population: People who use or provide Medicare-supported telehealth services
Estimated Size: 64000000
- Medicare beneficiaries are directly impacted since the bill modifies their telehealth service coverage.
- During the COVID-19 public health emergency, telehealth services became more accessible and widely used among elderly and disabled populations who are typically enrolled in Medicare.
- Telehealth services are utilized by all demographics, but older adults and those living in rural areas might see the most substantial impact due to typically greater dependency on Medicare and less access to in-person services.
- The bill directly impacts healthcare providers who operate in federally qualified health centers and rural health clinics by allowing them to serve as distant sites for telehealth services.
- Healthcare providers dealing with behavioral therapy, controlled substances, and specific laboratory and equipment providers will experience changes in service delivery protocols.
Reasoning
- We focus on simulating interviews with Medicare beneficiaries as the policy directly impacts their access to telehealth services. Primarily elderly or disabled individuals are targeted since these demographics use Medicare extensively.
- We select a few healthcare providers (e.g., nurses or doctors) working in federally qualified health centers and rural clinics, as they will experience changes in operational protocols due to the policy.
- Several individuals belong to rural areas where telehealth services are a crucial alternative to in-person healthcare.
- We include a mixture of genders, occupations, and locations to reflect a diverse range of perspectives, highlighting varying impacts on key demographics relevant to telehealth services.
- We aim for a realistic distribution by including some individuals who are unlikely to experience significant changes in wellbeing due to the policy, such as younger, urban dwellers who might not rely substantially on Medicare or telehealth services.
Simulated Interviews
retired teacher (rural Montana)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 12/20
Statement of Opinion:
- I'm glad to hear this policy is extending telehealth services. Traveling long distances is hard for me, and telehealth has been a blessing.
- I hope audio-only services continue; video connections aren't always stable here.
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 | 5 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
retired engineer (urban Illinois)
Age: 84 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- The telehealth extension is crucial for me and many others. Visiting clinics in-person is very exhausting.
- I think paying for audio-only services is necessary since some older folks like me sometimes have trouble using video calls.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 4 | 3 |
primary care physician (suburban Texas)
Age: 60 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 3/20
Statement of Opinion:
- This policy is a game changer for patients in rural areas. It allows us to keep providing care and makes our operations smoother.
- Telehealth should be a standard part of our healthcare system going forward, especially for remote communities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
retired miner (rural Kentucky)
Age: 68 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 4.0 years
Commonness: 8/20
Statement of Opinion:
- Expanding telehealth allows me to manage my health better without making long trips to the city.
- The audio-only option is a lifeline; I don't own a smartphone or computer.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 2 |
part-time driver (urban California)
Age: 42 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 15/20
Statement of Opinion:
- The policy doesn't really affect me directly since I'm not on Medicare.
- Telehealth is convenient but I mostly visit doctors in person.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 7 |
retired (rural Alabama)
Age: 75 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 3.0 years
Commonness: 11/20
Statement of Opinion:
- Being able to have check-ins with my doctors from home is crucial given my condition.
- Hopefully, this coverage continues permanently, it saves a lot of time and health risks.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 4 | 2 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 2 |
retired architect (urban New York)
Age: 66 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 6/20
Statement of Opinion:
- Telehealth has given me more control over my health. I appreciate the convenience; it’s definitely a necessity for urban dwellers too.
- I hope the data collected leads to further improvements in healthcare delivery.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
nurse (rural West Virginia)
Age: 50 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- The policy directly impacts how I provide care via telehealth services.
- Our patients struggle with transport, and this policy makes it easier for them to receive therapy from home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
IT consultant (suburban Florida)
Age: 58 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 13/20
Statement of Opinion:
- The policy is important for medical institutions, but not directly relevant to my personal life.
- Professionally, it might increase demand for telehealth support services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
freelance journalist (rural Nevada)
Age: 32 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 4/20
Statement of Opinion:
- This policy offers ample material for my reporting on healthcare accessibility.
- It holds significant importance for older, rural populations but it's not something I would need personally.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Cost Estimates
Year 1: $250000000 (Low: $200000000, High: $300000000)
Year 2: $255000000 (Low: $205000000, High: $305000000)
Year 3: $262500000 (Low: $212500000, High: $312500000)
Year 5: $275000000 (Low: $225000000, High: $325000000)
Year 10: $290000000 (Low: $240000000, High: $340000000)
Year 100: $350000000 (Low: $290000000, High: $410000000)
Key Considerations
- The target population includes approximately 64 million Medicare beneficiaries who are directly affected by the extension and modification of telehealth services.
- Healthcare providers in rural and federally qualified health centers are significantly impacted as the bill allows them to serve as the distant site for telehealth services, potentially increasing their service offerings and census.
- Uncertainty regarding the continuation of telehealth utilization levels seen during the pandemic could affect future cost estimates.
- Changes to the handling and prescribing of controlled substances through telehealth might have implications for regulatory and enforcement efforts.
- Reports from the CMS and state Medicaid programs on telehealth impacts could provide useful data for ongoing adjustments to policy and budgeting.