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 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: Sen. Cortez Masto, Catherine [D-NV]
Target Audience
Population: Medicare beneficiaries worldwide, particularly in the U.S.
Estimated Size: 60000000
- Telehealth services impact people who rely on Medicare, which includes elderly individuals over the age of 65, and younger individuals with disabilities.
- Medicare enrollees in rural areas are included since federally qualified health centers and rural clinics are covered as distant sites for telehealth.
- Patients requiring behavioral therapy are specifically affected as the bill allows telehealth payment for behavioral therapy via critical access hospitals.
- Since the bill extends Medicare telehealth flexibilities granted during the COVID-19 emergency, all Medicare beneficiaries who used these services during the pandemic are impacted.
- The coverage of high-cost laboratory tests and durable medical equipment via telehealth impacts those patients needing these services, given the requirement for an in-person visit.
- Prescription of Schedule II through V controlled substances via telehealth will affect patients needing these medications, contingent on video evaluations.
Reasoning
- The policy primarily affects Medicare beneficiaries, who consist mostly of elderly individuals aged 65 and above, as well as younger individuals with disabilities.
- Residing in rural areas makes individuals more likely to benefit from this policy due to the expansion of telehealth to federally qualified health centers and rural clinics.
- People needing behavioral therapy are significantly impacted since telehealth payments for these services become available to more critical access hospitals.
- There's a sizable impact on those who previously took advantage of telehealth flexibilities during the COVID-19 pandemic, as these are extended by the policy.
- However, the policy may have little to no impact on Medicare beneficiaries who do not use telehealth or are indifferent to the shift from in-person visits to telehealth.
- The target population for high-cost lab tests and durable medical equipment is smaller due to the prerequisite of an in-person visit.
- The prescription of controlled substances through telehealth will particularly affect those requiring such medications, although total impact size is moderate due to specific eligibility conditions.
Simulated Interviews
retired (rural Alabama)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I loved using telehealth during the pandemic because it meant I didn't have to travel far for my appointments.
- The extension of telehealth means I don't have to worry as much about seeing my doctor, especially with my mobility issues.
- However, I am concerned about maintaining a quality connection for my appointments given my rural internet service.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 5 |
| Year 2 | 8 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
retired (urban New York)
Age: 82 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 8/20
Statement of Opinion:
- I find telehealth convenient, especially for my therapy sessions that are frequent.
- The policy seems to really help keep these services covered, which gives me peace of mind.
- However, nothing compares to the reassurance of seeing a doctor in person when something is serious.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 4 |
| Year 2 | 7 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
disabled, not working (rural Kansas)
Age: 55 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 2.0 years
Commonness: 4/20
Statement of Opinion:
- Getting my equipment has always been hard, and sometimes telehealth makes it easier.
- I worry about the requirement for an in-person visit because I have transportation challenges.
- The policy is helpful but could be broader to reduce the need for physical visits where possible.
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 | 3 | 2 |
| Year 20 | 3 | 2 |
retired (suburban California)
Age: 66 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 7/20
Statement of Opinion:
- This doesn't change much for me since I'm used to in-person visits.
- I suppose more options are better for others, but I'm indifferent to this policy.
- I might try a video appointment if I can't drive, but I prefer face-to-face.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 6 | 6 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
disabled military veteran (urban Chicago)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 6/20
Statement of Opinion:
- I rely on my meds, which I can now get via telehealth without risking exposure at the doctor’s office.
- It's a relief during flu season, although some tests need me to show up physically.
- This policy significantly helps, especially for managing my mental health remotely.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 5 |
| Year 2 | 8 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
part-time librarian (rural Oregon)
Age: 69 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- Telehealth saves me a trip into town, which is quite a hassle for me.
- I'm grateful for the continued flexibility, especially since my local clinic provides these services.
- The policy supports small communities like mine greatly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 4 |
| Year 2 | 8 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 2 |
| Year 20 | 4 | 2 |
retired financial analyst (urban Florida)
Age: 74 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 1.0 years
Commonness: 9/20
Statement of Opinion:
- I prefer visiting the hospital to see my doctor in person.
- Telehealth continuation is more beneficial for others, maybe those in rural areas or who can't drive.
- Unless my health greatly changes, I wouldn't use it much.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 6 | 6 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
retired teacher (rural Mississippi)
Age: 60 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 5/20
Statement of Opinion:
- The extension makes accessing my therapist easier.
- I believe more people in rural areas should know about and use telehealth.
- The policy makes life easier for me, but I worry about internet reliability.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 2 |
semi-retired consultant (suburban Connecticut)
Age: 62 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 6/20
Statement of Opinion:
- Telehealth was crucial during the pandemic, but the extensions help me keep in touch with my doctors more easily now.
- I appreciate the convenience, especially for routine checkups.
- It doesn't change everything, but enough to make life easier and less stressful.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
retired (remote Alaska)
Age: 68 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- I heavily depend on telehealth due to living in a remote area.
- This policy continuation is a relief and keeps me connected to medical services.
- The service quality can vary, but the benefits outweigh the hassles.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 3 |
| Year 2 | 7 | 3 |
| Year 3 | 6 | 2 |
| Year 5 | 6 | 2 |
| Year 10 | 5 | 2 |
| Year 20 | 4 | 2 |
Cost Estimates
Year 1: $1500000000 (Low: $1200000000, High: $1800000000)
Year 2: $1500000000 (Low: $1200000000, High: $1800000000)
Year 3: $0 (Low: $0, High: $0)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Telehealth infrastructure and service coverage are crucial to maintain access and ensure healthcare equity.
- Cost savings from decreased incurment of in-person visit costs must be balanced against increased administrative and technological costs.
- Monitoring the impacts on Medicare payouts and evaluating cost-effectiveness over time is necessary to assess telehealth continuation.
- Medication adherence and compliance issues should be tracked due to expanded prescription telehealth services.