Congress mulls Medicare’s COVID-19-accelerated telehealth allowances

Medicare’s temporary, COVID-19-induced telehealth allowances could become permanent with Congress eyeing actions to reverse certain limitations, piquing the AOA’s attentiveness that such expansion bolsters—not precludes—an established doctor-patient relationship.

Currently under consideration by the U.S. House Energy and Commerce, and Ways and Means committees, H.R. 366, the Protecting Access to Post-COVID-19 Telehealth Act, is just one of several telehealth expansion bills before Congress that seek to permanently expand Medicare requirements for the furnishing of telehealth services. Such legislation is gaining popular momentum considering over 10 million Medicare beneficiaries utilized telehealth visits by the end of July 2020 and Americans’ familiarity with the technology is at an all-time high.

“Early data shows that telehealth utilization has skyrocketed not only in the Medicare program but also in Medicaid and private insurance plans,” noted House Energy and Commerce Chair Rep. Frank Pallone, Jr., D-N.J., in a March 2 subcommittee hearing on telehealth expansion. “Unlike Medicare, private insurance plans and Medicaid do not have the same statutory restrictions on telehealth, such as rural and ongoing site requirements.

“We have a unique opportunity to use the lessons learned from this pandemic and translate them into legislation that ensures that these critical telehealth tools are used appropriately to advance health equity and improve quality of care for all Americans.”

In March 2020, the Centers for Medicare & Medicaid Services (CMS) invoked its 1135 waiver authority with the evolving COVID-19 public health emergency to temporarily suspend Medicare’s geographic requirements for telehealth usage and issued new guidance for how these visits would be furnished and paid. Concurrently, the AOA helped translate this new direction into actionable information that many optometry practices adopted. In fact, as many as 46% of doctors of optometry elected to provide clinical patient care via telehealth at the height of pandemic restrictions with a quarter of doctors continuing to do so as 2020 drew to a close.

Now, as COVID-19 cases trend downward and restrictions loosen state by state, proposed telehealth legislation seeks to concretize these temporary allowances set to expire once the public health emergency ends. Such is the case, H.R. 366 has come to the forefront of Congressional discussions with provisions that include: 

• Eliminating most geographic and originating site restrictions on the use of telehealth in Medicare and establishing the patient’s home as an eligible site.
• Authorizing the CMS to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency.
• Make permanent the disaster waiver authority, enabling the Department of Health and Human Services (HHS) to expand telehealth in Medicare during all future emergencies and disasters.
• Requiring a study on telehealth usage during COVID-19, including costs, uptake rates, measurable health outcomes, and racial and geographic disparities.

As Congress actively considers its next move regarding a Medicare telehealth expansion, the AOA continues to emphasize that certain safeguards are necessary to ensuring patients’ eye health and vision care needs are sufficiently addressed, in addition to reiterating that remote care cannot supplant the necessity for in-person, comprehensive care.

Such is the case, the AOA remains concerned that a permanent telehealth expansion without appropriate direction might unnecessarily jeopardize the availability of in-person, primary eye care services offered at health centers, in addition to opening the door on telehealth apps attempting to capitalize on unsuspecting seniors.

AOA’s position reiterates supportive role for telehealth

In 2020, the AOA’s Telehealth Council developed a new AOA position statement on telehealth with input from leaders and innovators within the eye care industry that reaffirmed the in-person, comprehensive eye examination as optometry’s “gold standard” of care, yet acknowledged the evolving role of technology as it pertains to patient access.

“The AOA supports the appropriate use of telemedicine in optometry to access high-value, high-quality eye health and vision care,” the 2020 statement reads. “Telemedicine in optometry can serve to expand patient access to care, improve coordination of care, and enhance communication among all health care practitioners involved in the care of a patient. The AOA supports coverage of and fair and equitable reimbursement for telemedicine in optometry.”

Additionally, the statement emphasizes that one standard of care must remain constant regardless of whether services are provided in person or remotely; telemedicine is appropriate to bolster doctors’ decision-making; and direct-to-patient eye or vision apps do not constitute telemedicine and cannot replace or replicate a comprehensive eye exam provided by a doctor, based on current technologies.

Importantly, the AOA believes a fundamental doctor-patient relationship must be established and maintained, while “physicians must act as advocates on behalf of the patient and are obligated to discuss necessary and appropriate treatment alternatives, and in good faith to fully inform he patient of all treatment options.”

Keep reading about the intersection of optometry and telemedicine, post-COVID-19, in the March/April 2021 issue of AOA Focus.

Join optometry’s advocates for Virtual AOA on Capitol Hill, May 23-25

As Congress mulls important legislation dealing with the COVID-19 public health emergency and other health care issues, now is the time for the profession to take a stand in support of the AOA’s federal advocacy.

Virtual AOA on Capitol Hill, May 23-25, is a remarkable opportunity for advocacy-minded doctors, optometry students and paraoptometrics to voice the profession’s priorities and leave a lasting impression on members of Congress. The AOA’s single-largest annual advocacy event and centerpiece of optometry’s federal advocacy efforts, Virtual AOA on Capitol Hill returns in a virtual format for 2021 with new priority issues that immediately affect optometry practices, their current viability and future prosperity.

What:  Virtual AOA on Capitol Hill
When: Sunday, May 23, through Tuesday, May 25 (online sessions at various times)

For more information about Virtual AOA on Capitol Hill, agenda questions or the issues, email advocacy@aoa.org or call 800.365.2219. Please note: Virtual meetings with members of Congress are pre-arranged and coordinated through state associations.