House committee advances bill extending telehealth, HaH flexibilities

May 09, 2024 - The United States House Ways and Means Committee has advanced several new pieces of legislation, including one extending pandemic-era telehealth flexibilities through 2026.

Called the Preserving Telehealth, Hospital, and Ambulance Access Act, the legislation would not only preserve Medicare beneficiaries’ access to telehealth through December 31, 2026, but also extend the Acute Hospital Care at Home (AHCAH) waiver through 2029. However, if the bill does not pass through Congress, the telehealth flexibilities and AHCAH waiver will expire at the end of 2024.

The bill preserves several pandemic-era waivers, including ones that eliminate geographic requirements and expand originating sites for telehealth services, allow more healthcare practitioners to provide telehealth services, enable rural health centers and federally qualified health centers (FQHCs) to offer telehealth services, delay prior in-person exam requirements for telemental healthcare services, and allow coverage of audio-only telehealth under the Medicare program.

Additionally, the bill extends the AHCAH waiver, which allows hospitals to forgo certain Medicare Hospital Conditions of Participation, enabling them to provide inpatient-level care to Medicare beneficiaries in their homes. As of May 6, 327 hospitals across 37 states had been approved for the waiver.

“Only a few short years ago, these possibilities seemed unthinkable but are now revolutionizing care for seniors on Medicare and those living in rural areas,” said Ways and Means Committee Chairman Rep. Jason Smith (MO-08) in his opening statement at the mark-up session. “Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home starting at the end of this year.”

Though disappointed that making the telehealth flexibilities and ACHAH waiver permanent appears to be off the table, telehealth advocates praised the committee’s move.

“While we prefer Medicare telehealth flexibilities be made permanent, we understand the dynamics and applaud the committee for a two-year extension of many of the critical flexibilities without arbitrary and unnecessary guardrails such as in-person requirements,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association (ATA) and executive director of ATA Action, the association’s advocacy arm.

The committee markup moves the bill to the next step, advancing it to the floor of the House.  

Telehealth Access for America Executive Director Alye Mlinar noted, “Patients, especially seniors, are counting on Congress to pass an extension of critical flexibilities that provides enough long-term certainty to avoid disruptions that would negatively impact health outcomes and without burdensome restrictions that would undermine the value of virtual care.”

Notably, the bill does not mention the waiver that eases restrictions on the virtual prescribing of controlled substances. After the onset of the COVID-19 pandemic, the Drug Enforcement Administration (DEA) waived the requirement for healthcare practitioners to conduct an in-person medical evaluation before prescribing controlled substances through telehealth. Last October, following thousands of comments and passionate pleas at a listening session, the DEA extended the waiver through December 31, 2024.

In his emailed statement, ATA’s Zebley noted that if this waiver is not extended alongside the others, it “would lead to a tremendous gap in care.”

The committee markup follows ATA Nexus, the ATA’s annual conference, where virtual care stakeholders gathered to discuss the future of telehealth. Telehealth and hospital-at-home regulatory flexibilities are critical to the industry’s plans for the future, which include a focus on digital health tool evaluations, integrating artificial intelligence into virtual care responsibly, and removing barriers to cross-state telehealth.