Congressional Momentum Builds for Telehealth Expansion

March 31, 2022

Michelle Winokur, DrPH, and the AfPA Governmental Affairs Team, Alliance for Patient Access (AfPA)

Legislation to expand access to telehealth services is likely to pass Congress this year, but what exactly will it entail? Policymakers agree they need to extend the waivers that made the rapid expansion of telehealth during the pandemic possible. They remain divided, however, about the duration of those waivers.

The Telehealth Extension and Evaluation Act, for example, calls for only a two-year extension of all waivers. (1) This waiver would allow time for a study of telehealth service delivery that gives policymakers more information before making telehealth permanent. If this is the chosen path, maternal health advocates hope policymakers take a closer look at expanding the scope of permitted and reimbursed telehealth services. (2) Doula support, prenatal risk assessment, postpartum depression screening, and childbirth education are critical services that could be provided remotely but are not uniformly covered under current rules.

In contrast, the Telehealth Extension Act would permanently remove certain site-based and geographic restrictions that limit where patients can receive services. (3) The bill’s sponsors say there is already broad support to eliminate them. Research has found that the loosening of these restrictions during the pandemic has improved access to care and attendance at prenatal appointments, especially for an expectant mom who lives in rural communities or who needs frequent yet routine monitoring.

A Patient-Centered Approach

The bills include some other differences, but regardless of which one ends up moving forward, policymakers need to approach the issue from a patient-centered perspective. Telehealth is a valuable complement to in-person care, not a substitute for it. With this goal in mind, the ideal telehealth policy would:

Create payment parity, so providers get paid the same whether they see patients in-person or via telehealth
Ensure policies do not limit the ability to get in-person care
Allow providers to see patients across state lines, which reduces patients’ travel burden
Ensure “low-tech” audio-only visits are allowable and paid at the same rate as an appointment with an audio and video connection
Support the infrastructure necessary to get more Americans access to the broadband internet that allows “high-tech” tele-health visits.

Expanding Access to Broadband

This last issue – addressing access to high-speed internet – has long been a problem, but the pandemic laid bare how America’s digital divide affects access to equitable health care.

Nearly a quarter of Americans still do not have high-speed internet at home, though there are movements afoot for insurers to pay for broadband access. (4,5) In addition, certain state Medicaid programs are promoting the Affordable Connectivity Program to those they serve. It provides $30 internet subsidies for the poorest households, plus a $100 one-time credit for a connected device.

While the Biden administration is pushing for expanded broadband connections, it is also pledged to take a closer look at the effectiveness of telehealth in serving all Americans. (6) The White House Office of Science and Technology Policy launched a series of roundtable discussions examining which pandemic-driven tele-health innovations are worth keeping and which might reinforce existing disparities in healthcare access.

There are still many questions about the long-term role of telehealth. However, momentum for expanded telehealth services is building. If done correctly, policy changes should bode well for Americans’ maternal health and postpartum care.