Telehealth was first established as a Medicare service in 2002, limited to Medicare beneficiaries who were in rural and Health Professional Shortage Areas (HPSAs). The rationale at the time to limit Medicare coverage of telehealth to rural areas was that this population would benefit most from having the flexibility to have a video chat with their doctors, while limiting the risk of unnecessary use or over-utilization of telehealth. This was of course before the advent of the iPhone, and before the development of many of the digital health technologies that HIMSS member companies create. For over a decade — especially after smartphones were introduced and transformed how people could communicate — the practice of what Medicare reimburses for telehealth has been incredibly outdated.
While there have been many attempts over the years to modernize Medicare’s reimbursement of telehealth, there was often limited success to show for it. Previous attempts at modernizing Medicare telehealth through legislation had always been through piecemeal improvements.
In 2014, a small group of key stakeholders, including HIMSS, came together with an idea of creating a comprehensive bill that would fundamentally rewrite the Medicare telehealth regulations and laws and help bring Medicare into the 21st century. That bill would become the CONNECT (Creating Opportunities Now for Necessary and Effective Care Technologies) for Health Act, led by Senator Schatz (HI), and was the first comprehensive attempt to update Medicare telehealth coverage on Capitol Hill.
The bill was first introduced in 2016, and it has been re-introduced in each successive Congress. Every time the CONNECT for Health Act has been updated and re-introduced, HIMSS has been one of the few organizations that have directly helped with the revisions.
The most recent version was re-introduced in 2019, led by Senators Schatz, Wicker, Cardin, Thune, Warner, and Hyde-Smith, and Representatives Thompson, Welch, Johnson, Schweikert, and Matsui. These Members of Congress have been the key telehealth champions on Capitol Hill and have led efforts on the CONNECT for Health Act since it was first introduced. While at this time, Congress has yet the pass the bill, it has increasingly gained wide-spread support every time it’s been introduced.
Despite Congress’s failure to pass the CONNECT for Health Act, since 2017 there have really been two bills passed that have updated Medicare coverage of telehealth.
The CHRONIC Care Act, which was signed into law as part of the Bipartisan Budget Act of 2018, included some key telehealth changes for a few specific uses. The CHRONIC Care Act, contained four sections of the second iteration of the CONNECT for Health Act, focused on telestroke, telehealth delivered by Medicare Advantage and Accountable Care Organizations, and telehealth for patients with end stage renal disease. HIMSS was instrumental in drafting those provisions in the CONNECT for Health Act that were ultimately signed into law.
H.R.6, the SUPPORT for Patients and Communities Act, was the legislation aimed at stemming the growing opioids pandemic. The comprehensive package also included expanded access to Medicare telehealth for beneficiaries being treated for a substance use disorder or co-occurring mental health issue by opening the home as an eligible originating site for those beneficiaries.
Whenever Congress has talked about telehealth policy in any substantive manner, HIMSS has been among the organizations championing those conversations, helping congressional offices with their priorities and messaging. HIMSS works closely with other stakeholders on pushing these efforts forward, but as a large organization with a vast network, HIMSS has been able to leveraging the membership, the HIMSS staff and subject matter experts and the global conference to advocate for telehealth.
HIMSS’s ability to educate members of Congress over the last 5-plus years has been critical. One of the biggest roadblocks on Capitol Hill has really been a lack of understanding. For example, there continues to be a knowledge gap around what specifically is covered for telehealth under Medicare through the statutes and regulations. Members of Congress often haven’t realized how limited and narrow telehealth coverage is. Over the past five years, one of HIMSS’s top legislative priorities has been educating members and their staff on what the key issues are, what the current regulatory environment is, and why it needs to change.
HIMSS sends letters, has endorsed legislation, and has always focused on evidence-based uses of telehealth.
Another provision borrowed from the CONNECT for Health Act that was signed into law in March 2020 as part of the CARES Act gave the HHS Secretary the authority to waive all telehealth restrictions during a public health emergency. This provision essentially made telehealth during the global pandemic accessible to every Medicare beneficiary outside of a rural area. That waiver authority was among the original asks HIMSS and PCHAlliance submitted in comments for the latest version of the CONNECT for Health Act in April 2019. HIMSS specifically said the Secretary needed to have waiver authority during a natural disaster or public health emergency in order to connect healthcare providers with patients needing immediate access to care under unique circumstances.. That provision was ultimately included in the CONNECT for Health Act, and when Congress passed their first COVID-19 relief bill, they plucked out a section from the CONNECT for Health Act, and narrowed it specifically to the COVID-19 pandemic.
Whether it’s the Davies program or any of the work that PCHAlliance has done, such as the Continua Design Guidelines, HIMSS has been on the forefront of digital health, telehealth and remote patient monitoring for close to two decades. These tools have been leveraged across the world, both pre-pandemic and now amidst the pandemic.
HIMSS’s thought leadership isn’t necessarily limited to policy advocacy; HIMSS is elevating the role that telehealth, remote patient monitoring and all virtual care services play in healthcare delivery. HIMSS is highlighting the research its members are doing around the world in telehealth interventions, remote patient monitoring interventions and research. It’s all tied together. HIMSS is working to create a regulatory environment that supports innovation and protects patient safety while taking advantage of a modern 21st-century digital healthcare system that Congress, the government, and the healthcare community at large have been driving forward over the past 20 years.
The HIMSS policy team works closely with the U.S. Congress, federal decision makers, state legislatures and governments, and other organizations to recommend policy, and legislative and regulatory solutions to improve health through information and technology.