Critical Access Hospitals Not Included in Congressional Telemedicine Expansion

Critical access hospitals are warning they will no longer be able to bill Medicare for telehealth services when the public health emergency ends after they were excluded from a public spending bill the US House of Representatives passed on Wednesday.

The $1.5 trillion package will extend Medicare telemedicine coverage for five months after the end of the public health emergency for several types of providers, but not for critical access hospitals that primarily serve rural areas.

It’s not yet clear why CAH hasn’t been included, but supporters say they’re going to fight to have the issue resolved before PHE ends, which could happen as early as July.

Federal medical centers, rural health clinics, physical and occupational therapists, hospices and other Medicare providers have been included in the telemedicine expansion.

“In our view, removing CAH from legislation would be disproportionately damaging to rural health,” said Josh Jorgensen, director of government relations and policy for the National Rural Health Association. “Politicians widely acknowledge that telehealth is good and they want it to grow, which is why it was included in this package. But, unfortunately, we do not take into account the type of supplier, and this will lead to a service interruption.”

The Centers for Medicare and Medicaid services identify some rural hospitals as critical. These providers receive cost-based reimbursement to help them stay financially viable and are usually more than 35 miles away from another hospital.

CAHs have been using telemedicine to communicate with patients since 2020, when CMS started temporarily allowing it. This has been especially helpful in promoting behavioral health in their communities, Jorgensen says.

When Congress passed the COVID-19 Response Bill in early 2020, it gave the HHS Secretary the power to lift restrictions on Medicare telemedicine during a public health emergency. This legislation also does not cover critical access hospitals, but CMS has been able to temporarily pay for emergency telemedicine services for them through the Hospitals Without Walls program, which expires at the end of PHE.

If PHE ends in July, as many expect, “it means the ability of critical access hospitals to provide telemedicine will come to an end,” Jorgensen said.

The issue has attracted attention on Capitol Hill.

Several bills, including one introduced by Senators Joe Manchin (DW.V.), Joni Ernst (R-Iowa), Jeanne Shaheen (DN.H.), and Jerry Moran (R-Kan.), would permanently allow Medicare to cover telemedicine services at the CSC.

“The telehealth provisions included in the omnibus are a step in the right direction, and I am delighted that many of the provisions that I advocated are included,” Manchin said in a statement to Modern Healthcare. “As we move forward, I will continue to advocate for telemedicine needs in rural areas, including critical access hospitals, to ensure that all West Virginians have access to the quality, affordable health care they deserve.”

Representatives of the House Ways and Means Committee and the Senate Finance Committee, which have jurisdiction over the bill, did not respond to a request for comment.

Congress extended telemedicine flexibilities by another five months to give providers more time to collect cost and usage data. Many legislators hoped for a permanent expansion of telehealth policy, including one that would allow Medicare recipients to access services from home. Congress may consider CAH telemedicine payment issues in future legislation.