Author: Will Humble

The COVID-19 pandemic forced the US to rethink how care could be delivered safely and effectively, especially for older and underserved populations. One of the most significant developments was the expanded use of telehealth services within the Medicare program.

As the country shifted to remote care, telehealth became a lifeline for millions of Medicare members. It let people get care without the risks associated with in-person visits, especially for high-risk populations. It also really helped out in rural reals that have weak networks for behavioral health, psychiatric and other critical care.

However, now that the public health emergency is over – the benefits of telehealth for Medicare members is also expiring at the end of 2024 (telehealth was temporarily extended when the PH emergency ended).

In order for Medicare to be able to continue to provide telehealth for certain things Congress will need to act before the end of the year.

The question before congress isn’t just whether telehealth should remain a part of Medicare – but how it can be structured to improve care and ensure long-term sustainability.

The Pandemic’s Lessons:

Improved Access Through Telehealth

The expansion of telehealth during the pandemic showed remarkable improvements in access to care. As documented in a Kaiser Family Foundation report, before the pandemic, Medicare’s telehealth coverage was limited.

Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology. The public health emergency lifted these barriers, enabling all Medicare beneficiaries to use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits.

A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions benefitted the most.

Telehealth made it easier for patients to stay connected with their providers, avoiding travel, and waiting times. Patient and provider satisfaction surveys showed a high level of approval for telehealth, with many beneficiaries preferring virtual visits for routine care.

A Crucial Moment for Telehealth Policy

Before the end of the telehealth extension is here (12/31/24) Congress will need to decide whether to again temporarily extend telehealth or make permanent the telehealth flexibilities enacted during the pandemic.

There’s a current proposal for a two-year extension of these flexibilities, which would provide a temporary solution but falls short of addressing long-term needs.

A two-year extension is better than allowing the COVID-era policies to expire altogether, but it’s only a stopgap.

But… the bipartisan CONNECT for Health Act offers a more comprehensive and forward-looking solution. This bill proposes permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and eliminates in-person visit rules for behavioral health.

Importantly, it also includes critical measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.

The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.

Not all medical issues are suited for telehealth, but many conditions—particularly in behavioral health—benefit greatly from continued virtual access. The CONNECT Act emphasizes this distinction, ensuring that telehealth is used where it can be most effective without undermining the need for in-person care.

The Stakes: What Happens If Congress Fails to Act

If Congress doesn’t at least extend the current Medicare telehealth policies seniors could lose access to a vital service -especially for behavioral health services and in rural areas, erasing the gains in access achieved in the last 4 years.

While a two-year extension would temporarily keep access, it doesn’t provide the certainty needed to build sustainable, long-term solutions for telehealth in Medicare.

A Call to Action

Congress needs to act by December 31 to prevent the rollback of important Medicare telehealth services. While a two-year extension is a start, it really just kicks the can down the road.

Passing the CONNECT for Health Act would ensure that telehealth stays a permanent and sustainable part of the Medicare program.

• What to Know About Medicare Coverage of Telehealth | KFF

• Addressing concerns about permanent telehealth expansion in Medicare – Niskanen Center

• The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019–22 | Health Affairs

• MedPAC Report To Congress

• CONNECT Act