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Telehealth offers many benefits to lung cancer patients, caregivers, and providers, and it can be an integral part of the cancer care experience. Advocating for changes to ensure accessibility of telemedicine is an important area of focus in LUNGevity’s public policy work.
Many patients began utilizing telehealth services as part of their care during the COVID-19 pandemic. While it is now clear that telehealth is here to stay, policymakers will need to take action to ensure that the services valued by patients are available and covered by insurance. In this blog, we answer some frequently asked questions and talk about what’s on the horizon for telehealth policy.
The terms “telehealth” and “telemedicine” are often used interchangeably. Telemedicine refers to the use of technology to deliver clinical care to patients remotely. Telehealth encompasses a broader range of services provided through telecommunications technology, including both clinical and non-clinical services. In this blog we’re going to use “telehealth” to include all the ways that patients can utilize technology in their care.
For many patients living with lung cancer, telehealth is a critical link to care. During the COVID-19 pandemic, remote visits have allowed patients to interact with their providers without the need to travel or visit a clinical site, reducing their potential exposure to the virus. More broadly, there are many ways that telehealth services may benefit patients with lung cancer. For example, telehealth can facilitate remote appointments to receive a second opinion, discuss biomarker test results, follow up on scans, or have regular check-ins with your physician. Having these appointments from the comfort of your home – or a facility that is convenient to access – may help to reduce costs and stress, as well as time away from loved ones and work responsibilities.
Policy impacts the availability of telehealth services in many ways. One of the most significant is through setting requirements for insurance coverage. For example, Congress can pass legislation expanding (or restricting) coverage for telehealth services in Medicare, and these policies are implemented through the Centers for Medicare and Medicaid Services (CMS). Medicaid coverage is subject to federal law to an extent but is largely determined by state governments and can vary considerably from one state to another. Private health insurance coverage for telehealth may be subject to both federal and state laws. Policies at both the state and federal levels can also affect the types of services that can be provided via telehealth, the types of providers who can deliver these services, and what requirements providers must meet to utilize telehealth for patients in their own state as well as patients who live in other states.
The use of telehealth services was already gradually increasing prior to the pandemic. However, there were several restrictions in place that limited the ability of patients to fully take advantage of telehealth. For example, Medicare only paid for telehealth services in limited circumstances based on the location of the patient and type of provider they were seeing, and audio-only appointments were not covered. State licensing requirements also made it difficult for most patients to receive telehealth services from a provider located in another state.
The COVID-19 pandemic dramatically altered the delivery of care and drove a marked increase in telehealth usage. In March of 2020, the Department of Health and Human Services took administrative steps to significantly expand telehealth access in Medicare. Some of the most notable changes, which were made on a temporary basis, include: allowing more locations, including the patient’s home, to serve as the “originating site” (the place where the patient is physically located) for telehealth services; allowing federally qualified health centers and rural health centers to serve as the “distant site” (the place where the provider is physically located); reimbursing for telehealth services by a broader range of providers, including physical therapists and occupational therapists; and covering audio-only visits for physical health-related appointments.
Significantly for many patients, states also temporarily modified licensure requirements for out-of-state providers. This meant that in most cases, a patient living in one state could have a telehealth visit with a provider in another state, without that provider being required to hold a license from the patient’s state of residence – so long as the provider was licensed and in good standing in their own state. State governments also made temporary adjustments to Medicaid coverage policies to allow for more flexibility in the use of telehealth services by beneficiaries.
Most of the key changes to telehealth policy mentioned in this blog are temporary and tied to public health emergencies (PHEs) on the federal or state level. In March of 2022, Congress passed a legislative and funding package that extended Medicare telehealth flexibilities through the end of the federal PHE plus an additional 151 days. Currently, the federal PHE is set to end on October 13, though the Biden Administration has indicated that it will likely be extended into early 2023. There are several bills in Congress that would at least temporarily extend Medicare telehealth flexibilities while further studies are conducted about telehealth utilization and costs. One of these bills, the “Advancing Telehealth Beyond COVID–19 Act of 2021,” passed the House in late July and could be considered by the Senate this fall.
On the state level, many PHEs have already ended or are slated to end in 2022. This means that in many cases, provisions such as those exempting providers from out-of-state licensing requirements have already expired and the pre-pandemic status quo is back in effect. While it is unlikely that cross-state licensure will be implemented on a permanent basis, there are some state bills that would increase flexibility related to licensure overall or for telehealth in particular. Additionally, many states have joined the Interstate Medical Licensure Compact (IMLC), which provides an expedited pathway for physicians to become licensed in additional states.
Legislation to extend telehealth flexibilities in Medicare has strong bipartisan support in Congress and could pass this fall, though it may also be pushed to next year. Meanwhile, many states are considering bills to make long-term changes that will increase patient access to telehealth. For some states that have not already joined the IMLC, legislation to make this happen is expected in 2023.
Stay tuned to the LUNGevity Action Network for more updates and ways that you can contact your policymakers about important telehealth legislation. Be sure to join the Network so that you’ll be the first to receive news and action alerts when they come out!