"While several bills circulating through Congress would extend telehealth benefits more permanently, the House and Senate have yet to reach a consensus agreement about moving forward. In this Alert, [the authors] review the current telehealth flexibilities in place during the [public health emergency], outline the advocacy and policy considerations presently swirling around this service, and explore the various bills in Congress and the likelihood of their being signed into law."

"The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and March 31, 2022.... The data include Medicare Part B Fee-for-Service Claims for services. All data are preliminary."

"HHS-OIG identified 1,714 providers who had 'concerning billing on at least one of seven measures… that may indicate fraud, waste, or abuse of telehealth services' and referred these providers to CMS for further investigation. While this could be read to suggest that billing data for the vast majority of providers has a clean bill of health, the report indicates that HHS-OIG identified only the most significant outliers on each metric."

"The results of this study highlight the convenience of teletherapy, positive experiences patients have and its increase in popularity across generations. The results also confirm ... that most participants (76%) reported being very or extremely satisfied with their most recent telehealth visit. Health insurers and health systems should recognize these positive sentiments and continue to offer and enhance such services."

"Jeremy Nordquist, president of the Nebraska Hospital Association, said Blue Cross and Blue Shield of Nebraska's decision to cut reimbursement for telehealth visits by 50% as of July 1 is a huge concern that could drastically reduce the use of virtual care in the state if other insurers follow suit.... [It's] not clear if any other health insurers plan to follow suit."

"All respondents (100%) provide coverage for tele-behavioral health services. The number of in-network behavioral health providers has grown by an average of 48% in 3 years among commercial health plans. The overwhelming majority of health plans (89%) are actively recruiting mental health care providers ... The number of providers eligible to prescribe Medication Assisted Therapy (MAT) for substance use disorder, including opioid dependence, has more than doubled -- growing 114% over 3 years."

"[T]he movement shifts the concept of off-hours or urgent online visits to that of a virtual yet consistent care team that replaces the traditional in-office primary care relationship....Virtual primary care can treat more than people think.... Virtual primary care reduces unnecessary ER and urgent care visits -- and costs.... Virtual primary care doctors work with in-person providers, too."

"On July 20, 2022, HHS-OIG published a new Special Fraud Alert on arrangements with telemedicine companies, setting forth seven characteristics OIG believes could suggest a given arrangement poses a heightened risk of fraud and abuse. The Alert follows dozens of civil and criminal investigations into fraud schemes involving companies that claimed to provide telehealth, telemedicine, or telemarketing services, but allegedly engaged in kickbacks and substandard medical practices to generate medically unnecessary orders and prescriptions."

"Health plans are expanding their platform to include home-based healthcare services, and sometimes acting as the primary care provider of record. These new services are part of the evolution to risk-based care. New technologies, including telehealth, allow for more services in the home and connections to providers in other locations."

"The COVID-19 pandemic has intensified interest in telehealth services among health care providers and health plans. Telehealth raises numerous legal issues, and OCR's proactive approach to HIPAA guidance has provided welcome clarity to providers and plans."

"Alabama Governor Kay Ivey recently signed SB 272 into law, setting forth telemedicine practice standards and abolishing Alabama's previous 'special purpose license' that allowed physicians licensed in other states to practice across state lines into Alabama. The law is effective July 11, 2022."

"States are utilizing a variety of policy levers to maintain access to telebehavioral health services. Commonly used levers include: [1] Creating allowances for out-of-state behavioral health [roviders.... [2] Enabling coverage for audio-only telebehavioral health services.... [3] Expanding telehealth-eligible provider types to include a broad range of behavioral health providers.... [4] Requiring payment parity for telebehavioral health visits."

"[F]or HDHPs with plan years beginning on or after January 1, 2022, this temporary relief generally does not apply to telehealth services that occurred from January 1 through March 31, 2022, and such telemedicine visits must be subject to the HDHP minimum deductible. Plan sponsors are permitted but not required to adopt this temporary relief."

"[T]he Extended Telehealth Relief is optional. If a plan sponsor decides to implement the Extended Telehealth Relief, it should ... [1] [For fully-insured plans,] contact its HDHP carrier to ascertain whether the carrier's plans will adopt the Extended Telehealth Relief from April 2022 to December 2022.... [1] If the HDHP is self-insured, the plan sponsor should consult with its stop-loss carrier and third party administrator regarding the telehealth relief extension."

"The Consolidated Appropriations Act of 2022 restores the exception for telehealth and other remote services, but only for the period from April 1 through December 31, 2022. This means that if a plan's year started at any time from January 1, 2022 through March 31, 2022, and the plan did not impose the minimum deductible for telehealth or other remote services from the start of the plan year through March 31, 2022, the plan would not be a high-deductible health plan for that period. Consequently, participants covered by the plan would be ineligible to make or receive HSA contributions for that period."

"Telehealth services do not need to be preventative or related to COVID-19 to qualify for the relief. This relief is optional ... The relief will not apply for the period between January 1, 2022 and March 31, 2022."

"Medicare will pay for telehealth provided at home ... Expands list of telehealth practitioners ... Extension of first dollar coverage for telehealth under HDHP/HSA plans ... Study on COVID-19-related telehealth changes under Medicare & Medicaid."

"The relief is permissive, not required.... The relief is extended on a prospective basis.... The relief applies on a monthly basis, not on a plan year basis."

"The new omnibus extension of this relief only applies to months from April 1, 2022, through January 31, 2022. Note that this is not based on plan years. Therefore, any HDHP that wants to can provide coverage for telehealth prior to the deductible, but only through the end of this year, regardless of its plan year. For plans that are not calendar year HDHPs, this relief may overlap with the existing CARES Act relief."

"Included in the bill is a provision that would temporarily allow expenses for telehealth and other remote care services to continue be paid from a health savings account (HSA) without first meeting the deductible under the high deductible health plan (HDHP). The provision would allow the deductible to be disregarded for the period April 1, 2022, through December 31, 2022."

"The good news for the telemedicine industry is that the majority of the several hundred pages of statutes and regulations are inapplicable to many telehealth providers."

"During the first year of the pandemic, 37.4 percent of nonelderly adults and 46.2 percent of elderly adults had at least one telehealth.... Publicly insured nonelderly adults were more likely to have had a phone visit, as opposed to a video visit, than those with private insurance, which may reflect differences in patient access to video technology or the telehealth modalities insurers cover."

"Some states have rescinded [public health emergency (PHE)] declarations, or simply allowed them to lapse. As a result, the regulatory flexibilities impacting telehealth services in those states have terminated.... Other states.... are making permanent changes that will make it easier for out-of-state health care providers to practice telehealth across state lines.... Interstate compacts are binding agreements between participating states that make it easier for providers to render telehealth services across state lines by creating an expedited path to licensure in participating states."

"Telehealth has proven itself undeniably practical. However, ensuring its long-term survival will require ongoing work and revision, including broadband improvements, permanent Medicare reforms, Interstate Medical Licensure Compact participation and payment parity assurance."

"The legislation aims to extend the waivers of the geographic and site restrictions and allow Medicare beneficiaries to access telehealth even when at home [and] allow controlled substances to be prescribed via an initial telehealth encounter under the Ryan Haight Act ... The legislation would require HHS to study the impact of the pandemic telehealth flexibilities and deliver a report to Congress no later than 18 months after the end of the public health emergency."