Trump EO rural telehealth Azar.jpg White House

Trump signs executive order expanding rural telehealth

Telehealth services offered temporarily during COVID-19 pandemic now made permanent under presidential action.

President Donald Trump signed a new Executive Order Aug. 3 to further expand access to telehealth services during the COVID-19 pandemic, especially in rural communities. Through this order, the President is also taking action to extend the availability of certain telehealth services after the current public health emergency ends.

The order requires the U.S. Department of Health & Human Services to announce a new payment model testing innovations that empower rural hospitals to transform health care in their communities on a broader scale. To improve connectivity, Trump’s order also directs the federal government to launch a joint initiative in 30 days to improve the health care communication infrastructure and to expand rural health care services.

Health & Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma explained the details of the order on a call to reporters.

Azar said the President is directing the agency to transform rural health care with new, more sustainable models, which it already has been working to do for some time.

“First, we'll do that through a new rural payment model from the CMS Innovation Center, which will provide ways for payers and providers in a given area to work together to improve the availability, acceptability and quality of care,” Azar said. “Second, we'll be rolling out a rural health action plan that will lay out a number of areas across HHS where we can begin to execute on improving rural health care very quickly. That action plan will build on a number of rural health efforts we've already taken, such as adjustments to the hospital wage index.”

During the early days of the pandemic, using emergency authority, the Administration temporarily got rid of restrictive regulations regarding telehealth use and added 135 allowable services, such as emergency department visits, nursing home visits, physical, occupational and speech therapy services, mental health services and eye exams. The executive order issued Aug. 3 proposes to permanently add some services to the Medicare telehealth list, including prolonged office visits, mental health services like group psychotherapy, neuro-behavioral exams and other types of visits. A previous action also proposed to make telehealth for home health services available permanently.

On the call, Verma said before the public health emergency, only around 13,000 beneficiaries received telemedicine service in a week. By contrast, more than 10.1 million beneficiaries made a telemedicine visit during the public health emergency from mid-March to early July.

Azar added that the experience from the pandemic and expanding telehealth has provided evidence to challenge certain assumptions, such as that services would cost too much or would be utilized too much.

“We've now gotten to see the real-world impact of telehealth, the real-world evidence of its utilization, and that will be able to, at a minimum, cause the revision of a lot of those rather extreme and unbalanced assumptions that have guided and blocked telehealth in the past,” Azar said. “We’ll be able to look at the many, many benefits -- in terms of health outcomes, access to rural health care, access for the underserved to care -- that have been brought about by the President’s historic deregulatory action here during the pandemic.”

Verma added that over the past three years, at Trump’s direction, CMS has taken historic steps to address the unique challenges facing rural patients and providers. “We increased the wage index for low-wage hospitals, thereby bringing rural payments on par with those in urban areas, and this allows hospitals to improve quality, attract more talent and improve patient access for rural Americans," Verma said. "In addition, we have given Medicare Advantage plans increased flexibility to provide innovative benefits, including telehealth, and we’ve also reduced the minimum required level of supervision for outpatient therapeutic services provided by rural hospitals, freeing physicians from the responsibility to be physically present while procedures are performed. This provides significant flexibility for the often-limited hospital workforces in rural areas.”

Verma said building on those efforts will be the release of a new innovative payment model specifically designed to improve the care rural Americans receive. One idea is to utilize seed money for rural communities, basically to bring their communities together.

Azar added that HHS recognizes that telehealth isn’t limited just by payment issues but also by infrastructure, which is why the President has directed the agency to reach an agreement with the Federal Communications Commission and the U.S. Department of Agriculture to improve the broadband infrastructure needed for telehealth. “Access to telehealth can be a lifeline in rural areas especially,” he said.

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