The clock is ticking for Congress to reach a funding agreement before midnight on September 30 to avoid a government shutdown. Last week the House passed a continuing resolution to extend government funding but the bill failed to make it through the Senate. Both chambers are now in recess, leaving little time to strike a bipartisan deal.
If the government were to shut down, the Medicare telehealth flexibilities put in place in 2020 would expire, which could result in Medicare patients losing access to telehealth services.
Sonya Ebeling is the director of the South Carolina Telehealth Alliance. She said if the government shuts down, Medicare coverage for telehealth will revert back to the pre-pandemic rules.
“Before Covid, the Medicare program only covered telehealth services provided to facilities like clinics or hospitals,” Ebeling said. “So in March 2020 when the flexibilities were first put in place it allowed reimbursement to providers to provide telehealth directly to patients in their homes. And it also took away any geographic restrictions around rurality so you could be in an urban place, a rural place, a home or a facility and receive telehealth services through the Medicare program.”
The South Carolina Telehealth Alliance is monitoring federal developments and sharing updates with healthcare providers in South Carolina. Almost twenty percent of Americans are covered by Medicare. In South Carolina, more than 600,000 South Carolina Medicare patients could lose access to telehealth services if the shut down occurs.
The current flexibilities also allow different types of providers to be reimbursed for telehealth services through the Medicare program, including physical and occupational therapists. And Medicare has been covering some visits by phone which is helpful for patients without internet or video capability. That coverage could go away too. The special allowance for mental health and substance use treatment by telehealth could also scale back, creating a barrier at a time when demand for these services is high.
“We’ve always been relatively confident that these extensions for these flexibilities would be extended again because they’re a pretty bipartisan issue and everyone kind of supports that these flexibilities either become permanent or be extended,” Ebeling said.
She said the South Carolina congressional delegation has been supportive of making these flexibilities permanent. But as a shutdown looms, the SCTA is looking to the American Telemedicine Association for guidance on what comes next. Alexis Apple is the director of federal affairs at the ATA.
“Over the last few days I’ve had an overwhelming amount of questions from our membership asking what should we do; how should we plan and I do believe hospital systems and providers are preparing for the worst at this point,” Apple said.
The last federal shutdown happened in 2018 and lasted about 35 days, making it the longest in our nation's history. Apple said the ATA is hopeful that Congress will still pass a short-term continuing resolution before the deadline.
“That is the ultimate goal,” Apple said. “Plan B if we do end up going to a shutdown which is most likely going to occur at this point, we are advocating to Congress that they include some kind of retroactive reimbursement provision which would essentially allow providers to submit claims after the shutdown and then the Centers for Medicare and Medicaid Services can backpay them for the services that they provided during the shutdown.”