Kim Callinan, president & CEO of Compassion & Choices

Compassion & Choices praised congressional leaders for including five provisions it and other healthcare advocacy groups recommended to expand patient access to telehealth services to the ‘‘Coronavirus Aid, Relief, and Economic Security Act’’  or “CARES Act” (H.R. 748). The U.S. Senate passed the emergency legislation Wednesday night, 96-0, and the U.S. House of Representatives is scheduled to vote on the bill Friday.

“We are grateful to Speaker Pelosi, Leader McCarthy, Leader McConnell, and Leader Schumer for including these vital provisions in the CARES Act and look forward to continuing to work in partnership with them on future legislation to further improve patients’ access to care,” said Kim Callinan, president & CEO of Compassion & Choices, the nation’s largest end-of-life care advocacy group. “Seriously ill Americans are counting on us to adapt to this ever evolving, growing crisis, by continuing to ensure they can access the healthcare services they need to treat their conditions and minimize their suffering.”

“We are particularly concerned with preserving access to care for those patients facing terminal illnesses from other diseases…who will continue to need end-of-life care options, including palliative and hospice care,” wrote Callinan in oneof two letters to congressional leaders earlier this week. “Without access to clinical care, this vulnerable population is likely to seek care in already-crowded, infectious emergency departments and urgent care that would increase their risk of a premature, potentially painful death from coronavirus. Instead, they should be provided safer quality care, virtually in-home or in community settings.”

The telehealth provisions included in the CARES Act that Compassion & Choices recommended include:

Sec. 3706. Use of telehealth to conduct face-to-face encounters prior to Medicare certification and recertification of eligibility for hospice care during the emergency period.

Why this provision is important: Use of telehealth to certify and recertify hospice eligibility is essential to address the barriers that will be faced by individuals who already endure impediments to access. The coronavirus will place an unprecedented strain on our healthcare system and reduce the availability of clinicians who are able to provide certification and recertification in-person.

Sec. 3212. Reauthorizes Health Resources and Services Administration HRSA grant programs that promote the use of telehealth technologies for health care delivery, education, and health information services. Expands grant funding for evidence-based telehealth networks and telehealth technologies.

Why this provision is important: Clinicians providing palliative and hospice care will need support to quickly adopt virtual care modalities to continue to provide care to their patients, given the significant risks to care to individuals with terminal conditions posed by COVID-19 exposure and the barriers to access due to likely virus surges.

Sec. 3701. Permits Employee Retirement Income Security Act (ERISA) health plans in private industry to waive the deductible for telehealth and other remote services.

Why this provision is important: Employer sponsored health plans need additional flexibility related to the Health Savings Account–eligible high-deductible health plan (HDHP-HSA) options. The Treasury and Internal Revenue Service guidance 2020-15 provided flexibility for testing and treatment of COVID-19 without a deductible for such plans, but it is critical to expand upon this guidance and allow payment of telehealth services pre-deductible in all instances (rather than just testing and treatment pertaining to COVID-19).

Sec. 3704. Enhancing Medicare telehealth services for federally qualified health centers and rural health clinics during the emergency period.

Why this provision is important: Patients with terminal conditions in underserved communities need to be able to access care, including end-of-life care options, such as palliative care, from clinicians quickly and efficiently, especially during the COVID-19 crisis.

Sec. 3703. Increasing Medicare telehealth flexibilities during the emergency period. Authorizes waivers for telehealth services which, if HHS exercised this authority could include expanding the clinicians authorized to bill telehealth and waivers of other existing telehealth restrictions beyond geographic and originating site restrictions that Congress had recently provided the federal agency administering the program.

Why this provision is important: Provides Medicare the discretion to allow non-physician healthcare professionals, such as advanced practice registered nurses, registered nurses, nurse assistants, and licensed vocational nurses, to conduct and bill for Medicare telehealth visits, remote physiologic management/monitoring, and virtual check-ins.

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