Connecting Rural Telehealth to the Future Act

Madam Speaker, may I inquire how much time is remaining?

Madam Speaker, I yield 2 minutes to the gentlewoman from Iowa (Mrs. Miller-Meeks).

Madam Speaker, I yield 2 minutes to the gentleman from North Carolina (Mr. Murphy).

Madam Speaker, I yield myself such time as I may consume. I will be brief in my remarks here.

I know that you have heard several concerns expressed about this entire process, and I would certainly share those concerns.

I do think that this is a great opportunity to address a bipartisan issue that is important across America. But it appears this bill was negotiated quickly, in secret, and outside the committees of jurisdiction. Neither outside stakeholders nor Members who have worked extensively on telehealth policy were consulted, as far as I can tell, and the closed rule under which this is being considered has precluded any opportunity to improve or amend the bill.

An issue this important deserves an open and transparent process that follows regular order, allowing Members to offer input and highlight important needs which might otherwise have been overlooked. We call this legislating.

If we had worked together on the Ways and Means Committee with our Energy and Commerce friends and had included the various ideas and innovations, this would have been a true and real bipartisan bill. I am confident that the telehealth extension we are considering today would be even better, as has been mentioned by my colleagues.

In fact, back in May, I introduced a bipartisan bill almost identical to this one called the Connecting Rural Telehealth to the Future Act. That bill extended all the provisions included in the FY22 omnibus through at least 2024 and also included provisions to ensure critical access hospitals can continue to provide telehealth services to their patients. It also corrects a flaw in the CARES Act which shortchanges federally qualified health centers and rural health clinics which offer telehealth services.

Madam Speaker, I include in the Record two letters from the National Rural Health Association and the National Association of Rural Health Clinics expressing their support for both the aims of H.R. 4040 as well as the need to extend critical rural health provisions from the Connecting Rural Telehealth to the Future bill.

National Rural

Health Association,

July 26, 2022.

Hon. Nancy Pelosi,

Speaker, House of Representatives.

Hon. Kevin McCarthy,

Minority Leader, House of Representatives.

Dear Speaker Pelosi and Minority Leader McCarthy: The

National Rural Health Association (NRHA) applauds the House

of Representatives for prioritizing telehealth flexibilities

by scheduling a vote on H.R. 4040, the Advancing Telehealth

Beyond COVID-19 Act of 2022. This legislation will extend

important telehealth flexibilities enacted in the Coronavirus

Aid, Relief, and Economic Security (CARES) Act, and extended

for 151 days post-public health emergency in the Consolidated

Appropriations

Act (CAA), 2022, until December 31, 2024. NRHA supports the

extension of telehealth flexibilities to show providers that

telehealth is here to stay but urges rural friendly tweaks to

the legislation.

NRHA is a non-profit membership organization with more than

21,000 members nationwide that provides leadership on rural

health issues. Our membership includes every component of

rural America's health care, including rural community

hospitals, critical access hospitals, doctors, nurses, and

patients. We provide leadership on rural health issues

through advocacy, communications, education, and research.

As the text is currently written, H.R. 4040 includes the

extension of distant-site status for Federally Qualified

Health Centers (FQHC) and Rural Health Clinics (RHC) at their

current reimbursement level. While continuation of this

flexibility is necessary, the reimbursement level for virtual

services is significantly lower than in-person services under

current statute. Should reimbursement remain as it is

currently written, by 2028 there will be nearly a $100

discrepancy between services provided in-person and virtually

at RHCs. NRHA believes this will cause rural communities to

utilize these important services less often than their urban

and suburban counterparts moving forward and will cause harm

to an already fragile rural safety net.

To remedy this discrepancy, NRHA urges this text be amended

to incorporate reimbursement updates as reflected in Section

9 of H.R. 7876, the Connecting Rural Telehealth into the

Future Act, introduced by Representatives Adrian Smith (R-NE)

and Terri Sewell (D-AL). Incorporating this legislative text

will bring payment parity between in-person and virtual care

at RHCs and FQHCs and ensure that rural communities have

access to the same health care delivery methods as their

urban and suburban counterparts.

NRHA applauds the House of Representatives for acting on

telehealth to show providers long-term stability. However, to

ensure that rural providers, and their patients, can properly

utilize these services tweaks are needed.

Sincerely,

Alan Morgan,

Chief Executive Officer.

Madam Speaker, these organizations fully understand the vital role that rural health clinics and FQHCs and critical access hospitals play in ensuring access to care for those in rural and underserved areas.

Even with the passage of this bill, the future of telehealth after the government-designated public health emergency is uncertain. More work needs to be done to assess what has worked well over the last 2 years, what can be improved, and what can safely be left behind.

While I do encourage Members to vote ``yes'' on this bill, I hope in the future we can work in a true bipartisan fashion under regular order to address the gaps that we know exist in policy and set a long-term, sustainable course for telehealth well beyond 2024.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield 1 minute to the gentleman from Oklahoma (Mr. Hern), a member of the Ways and Means Committee.

Madam Speaker, I yield 1 minute to the gentlewoman from New Mexico (Ms. Herrell).

Madam Speaker, I yield 1 minute to the gentlewoman from California (Mrs. Steel).

Madam Speaker, I yield 1 minute to the gentleman from California (Mr. Obernolte).

Madam Speaker, I yield 3 minutes to the gentleman from Arizona (Mr. Schweikert).

Madam Speaker, I yield myself the balance of my time.

I think we have had a good discussion here today. I think we have laid out that we are acting in good faith, supporting an issue, moving it forward, but also posing the scenario that there are so many other things we can do to address the very matter that we are taking up here today.

The surrounding details about how this bill came up and everything, I think it is problematic for the institution. But the fact of the matter is, we have an issue here that we need to address. I hope that we can work to continue to make it permanent in the future so that we can encourage investment, as was outlined previously, and encourage bending of the cost curve, ultimately, on healthcare, which is lacking at this point in time.

Madam Speaker, I urge a ``yes'' vote on this bill, and I urge a different kind of cooperation moving forward.

Madam Speaker, I yield back the balance of my time.

Madam Speaker, pursuant to House Resolution 1256, I call up the bill (H.R. 4040) to amend title XVIII of the Social Security Act to extend telehealth flexibilities under the Medicare program, and for other purposes, and ask for its immediate consideration in the House.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and add extraneous material on H.R. 4040.

Madam, I yield myself such time as I may consume.

I rise in support of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act, bipartisan legislation, introduced by Representatives Cheney and Dingell.

Over the course of this pandemic, telehealth has served as an important tool for staying connected to care without increasing the risk of exposure to COVID-19. And in the Medicare program, millions have utilized telehealth for the first time during the pandemic, thanks to actions taken early on by Congress and the administration.

When the pandemic was beginning to take hold in America, Congress moved quickly to significantly expand access to telehealth for Medicaid beneficiaries. And this was critically important because Medicare beneficiaries are some of the most vulnerable to COVID-19.

The waiver of Medicare's originating site and geographic restrictions during the public health emergency has allowed millions of Medicare beneficiaries nationwide to receive telehealth services, including audio-only services, without ever having to leave their homes.

Now, the Energy and Commerce Committee has a long history of working to expand access to telehealth services in the Medicare program. For example, the SUPPORT Act expanded access to substance use disorder services delivered via telehealth.

The Consolidated Appropriations Act of 2021 permanently expanded access to telemental health services and Medicare. And most recently, the Consolidated Appropriations Act of 2020 extended key telehealth flexibilities for an additional 5 months after the end of the public health emergency.

So H.R. 4040 builds on the bipartisan telehealth extension included in the Consolidated Appropriations Act of 2022. The bill extends the same key telehealth flexibilities as the previous legislation, but now would extend them until December 31, 2024, essentially 2 more years. And this longer-term extension will provide beneficiaries and stakeholders with more certainty.

It will also give policymakers time to assess the impact expanded telehealth services have had on the Medicare program and on beneficiaries' health and well-being, and the quality of care that they are receiving.

So I thank the many Energy and Commerce Committee members who have been leaders on this issue over the years, such as Representatives Dingell, Eshoo, Matsui, Welch, Blunt-Rochester, Kelly, and many more.

And I also commend Representative Cheney and Dingell for their bipartisan leadership on this legislation today.

I look forward to working with all Members on a permanent solution to address telehealth coverage under Medicare but, in the meantime, this multi-year extension is critical for preserving access to telehealth services.

The language included in the bill is the same bipartisan language previously negotiated by the House and Senate committees and the bill-- and I stress, Madam Speaker, that the bill is fully paid for.

So I hope we can, once again, extend these flexibilities with strong bipartisan support.

I urge all my colleagues to support this bill, and I reserve the balance of my time.

Madam Speaker, I yield 3 minutes to the gentlewoman from Michigan (Mrs. Dingell).

Madam Speaker, I yield 3 minutes to the gentlewoman from California (Ms. Matsui), a member of the Energy and Commerce Committee.

Madam Speaker, I yield such time as she may consume to the gentlewoman from Wyoming (Ms. Cheney).

Madam Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Doggett).

Madam Speaker, I yield the gentleman an additional 1 minute.

Madam Speaker, I have no additional speakers at this time. We may have one more, but not at this time. I reserve the balance of my time.

Madam Speaker, I am prepared to close, but I think Republicans may have additional speakers.

Madam Speaker, I continue to reserve the balance of my time.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield myself the balance of my time.

Since I heard every Republican who spoke say that they support the bill, I was certainly reluctant to suggest that we would have any kind of significant debate about the bill. I generally feel that if I have both sides of the aisle saying it is a good bill, I should leave well enough alone.

But I do want to say this in response to some of the comments that were made by the Republican Members. We were reluctant in the committee to move to have permanent authorization of the telehealth flexibility expansion for several reasons.

First of all, it is expensive. In other words, the Congressional Budget Office scored this bill. As I said, the bill for the 2 years is paid for. If you wanted to go permanent, I think they would have said that we needed another $20 billion. I feel very strongly that the bill should be paid for. That is part of what we believe as Democrats. We were able to get agreement with the Republicans on a pay-for for the 2 years, so that was a factor as to why it is for 2 years instead of permanent.

Beyond that, and more importantly, really, is the fact that a permanent expansion is a major change. I think it needs a lot of study, a lot of oversight and investigation. One of the things that I mentioned in Rules is that both HHS and the inspector general have been tasked to report back to us this spring with a report on a lot of the things that were mentioned here today, integrity issues, in terms of fraud and abuse, that were mentioned by both sides of the aisle.

I think the feeling of the committee was that this was something that needed more study before we went ahead and made this permanent. That is what we do. In other words, right now, the concern is that because the omnibus appropriations bill basically expanded the telehealth program until 5 months after the public health emergency for COVID ends, that would take us to the end of this year. But we don't have a lot of legislative days left. We figured the best thing was to at least extend it for another 2 years. We can pay for it, as was mentioned by Ms. Cheney.

This, I think, is the best way to resolve this: Do a 2-year extend, pay for it, and let's spend the time between now and next spring having some more hearings and opportunities to talk about a further extension or possibly making it permanent.

Again, I appreciate the fact that everyone on the Republican side supports the bill, but I do want to address some of the things that you mentioned.

Madam Speaker, I yield back the balance of my time.

Madam Speaker, I rise in support of H.R. 4040 the Advancing Telehealth Beyond COVID-19 Act of 2021, which would make permanent several telehealth flexibilities under Medicare that were initially authorized during the COVID-19 public health emergency.

This bill would extend the life-saving measures put in place by Congress during the

COVID-19 pandemic that allowed millions of American people to access telehealth-care.

Specifically, H.R. 4040 would:

permanently remove originating site and geographical restrictions that limited telehealth services to designated clinics in the event of a physician shortage,

give rural providers the ability to serve patients remotely while being properly compensated for their work,

empower providers to provide access to smart devices and innovative digital technology to their patients for monitoring purposes, and

provide coverage for audio-only evaluation, management, and behavioral health services.

H.R. 4040 would codify critical telehealth policies implemented during the pandemic for the continued benefit of all, but especially those in isolated communities, people with disabilities, and seniors.

Telehealth has dramatically improved the medical industry by making healthcare more accessible to people in rural areas, those with mobility concerns, and individuals whose work or family schedules may not accommodate an appointment at a physical location.

During the height of the pandemic, while more than 3,000 people were dying per day of the virus, telehealth served as an invaluable weapon against the spread of infectious disease.

Remote screening and care prevented undue burden on our already exhausted medical professionals and allowed patients to get the care they needed without putting themselves or their families at risk.

What began as emergency protocol then, has now emerged as best practice.

Currently, 76 percent of hospitals in the U.S. connect doctors and patients remotely via telehealth.

This is up from 35 percent a decade ago.

Remote healthcare allows for greater flexibility for patients, enables certain physicians like allergists or occupational therapists to access an individual's environmental needs, and streamlines the scheduling process to prevent long wait times and wasted time.

Telehealth has allowed doctors to monitor their patients' chronic conditions more closely, like heart or lung disease.

Better monitoring can improve patients' quality-of life and reduce hospital admissions and deaths from chronic diseases.

Additionally, telehealth is a good way to deliver care quickly in an emergency, such as a stroke or heart attack.

Telehealth has also played a significant role in expanding pediatric mental healthcare access.

As of April 2019, there were only 8,300 practicing child and adolescent psychiatrists in the U.S.

This number is dwarfed by the more than 15 million kids and teens in need of a psychiatric provider.

For over a decade, The University of Texas Medical Branch has offered telehealth services for rural patients.

After initially partnering with community mental health clinics in fringe counties, the program has since been able to expand adolescent mental health services directly to school districts.

This means children without access to a local psychiatrist can receive the care they need without being pulled from school or traveling long distances.

It also means psychiatrists can observe children in their natural setting at home or in school, rather than in an inorganic hospital environment.

Telehealth allows children to be where they ought to be--in the classroom getting an education.

These are just some of the many examples of how telehealth has aided our healthcare system in providing the quality medical services that our constituents deserve.

The passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, would ensure that these positive developments continue to benefit communities across the country.

It is important to note, however, that telehealth has not always served all people equally.

Historical data shows that People of Color have long faced obstacles to getting the critical health care services they need.

Unfortunately, the rapid implementation of telemedicine hasn't bridged the equality divide as much as one would have hoped.

A study led by the University of Houston College of Medicine found that African Americans were 35 percent less likely to use telemedicine compared to White Americans, and those in Hispanic communities were 51 percent less likely to use it.

Only 66 percent of African American and 61 percent of Hispanic households have access to broadband internet compared to 79 percent of white households.

Additionally, only a quarter of families earning $30,000 or less have smart devices, such as a phone, tablet, or laptop at home, limiting their access to telehealth services.

So, while telehealth has reduced many barriers to adequate healthcare, we must stay vigilant to the needs of our most disadvantaged community members.

We are a long way from full medical equality in this country, however, I believe that the Advancing Telehealth Beyond COVID-19 Act of 2021 is an important step in bringing us closer to that goal.

H.R. 4040 is an opportunity to connect our healthcare providers with patients who might otherwise go without the medical care they so desperately need.

It is an opportunity to lift our nation's healthcare into the 21st century and to utilize technology as a medical equalizer.

I urge all my colleagues to support H.R. 4040 the Advancing Telehealth Beyond COVID-19 Act of 2021.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, one of my top priorities since I have been a Member of Congress has been to make sure that healthcare is accessible and available for all Americans. Telehealth has played a critical role for patients to access the care they desperately need.

On the Energy and Commerce Committee, we have been discussing the importance of telehealth flexibilities for years. It is bringing doctors right into families' living rooms and is an example of how innovation can improve and save people's lives.

As the coronavirus spread and providers closed their doors, patients and providers were forced to adapt and utilize telehealth services. Just months into the public health emergency, Medicare was receiving over a million telehealth visits a week, an almost 3,000 percent increase. Those without adequate transportation or in rural areas were still able to visit with their doctor.

While we have made great strides in making telehealth more broadly available, we know that Congress can do more. Increasing access to telehealth means increasing access to quality care for all patients.

I often discuss how, before the pandemic, we had a lot of regulations and red tape that piled up over the years. So while I will support this legislation, it is a shame that we did not take something as important as this through committee to make sure it could be the best possible product.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield 2 minutes to the gentlewoman from Washington (Mrs. Rodgers), the ranking member of the Energy and Commerce Committee.

Madam Speaker, I yield 2 minutes to the gentleman from Utah (Mr. Curtis), an important member of the Energy and Commerce Committee.

Madam Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Burgess).

Madam Speaker, I yield 2\1/2\ minutes to the gentleman from Ohio (Mr. Johnson), another valuable member of the Energy and Commerce Committee.

Madam Speaker, I yield 1 minute to the gentleman from California (Mr. Valadao).

Madam Speaker, I yield myself such time as I may consume.

Again, let me be clear about my standing on this bill. I support this bill. We support telehealth. We are all in favor of telehealth, but we also support the fact that we have committees that this type of legislation needs to go through, and we missed an opportunity here to make this a better bill. That is simply what we are saying.

No one is saying they are not in favor of telehealth. Telehealth has become an integral part of our healthcare system during this pandemic. There is no question about that. All of us agree on that. It needs to be extended.

But, again, the committee process is exceptionally important, and we need to make sure that we follow that, particularly when we are talking about subject matter as important as this because it is important.

Again, since I have been a Member of Congress, I have been working to make healthcare accessible and available, and telehealth does just that. This is exactly what we want, but there are ways that we could have made this better.

One example is that we need to make sure there is no waste, fraud, and abuse. That is one thing that could have been tightened up in this legislation.

Another example is to make sure that we are not having any information that is inadvertently or intentionally being released. That is extremely important as well.

So again, there are ways that we could have made this legislation better if we had gone through the committee process, which is a process that is extremely important.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I thank the chairman for yielding. I appreciate it.

I am very pleased, Madam Speaker, that today the House will have the opportunity to vote on this important bipartisan legislation. It is an unusual circumstance to have a bill that has such broad bipartisan support.

I know many of my colleagues have worked on many different aspects of the bill that we are going to consider and vote on today. I am honored to be an original cosponsor of this bill, along with my good friend from Michigan, Congresswoman Dingell, who spoke earlier.

All of us, I think, around the country, especially in rural America, saw the impact of COVID on the ability of our constituents to get the treatment that they need. We first began working on legislation to expand telehealth capabilities more than 2 years ago, following the onset of the pandemic.

In Wyoming, we have long known how important it is for citizens to be able to take advantage of the technology that exists today, how crucial telehealth services are in allowing all of our citizens to interact with their doctors and their other healthcare providers, and we saw this, in particular, during the pandemic.

We know it is vital that Medicare adapt to the ever-changing innovation in medical technology that allows telehealth services, and this legislation really will expand freedom for patients by giving them more flexibility and more capability to use telehealth services.

Specifically, the legislation removes geographic requirements, and it expands originating sites so that Medicare beneficiaries can receive care at any site. It can expand the practitioners who are able to furnish telehealth services, and it also provides for audio-only telehealth.

I am very pleased that this extension through 2024 was fully paid for using the Medicare Improvement Fund, and the CBO has shown that it will not increase direct spending.

Madam Speaker, in Wyoming, especially, we know how important this is, how important telehealth access is. Many of our citizens live hours away, hundreds of miles away, from their closest medical provider. I am very proud that this bill has the support of the Wyoming Hospital Association, in addition to the American Medical Association and a number of other crucial groups whose mission is to serve patients and provide quality care.

While I know we in this body will continue to have legitimate and important ongoing policy debates about

healthcare, there is, as I said, broad bipartisan agreement for expanding access so that all of our citizens can receive high-quality care. That needs to continue to be a top priority. This bill does just that by allowing more Americans to utilize telehealth services.

Madam Speaker, I thank my colleagues from both sides of the aisle for joining me in advancing our bill to this point, and I urge all Members to vote in favor of this legislation so more citizens can connect and receive care from the medical professionals of their choice.