Trump Executive Order Aims to Make Some Pandemic-Induced Telehealth Expansions Permanent

President Donald Trump signed an executive order Monday targeting the improvement of health care for patients and medical providers in rural communities, expanding access to telehealth services in those areas and elsewhere and extending some telehealth flexibilities prompted by the pandemic to last permanently beyond it.

Months ahead of the 2020 presidential election that has candidates chasing rural votes, the move also comes on the heels of a mega surge in demand for telehealth appointments in the U.S., as the threat of catching COVID-19 forced people to pivot typically in-person experiences to virtual visits.

“[P]rior to the pandemic, the telehealth was fine, but it wasn't anything raging,” the president said during a press briefing Monday. “And I guess one of the only good things that we've gotten out of this whole horrible situation is telehealth has been incredible.” 

Early into the new pandemic-induced reality, federal agencies including the Veterans Affairs and Defense departments and the Centers for Medicare and Medicaid Services rapidly adjusted to boost telehealth and telemedicine services offered in their wheelhouses. With direction from the administration after COVID-19 emerged, CMS was able to get rid of what Administrator Seema Verma called “restrictive regulation” on a background press call Monday, which ultimately allowed for telehealth services to be accessed by approved patients across America—and not solely in rural areas. The agency enabled telehealth to be offered at more health care sites and increased the types of providers who can offer up telehealth to include physical therapists, speech language pathologists, those practicing from rural health clinics and federally qualified health centers. CMS also added 135 services that can be provided via telehealth, according to Verma, including emergency department visits, mental health services, eye exams and more.

“Before the public health emergency, only around 13,000 beneficiaries received a telemedicine service in a week,” Verma said. “By contrast, over 10.1 million beneficiaries have received a telemedicine visit during the public health emergency from mid-March to early July.”

As directed by the new executive order, CMS revealed Monday it’s accepting public comment on a newly proposed rule to extend, as appropriate, additional telehealth services offered to Medicare beneficiaries and certain flexibilities offered to Medicare providers in rural areas. 

“It’s the list of 135 services that CMS has authority to extend beyond the public health emergency through regulatory action … which is the focus of today’s rule,” Verma noted, confirming that the agency is proposing to permanently add services to the Medicare telehealth list. The agency is considering including prolonged office visits, mental health services, neuro-behavioral exams, though Verma said other services such as emergency department and nursing facility discharge visits may also extend beyond the current health crisis so the agency can study the impact of the changes.

Still, Verma said the agency’s regulatory authority outside the public health emergency is “largely limited to the types of services that can be provided via telehealth,” and that more comprehensive expansion and extension to telehealth-centered policies past the public health crisis’ duration would require actions from Congress. 

The new executive order is officially aimed at “Improving Rural Health and Telehealth Access,” and up-front the president in it notes that the roughly 57 million Americans living in rural communities “face unique challenges when seeking healthcare services,” including a lack of access to transportation, technological and care-delivery innovations across the field of medicine and healthcare workers in their areas. Those individuals are more likely to die from five leading cases of death such as cancer, compared to their urban counterparts, he noted. 

In hopes to improve those outcomes, the Health and Human Services Department Secretary Alex Azar is also directed by the order to release a new model—within 30 days—“to test innovative payment mechanisms in order to ensure that rural healthcare providers are able to provide the necessary level and quality of care.” In that time period, the secretary must also complete and submit to the president a full report of existing and upcoming policy initiatives to eliminating regulatory barriers that hinder healthcare access in rural areas, improve mental health in those areas, mitigate maternal mortality and morbidity, and “prevent disease and mortality by developing rural specific efforts to drive improved health outcomes.” 

During the background press call Monday, Azar noted that the newly proposed efforts will build on work HHS is conducting, adding that “rural healthcare providers have struggled and rural patients have struggled because they're too often bound by old models of delivering and financing care.”

The executive order also pushes the secretary to coordinate directly with the Agriculture Department, Federal Communications Commission and others to produce a strategy to boost rural health “by improving the physical and communications healthcare infrastructure available” to people in non-urban communities.