Telehealth survives in federal spending plan, but fight for longer extension continues

Healthcare advocates thought they had secured a significant extension of telehealth programs.

Telehealth advocates are pressing lawmakers for a longer extension for telehealth and hospital-at-home programs, says Kyle Zebley, senior vice president of public policy for the American Telemedicine Association.

The American Telemedicine Association and other trade groups had pressed lawmakers for action, since waivers for telehealth programs were set to expire Dec. 31. As Congress assembled a spending plan, lawmakers included language to extend telehealth programs for two years, and they also agreed to a five-year waiver for hospital-at-home programs.

But President-elect Donald Trump and Elon Musk denounced the spending plan and the package was scrapped. After a lot of drama, Congress approved a short-term spending package late last week to avert a government shutdown.

This time, the bill only included extensions of telehealth programs and hospital-at-home programs through March 31.

• Read more: Congressional spending plan: What’s in it for healthcare, and what isn’t

Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, tells Chief Healthcare Executive® that he doesn’t see any weakening of support for telehealth programs in Congress. Zebley says lawmakers focused on getting a spending package done that continued funding for key programs into March to avert a shutdown, and he’s grateful Congress didn’t allow key telehealth programs to expire.

“The fact that some of our provisions were included at all is just, again, a sign of the rarefied space our community lives in,” says Zebley, the executive director of ATA Action, the telemedicine group’s advocacy arm.

Now, the association plans to be pressing Congress to support a longer extension for telehealth and hospital-at-home programs.

“We're going to have to immediately fight for permanency or a much longer extension for the provisions included in this bill,” Zebley says.

While most key telehealth programs have secured a short-term extension into the spring, the Congressional spending package omitted some telehealth provisions that advocates had sought. Because they didn’t make it into the spending bill, some programs are going to expire Dec. 31.

Lawmakers didn’t include a telehealth tax provision related to high deductible health plans in the stopgap spending plan. The provision was first instituted during Trump’s administration and had been extended through the pandemic. The original spending plan included a two-year extension of the tax provision, but it didn’t end up in the final legislation Congress approved last week.

“There was a really important tax provision for first dollar coverage for those tens of millions of Americans with high deductible health plans, with health savings accounts attached to it. That unfortunately did not get included in this bill that passed on Friday. It will then expire,” Zebley says.

“We're going to need to do all we can to bring that back to life in the new year,” Zebley says.

Another program, enabling virtual care in the Medicare Diabetes Prevention Program, will also expire Dec. 31, since it wasn’t included in the short-term spending plan. Zebley calls it “a really great program.”

In addition, the SPEAK Act, which helps make telehealth services more accessible in a variety of languages, will also expire.

“We're going to have to fight for all those items left out,” Zebley says. He acknowledges restoring those programs is going to be tougher.

Congress won’t have a lot of time to move another spending package. The stop-gap plan only funds government programs through mid-March.

The telemedicine group and healthcare advocates will be pressing lawmakers and legislative leaders to approve a longer extension for telehealth and hospital-at-home programs. Zebley says some of that work is actually taking place during the holidays, and will certainly pick up when lawmakers return to Washington in January.

“We're going to do what we can to talk to our friends on both sides of the aisle, talk to the new Republican majority’s team in the Senate, and work with the Speaker's office and the majority in the House, along, of course, with our Democratic friends to see that we're included,” he says.

Telehealth programs have enjoyed bipartisan support in Congress, and Zebley says Trump, and President Biden, have been allies of telehealth. The Trump administration approved a broad expansion of telehealth early in the COVID-19 pandemic, and Biden signed a two-year extension to continue those programs through 2024.

“We very much appreciate the extraordinary bipartisan, bicameral support that transcends politics and geographic locations,” Zebley says. “So we're really lucky. And yet here we are with a less than ideal set of wins and losses in this bill.”

Even with the mixed results for telehealth in the spending plan, Zebley says he’s optimistic about longer-term extensions for telehealth and hospital-at-home programs and the possibility of reviving those programs that are set to expire.

“I think that there are things that we don't even know yet that offer real opportunities for positive change going into a new Congress and new administration, and we'll be trying to do our best to find those opportunities,” Zebley says.