House Energy and Commerce Committee presents own 2-year telehealth extension, with more rural health wins

The House Energy and Commerce Committee released telehealth extension legislation today that will be voted on during a health subcommittee markup Thursday. The markup will also include bills to change billing requirements for remote patient monitoring, expand the Medicare Diabetes Prevention Program to virtual-only providers and to prevent fraud in Medicare and Medicaid.

The Energy and Commerce telehealth extension legislation includes slight differences from the Ways and Means telehealth extension bill passed out of committee unanimously last week. 

The Energy and Commerce Committee finagled its changes into an amendment of the Telehealth Modernization Act (TMA), which Rep. Buddy Carter, R-Georgia, reintroduced in February. The TMA enjoys broad support by telehealth lobbyists. What remains to be seen is how groups react to the amendments floated Wednesday by the committee. 

The amended TMA would extend Medicare telehealth flexibilities by two years, including all of the major provisions drawn up by the House Ways and Means committee and passed unanimously out of the committee last week. Some of its key provisions were allowing telehealth visits to be conducted from any location, extending audio-only telehealth billing for two years and allowing more types of providers such as physical therapists, audiologists and speech language pathologists to bill for telehealth. The pay-fors include many pharmacy benefit manager reforms seen in the Ways and Means telehealth extension. 

There are two key differences in Energy and Commerce’s version: One, it fixes a long-standing billing issue for rural providers. Two, the amended TMA requires a billing modifier for “telehealth virtual platforms” and incident-to provider billing. 

Rural health clinics and federally qualified health centers have been getting paid at a lower rate than Medicare fee-for-service telehealth providers due to a part of the CARES Act that directed the Centers for Medicare & Medicaid (CMS) to come up with a special payment rate for rural telehealth. The National Association of Rural Health Clinics has advocated that Congress change CMS’ payment rule so rural providers in the qualifying clinics can get paid an equal amount as fee-for-service providers. 

The amended TMA would fix the payment disparity for rural providers and would reimburse RHC and FQHC telehealth visits at parity with in-person visits. The current payment is based on the weighted average of physician fee schedule codes billable via telehealth and pays $96.87 for all telehealth services. The National Association of Rural Health Clinics supports the billing changes proposed by the amended TMA. 

The Ways and Means legislation does not fix the payment issue.

The difference in the rural health provisions will have to be resolved by the two committees if Energy and Commerce passes the legislation. 

The new requirement for telehealth modifiers will also have to be debated by the committees. One modifier would siphon off claims billed by telehealth “virtual platforms,” which is causing stir among lobbyists. The legislation does not define telehealth virtual platforms, and lobbyists are unsure of the intent of the modifier. 

The other required modifier would be to denote telehealth services provided incident to a physician, such as those services performed by a physician assistant or nurse practitioner.

Editor's note: The amended Telehealth Modernization Act would extend Medicare billing for rural health clinics and federally qualified health centers for two years.