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Today, Rep. Cindy Axne (IA-03) led a bipartisan letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting clear, finalized telehealth guidance for health care providers serving Iowa’s rural communities during the novel coronavirus (COVID-19) pandemic.

The letter, which was signed by 10 other Members of Congress, follows concerns shared with Rep. Axne by rural physicians and health care administrators during her Virtual District Tour.

“During this public health emergency, CMS must work to support telehealth solutions for patients and providers without furthering health inequities between rural and urban areas,” the members wrote. “It has been reported that, without finalized telehealth coverage and payment guidance, these providers are conducting telehealth visits on just the hope that they will be reimbursed.”

As Iowans work to combat the outbreak of COVID-19, Rep. Axne has sought to make sure those living in Iowa’s rural communities who may lack broadband internet access are not excluded in the move to increased telehealth.

Last month, Rep. Axne introduced bipartisan legislation that would expand telehealth availability for Iowans needing important therapeutic services – including physical therapists, occupational therapists, speech pathologists, audiologists, and clinical social workers – and ensure fair reimbursement for these providers during the coronavirus (COVID-19) crisis. After pushing her legislation, CMS announced it would authorize telehealth for four of these key therapeutic services.

In March, Rep. Axne voted with a bipartisan majority of the House of Representatives to pass the Coronavirus Preparedness and Response Supplemental Appropriations Act, legislation allowing CMS and the Department of Health and Human Services (HHS) to waive requirements and restrictions for telehealth services during the coronavirus public health emergency.

The letter was also signed by Representatives Susan Wild (PA-07), Jim Hagedorn (MN-01), Thomas R. Suozzi (NY-03), TJ Cox (CA-21), Kendra S. Horn (OK-05), French Hill (AR-02), Michael F.Q. San Nicolas (GU-AL), David Trone (MD-06), Juan Vargas (CA-51), and Steven Horsford (NV-04).

The full letter can be found below:

Dear Administrator Verma:

We write expressing concern as to the urgent need for guidance from the Centers for Medicare and Medicaid Services (CMS) regarding payments to rural health care providers for telehealth services delivered during the novel coronavirus disease (COVID-19) emergency.

As you are aware, Congress allowed the Department of Health and Human Services (HHS) secretarial authority to waive requirements and restrictions for telehealth services during the coronavirus public health emergency as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. Section 1135 waivers allow additional secretarial authority to ensure continuity of care, including telehealth care, during a public health emergency. Expanding Medicare and Medicaid coverage of telehealth is critical to ensuring both patient and public health at this time.

We have heard concerns, however, from rural health care providers about their ability to receive reimbursement for telehealth care. For rural communities—which tend to rely more heavily on Medicare and Medicaid—COVID-19 has heightened existing challenges, like internet access. Whereas 98.3% of urban residents have access to broadband internet, only 73.6% of rural residents have access. Nationwide, 15% of rural residents do not use the internet. We worry that, given differential internet access between rural and urban residents, the requirement that telehealth services use a real-time, interactive audio and video communications system may discourage full utilization of telehealth services. During this public health emergency, CMS must work to support telehealth solutions for patients and providers without furthering health inequities between rural and urban areas.

While some telehealth issues—like permitting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant site providers—have been resolved, rural health care providers need additional guidance from CMS. It has been reported that, without finalized telehealth coverage and payment guidance, these providers are conducting telehealth visits hoping that they will be reimbursed.

Our rural hospitals, health care facilities, and clinics are an indispensable resource that serve millions of patients in America’s rural communities, and we encourage CMS to explore removing restrictions that may impede delivery of telehealth care and prioritize finalizing telehealth guidance for rural health care providers.

We appreciate your attention to this important matter.