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August 4, 2020

What you need to know about Trump's telehealth and rural health executive order

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    President Trump on Monday signed an executive order aimed at making permanent some of the telehealth expansions that his administration facilitated in response to America's coronavirus epidemic and implementing a new payment model to provide financial incentives to rural providers delivering high-quality health care.

    Executive order seeks to expand rural, telehealth

    The executive order directs the HHS secretary to develop a Medicare payment model that "should give rural providers flexibilities from existing Medicare rules, establish predictable financial payments, and encourage the movement into high-quality, value-based care." Sources told Politico that the administration plans to release the new payment program this week, although the order states that HHS will release the new model within 30 days. According to Politico, sources also said the new payment model will be optional.

    The executive order also directs HHS to work alongside the Department of Agriculture and the Federal Communications Commission to "develop and implement a strategy to improve rural health by improving the physical and communications health care infrastructure available to rural Americans."

    Further, the order directs the HHS secretary to make permanent "as appropriate" certain temporary measures that the Trump administration established during the federal government's declared public health emergency over the coronavirus epidemic, such as waiving certain regulatory barriers to telehealth. Specifically, the order directs the HHS secretary to review within 60 days temporary measures related to additional telehealth services available to Medicare beneficiaries and flexibilities on services, staffing, supervision, and reporting granted to Medicare providers in rural areas. The HHS secretary within 60 days also must propose a regulation that would extend those measures, as appropriate, beyond the public health emergency, according to the order.

    The executive order also directs HHS to issue a report examining policies intended to reduce maternal mortality and morbidity, improve mental health, increase health care access, and boost health outcomes within rural areas.


    Administration officials told the Associated Press that, while the executive order is aimed at rural communities, it is intended to signal to Congress that Trump will support legislation to permanently expand telehealth access for all Medicare beneficiaries.

    According to the AP, the administration has the power to permanently expand certain services in rural areas, but broader action—including making telehealth a standard option for people in urban areas—would require Congressional action.

    HHS Secretary Alex Azar in an op-ed published last week by USA Today wrote that his department already is seeking Congressional input on next steps to expand telehealth. "We're working with members of both parties on that already," he wrote.

    Azar added, "The past several months will give us experience and data that can inform regulatory reforms." In fact, the executive order cited data showing that, not only did virtual visits among Medicare beneficiaries increase when hospitals had to limit in-person visits at the start of America's coronavirus epidemic—jumping from 14,000 telehealth visits per week to nearly 1.7 million visits per week—but "telehealth visits continued to be frequent even after in-person primary care visits resumed in May, indicating that the expansion of telehealth services is likely to be a more permanent feature of the health care delivery system."

    Separately, CMS Administrator Seema Verma said, "In an earlier age, doctors commonly made house calls," and "[g]iven how effectively and efficiently the health care system has adapted to the advent of telehealth, it's become increasingly clear that it is poised to resurrect that tradition in modern form" (Diamond et. al., Politico, 8/3; Sullivan, The Hill, 8/3; Lee/Stein, Bloomberg, 8/3; Alonso-Zaldivar, Associated Press, 8/3; Executive Order on Improving Rural health and Telehealth Access, 8/3).

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