Advocacy Pushes for Extension of Telehealth Flexibilities Past Pandemic

Ever since the COVID-19 pandemic forced neurology practices around the country to dramatically reshape their delivery of care for the vulnerable populations they treat, telehealth has become an essential method of delivering care for most neurologists. This has only been possible due to the policy flexibilities enacted by Congress, along with the broad interpretation of these provisions by the Centers for Medicare & Medicaid Services. The AAN has been lobbying Congress to extend these telehealth flexibilities beyond the public health emergency, and this was one of the top three issues discussed by members with their senators and representatives during Neurology on the Hill in May 2022. To help solve this problem, the AAN has asked members of Congress to advance legislation to maintain access to care via telehealth for people with neurologic conditions for at least two years following the public health emergency. Nassim Zecavati, MD, FAAN, a member of the AAN’s Telehealth Subcommittee, helped Neurology on the Hill participants understand the scope of the bill. Zecavati said that a permanent expansion of telehealth coverage is projected to cost roughly $25 billion over 10 years, making a permanent expansion more challenging due to the cost. “The key questions posed by the Congressional Budget Office are: Does the use of telehealth supplement or replace existing care? Does pay parity provide too much incentive? Does fraud and abuse occur and how often? We need more data to help us answer these questions.” Fortunately, in July the House passed by a wide bipartisan margin an extension of current telehealth flexibilities, which included audio-only coverage, through the end of 2024. The Senate has not yet taken up this bill. Neurology is one of the top specialties benefiting from telehealth flexibilities, with an increase from one percent of neurology providers delivering telemedicine in the pre-COVID period to a high of 56.3 percent of neurology providers delivering telemedicine from March through June 2020. While virtual visits in many areas dropped after their early peak, neurology remains one of the highest utilizers of telehealth of all physician specialties, with one study showing headache patients have a 99-percent level of satisfaction. Telehealth has also benefited children with neurologic disease, with 86 percent of patients/caregivers in a large pediatric neurology care network indicating interest in telemedicine for future care after the onset of the pandemic. Access to audio-only telephone-based services is important for Medicare beneficiaries of limited means and is also vital for Medicare patients who live in communities that lack sufficient broadband cellular service and internet connectivity. As much as seven percent of the US population does not use the internet, including 25 percent of adults aged 65 or older, according to a Pew Research Center study. The ability for neurologic patients to access telehealth services will be severely threatened when the public health emergency and 151-day-extension recently enacted by Congress ends. The Senate must act to preserve the progress that has been made by extending telehealth flexibilities through the end of 2024 to provide additional time to further gather data, study this issue, and enact permanent reforms. “The AAN has been at the forefront in advocacy on this issue,” said Zecavati. “We had a big win last year when we championed the funding of $65 billion for improving internet access as part of the Infrastructure Investment and Jobs Act. We have had big wins in continuing to persuade the administration to extend the ongoing Public Health Emergency declaration, which is essential for telehealth flexibilities in Medicare. We now need the Senate to join the House in advancing this critical legislation to continue flexibilities through at least 2024, giving us adequate time to enact permanent reforms.” 

Zecavati

Capitol Hill Report

Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.

Latest Advocacy News

ƒ The AAN urged Congress to stave off an 8.55-percent

Medicare physician payment cut that is scheduled to go into effect at the end of 2022, and to also provide an inflationary update based on the Medicare Economic

Index to combat rising practice costs. ƒ The Centers for Medicare & Medicaid Services recently announced an indefinite delay in implementation of the

Appropriate Use Criteria (AUC) program. As such, there is currently no timeline for when the AUC program will transition from the education and testing phase into the payment penalty phase This delay is in alignment with the

AAN’s ongoing advocacy on this topic, which has urged

CMS and Congress to reconsider the utility of this program, given the burdens it is likely to place on providers. Congress was busy as both chambers aimed to wrap up their legislative sessions prior to leaving for the August recess. Outlined below are several key developments, including progress on two Neurology on the Hill 2022 priorities—prior authorization reform and telehealth. ƒ Democrats released and passed through the Senate the

Inflation Reduction Act, a package that proposes significant health care, climate, and tax policies via the reconciliation process that only requires a simple majority of votes. The

AAN has been supportive of provisions in the package that would lower the cost of prescription medications, cap outof-pocket drug costs for Medicare recipients, and extend

Affordable Care Act insurance subsidies for three years.

The House passed the bill and sent it to the president for his signature. ƒ The Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040) passed the House on July 27 by a vote of 416–12. This legislation mirrors our Neurology on the Hill 2022 telehealth ask, ensuring that Medicare beneficiaries continue to have access to telehealth in Medicare by extending key flexibilities that were enacted during the public health emergency until at least December 31, 2024.

Act now and tell your senators to support the extension of these flexibilities by passing H.R. 4040 through the Senate! ƒ On July 29, the AAN led a letter to the House and

Senate Judiciary Committees urging them to take swift action on the Conrad State 30 and Physician Access

Reauthorization Act (H.R. 3541/S. 1810) before the end of the 117th Congress. This letter was joined by

62 other organizations representing a broad range of constituencies, including patients, physicians, hospitals, and immigration organizations. ƒ Neurology on the Hill 2022’s #FixPriorAuth ask, the

Improving Senior’s Timely Access to Care Act (H.R. 8487), finally received a hearing in the House Ways &

Means Committee and was reported out favorably with overwhelming bipartisan support. This legislation, which would reform the use of prior authorization requirements in Medicare Advantage plans, has been a focus of AAN advocacy efforts for several years. The next step for this bill is consideration by the full House of Representatives. ƒ The Senate released its draft FY23 Appropriations packages on July 28. Congressional leaders have not agreed to a topline number, although Senate

Appropriations Chair Patrick Leahy (D-VT) has expressed his desire to finish the process by the end of this

Congress. The bills include $2.768 billion for NINDS, an increase of $150 million from FY22. Within NIH, the

BRAIN Initiative is funded at $700 million, $80 million more than was appropriated in the House version of the bill. All four Neurology Centers of Excellence (Epilepsy,

Headache, MS, Parkinson’s) are mentioned in the bill, with the Parkinson’s Center being appropriated $12 million, a 50-percent increase from FY22. The committee also recognizes the importance of increased investments for the expansion of MS Centers. Now that both chambers have released draft language, negotiations are able to begin. It is still unlikely an agreement will occur before government funding runs out, creating the need for a continuing resolution come October 1. ƒ The Medical Marijuana and Cannabidiol Research

Expansion Act (H.R. 8454) passed the House and was received in the Senate. This bill creates a registration process for researchers and manufacturers of medicinal marijuana and cannabidiol (CBD). It specifically allows physicians to discuss both the potential harms and benefits of medicinal cannabis with patients and requires relevant federal agencies to report findings on the therapeutic potential for conditions as well as its impact on developing adolescent brains and ability to operate motor vehicles. The AAN has repeatedly provided support for research in this area, discussed in our position statement. 