With Congress providing telehealth waivers as part of its omnibus spending bill at the close of 2022, delaying the "telehealth cliff" for two years, HIMSS says it's now ready to make the case for permanent reimbursement of virtual care.

Also on its policy agenda for the year ahead: advocating for data standardization, offering input for interoperability rulemaking and engaging with agencies and states to increase telehealth access. We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond.

Making telehealth's case for cost control

Telehealth has proven to reduce burdens on healthcare providers and improve access and has been a priority for HIMSS for many years, but the Congressional Budget Office has long complained that all of the data has been for non-Medicare patients, explained Tom Leary, senior vice president and head of government relations at HIMSS, parent company of Healthcare IT News.

Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be? We now have three years of data on the impact to the Medicare Trust Fund," he said.

While the pandemic-era telehealth waivers answered many questions at the federal level, the two-year extension to offer telehealth in high-deductible health plans with health savings accounts included in the final legislative package of 2022 has opened a new window to pursue making the changes permanent. 

HIMSS will "use the next two years to gather additional data to inform both Congress and CBO on either the cost of avoidance or the cost control aspects," said Leary.

In addition to making telehealth coverage permanent, simplifying access for patients is another goal for the mission-driven non-profit, whose goal is to reform the global health ecosystem through the power of information and technology.

HIMSS has also aggressively supported the Connect for Health Act, and a bill that's expected to be reintroduced this year, said Amanda Krzepicki, government relations manager at HIMSS.

In 2023, HIMSS will not only be working to prop up telehealth further with really strong data on how these services help patients to achieve broader reform, but will also work at the state level with licensing boards to discuss how telemedicine can reach more patients.

HIMSS members will convey the long-term impact of multiple provider types and care settings as they relate to reimbursements.

One example is audio calls and how to establish reimbursement rates based on the care needed and the appropriateness of care delivery through that channel.

Audio reimbursement can be helpful, particularly in regions where Internet connectivity is not dependable.

By July 2022, all state Medicaid programs provided at least some audio-only coverage for behavioral wellness, according to a recent Kaiser Family Foundation report.

Most state Medicaid programs want to keep telehealth expansions and have broad authority to do so without federal approval, according to the report.

Krzepicki said that while we need to remain concerned about bad actors in the space, the data "doesn't really hold true that costs have gone up because of utilization within the telehealth space."

"What it really boils down for HIMSS is making sure that we are, at the very minimum, using the technology in a way that improves access to care for the patient," Leary added.

Pushing for widespread broadband adoption

HIMSS has worked with the Senate Broadband Caucus to expand broadband on an ongoing basis.

"Broadband access is absolutely an issue that we're continuing to push for," said Leary.

The Infrastructure Improvement Act had several billion dollars for it, and HIMSS will be working in the year ahead on last-mile connectivity with the Federal Communications Commission, he said.

The agency has launched more broadband expansion programs to increase connectivity to more communities, like the Affordable Connectivity Outreach Grant Program, which will announce grantees on or before March 10.

That program provides funding to eligible state, local and tribal housing agencies as well as non-profit and community-based organizations and others for outreach activities that increase awareness and encourage participation in the ACP for households receiving federal housing assistance.

FCC will also award outreach grants to "trusted, neutral third-party entities, such as schools and school districts, or other local or state government entities."

"It's free to enroll in ACP, but many people are reluctant," Craig Settles wrote for Healthcare IT News in November on how the efficacy of telehealth depends on meeting the need  for broadband.

"Telehealth can win over fence-sitters. The universal need for healthcare can make ACP coupled with telehealth a win-win for everyone," says Settles, a telehealth and broadband advocate.

Healthcare access from home or healthcare access for the clinic is just as important as educational access, echoed Leary.

He noted that previous legislation with funding for broadband, like the 2009 American Recovery and Resiliency Act, defined what needed to be done to access funding.

What's less clear this time around, Leary said, is how communities that need the assistance access the funding.

"How do you leverage it for healthcare, and how does healthcare get involved in those discussions?" Leary said.

Creating standards synergy for 'Interoperability 3.0' 

For several years, there's been back and forth on what to do about provider burden, the HIMSS government relations specialists said.

The Centers for Medicare and Medicaid Services issued a proposed rulemaking to improve the electronic exchange of healthcare data and streamline processes related to prior authorization to further interoperability.

HIMSS members are interested in seeing information transport standards that are common to most health and pharmacy data used in the rulemaking.

"I think CMS is seeing the handwriting on the wall and is really taking advantage of the fact that it's part of the public discourse," said Leary.

Comments are due in early March. In its comments, Leary says he expects HIMSS will be stressing utilizing the most current information sharing standards HL7, use cases from the Integrating Healthcare Enterprise and marrying that with National Council for Prescription Drug Programs standards.

"So that we're creating some synergy, not creating something that increases provider burden," he said.

Another priority for members is seeing CMS getting more in lock-step with Trusted Exchange Framework and Common Agreement, or TEFCA, and qualified health information networks.

"Let's make sure that what [Office of the National Coordinator for Health IT] is proposing, CMS builds on to and doesn't doesn't take us in a different direction on interoperability," said Leary.

Fighting for more seamless patient records

Pieces of the Substance Abuse Confidentiality Regulations have restricted the sharing of mental health records with providers – even when patients have provided access.

U.S. Health and Human Services published a notice of proposed rulemaking on December 2 calling for significant changes to better align substance use confidentiality regulations– 42 C.F.R. Part 2 – with HIPAA. The deadline to submit comments is January 31.

HIMSS is a founding member of the Patient ID Now Coalition and long called for a national patient identifier for patient safety, Krzepicki said, explaining that a lack of access to substance abuse records can impede care and has even caused deaths.

Changes to the rule could make it easier for providers to share patient records and could help make the data cleaner.

"We won't lose information as we go patient to patient, and patients won't have to sign those waivers allowing certain physicians to see different information input from other providers," she said.