Some telehealth and home care frozen by shutdown
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The government shutdown left some seniors without access to telehealth, while others receiving hospital-level care at home are being discharged or sent back to inpatient units.
The big picture: Congress only authorized Medicare to pay for expanded telehealth care and the Acute Care Hospital at Home initiative through Sept. 30 — meaning additional legislation is required to restore the services.
- Most other Medicare and Medicaid services will continue as normal during the shutdown, and providers' insurance claims will still be paid out.
- "Real Americans will be worse off" without coverage of these services, said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association.
Where it stands: All hospitals participating in the hospital-at-home initiative had to discharge patients or move them to physical hospitals on Tuesday after government funding lapsed without Congress renewing the program, per a recent notice from Medicare administrators.
- Several health systems like Mass General Brigham in Boston and Hackensack Meridian Health in New Jersey started phasing out their hospital-at-home patients early, in anticipation of a shutdown. That further strained already crowded inpatient facilities, Stat News reported.
Providers can still offer telehealth services to all Medicare enrollees — they just won't get paid for it. Congress could authorize back pay for claims made during the shutdown if it chooses to extend the programs.
- Telehealth coverage will remain intact for Medicare enrollees in rural areas accessing a call in a health care setting.
- Some health systems and Medicare group practices that belong to the American Telemedicine Association are cutting off seniors' telehealth access starting Wednesday, Zebley said.
- Others will continue providing virtual care to Medicare enrollees but hold off on submitting claims until the shutdown is resolved, in hopes they can get paid retroactively, he said.
This is the first time these programs have expired, despite many close calls and last-minute funding extensions from Congress since Medicare got the authority to reimburse for them in 2020.
- "[M]any providers and organizations are showing signs of 'boy who cried wolf' fatigue — hesitant to mobilize as strongly this time because previous deadlines were extended at the last minute," the National Consortium of Telehealth Resource Centers wrote in a blog post last week.
- Both telehealth and hospital-at-home have broad bipartisan support.
- But it's expensive to make such benefits permanent for Medicare enrollees, which is why the COVID-19-era flexibilities are subject to the annual appropriations cycle. Permanently paying the same rate for telehealth and in-person services could cost Medicare billions of dollars.
What they're saying: House Majority Whip Tom Emmer (R-Minn.) told Axios that Democrats' willingness to not agree to a stopgap funding measure and to let telehealth coverage lapse exposes an inconsistency in their priorities.
- "Democrats have no moral high ground to stand on when it comes to health care," Emmer said in a statement.
- Both Democrats' and Republicans' continuing resolution proposals to temporarily fund the government and avoid a shutdown would have extended telehealth and hospital-at-home coverage.
- Representatives for House Minority Leader Hakeem Jeffries (D-N.Y.) and Senate Minority Leader Chuck Schumer (D-N.Y.) did not respond to Axios' request for comment.
- Democrat lawmakers refused to vote for the GOP's funding proposal in large part because it didn't extend enhanced premium subsidies for Affordable Care Act coverage.
