Wendy Chill
The issue of telehealth has been very prevalent since federal flexibilities put in place related to the COVID-19 public health emergency (PHE) allowed for extended use of these services. With the PHE having ended in May 2023, many of the federal rules allowing for these various flexibilities have come to an end. While access to telehealth has remained, these flexibilities were set to expire at the end of 2024. AAHPM has been steadily advocating for extensions of these provisions to allow its members to continue to provide valuable services to individuals with serious illness.
There are multiple telehealth-related policy issues of interest to Academy members: use of telehealth to prescribe controlled substances; use of telehealth for the face-to-face (F2F) visit for recertification of the Medicare hospice benefit; and extending current telehealth flexibilities within the Medicare program, such as geographic and originating site restrictions.
Over the past year, AAHPM advocated for these flexibilities to continue beyond 2024. These provisions have been addressed at the federal level, but there will be more work to do in 2025.
Use of Telehealth to Prescribe Controlled Substances
For years, the Drug Enforcement Administration (DEA) had implemented rules that allowed flexibilities for physicians to prescribe controlled substances using telehealth. Media reports had indicated that the DEA may have been set to end these flexibilities, creating access issues for patients in hospice and with serious illness.
AAHPM strongly advocated for these flexibilities to be maintained. In August 2024, the Academy participated in a meeting with the Office of Management and Budget to discuss the original proposed rule from 2023, regarding the use of telehealth to prescribed controlled substances, reiterating its position that the DEA account for the unique needs of seriously ill patients—including those near the end of life—when finalizing policies related to the prescribing of controlled substances via telemedicine. The Academy had previously submitted comments on this proposed rule, and Joe Rotella, MD, provided testimony to the DEA.
AAHPM also signed onto a letter requesting the DEA issue a new proposed rule on the matter as well as letters to Congressional leadership urging legislative action to extend prescribing flexibilities for 2 years and to urge the DEA to promulgate permanent rules creating a special registry for certain practitioners to prescribe controlled substances via telehealth. The Academy also worked in coalition with the Alliance for Connected Care on this issue.
Where Does This Issue Currently Stand?
In November 2024, the DEA and the Department of Health and Human Services (HHS) released a temporary rule, Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which extends the telemedicine flexibilities that have been in place since March 2020 for prescribing controlled medications via the practice of telemedicine until December 31, 2025. You can see the notice from the DEA here.
Subsequently, in January 2025, the DEA and HHS released a proposed rule to create a special registration process for the purpose of prescribing controlled substances via telehealth. This rule includes a specific provision that would create an Advanced Telemedicine Prescribing Registration for “certain specialized physicians and board-certified mid-level practitioners,” which would allow the prescribing of controlled substances without an in-person visit. This special registration type would include hospice and palliative care physicians, as well as mid-level practitioners who are board-certified in hospice and palliative care.
AAHPM is excited that the drafting of this proposed rule has taken the Academy’s advocacy efforts around the needs of patients with serious illness into account. The Academy is currently reviewing the full proposed rule and will be submitting comments to the DEA. It is important to note that this rule is not yet final and is subject to change. AAHPM will be sure to keep members informed on the status and content of this rule.
Use of Telehealth for the Face-to-Face Visit for Recertification of the Medicare Hospice Benefit
Under the current telehealth flexibilities, the F2F visit is permitted to be done via telehealth. This flexibility was set to expire at the end of 2024. AAHPM has supported the CONNECT for Health Act, which includes an extension for the F2F visit via telehealth. The Academy signed onto a letter to House and Senate leadership advocating for the extension of this flexibility, and subsequently worked with the National Alliance for Care at Home, LeadingAge, and the National Partnership for Healthcare and Hospice Innovation to directly reach out to Congressional leaders to reiterate the importance of this policy.
Where Does This Issue Currently Stand?
As part of the American Relief Act, 2025, the end-of-year funding package that was signed by President Biden, the flexibility allowing the F2F visit to be done virtually was extended until March 31, 2025. While this is good news in that it maintains the allowance for this service to be provided virtually, AAHPM and its partners will have work to do in 2025 to advocate for either a longer or a permanent extension of this flexibility.
Extending Other Telehealth Flexibilities Within the Medicare Program
The existing telehealth flexibilities within the Medicare program, such as the elimination of geographic and originating site restrictions, were also due to expire at the end of 2024. AAHPM supported the Telehealth Modernization Act, which would have extended such provisions. This bill initially passed unanimously out of the House Energy and Commerce Committee and had bipartisan support.
Where Does This Issue Currently Stand?
As with the F2F telehealth provision in the American Relief Act, 2025, these types of Medicare telehealth flexibilities were extended until March 31, 2025. Similarly, AAHPM will be working with its members over this next year to advocate for a longer or permanent extension of these flexibilities.
The Academy has advocated for the above telehealth-related policies throughout 2024 and will continue to do so moving forward to ensure the patient populations its members serve will keep their access to necessary services without interruption. AAHPM has been excited to see so many of its members actively taking part in these advocacy efforts through its Legislative Action Center. This will remain a priority for AAHPM, and members should be on the lookout for future opportunities to make their voices heard on these important policy issues.
Wendy Chill is AAHPM’s director of health policy and government relations. For more information or questions about the Academy’s advocacy efforts, email [email protected].