During the Pandemic, Compassion & Choices advocated for legislative and regulatory changes so that telehealth would be allowed for common end-of-life services. Now, we seek legislative action to make those provisions permanent.
Why does Compassion & Choices advocate for the use of telehealth at life’s end?
During the pandemic, as hospitals filled their beds with patients stricken from COVID, we received countless calls from patients who could not access the end-of-life care they needed for other terminal diseases. Other patients wanted to be able to engage in thoughtful advance care planning discussions with providers; however, in-person visits were no longer a safe option. In response, we began advocating for improvements to our nation’s telehealth laws with a focus on improvements that would benefit terminally ill patients and those who wanted to engage in advance care planning.
What Changed During the Pandemic?
The Coronavirus Aid, Relief and Economic Security (CARES) Act package included key provisions related to telehealth that improved the delivery of end-of-life care for everybody, especially historically disadvantaged populations and those who live in rural areas with limited access to health care. By receiving care in the convenience of their own home, patients didn't have to endure the challenges and risks associated with in-office visits. These provisions were a lifeline for patients with:
- compromised immune systems
- those who cannot travel easily,
- those challenged with mobility issues, and
- those who live in remote areas
The pandemic demonstrated to us that telehealth could be a much more important part of end-of-life care, resulting in patients spending more time with families and less time in transit. It is not a solution for all end-of-life care, but rather an important tool in the toolbox. However, the changes that were made were all temporary. So unless they are made permanent, we will return to the largely brick and mortar care we received pre-pandemic.
On May 11, 2023, the COVID-19 public health emergency declaration ends. The following waivers from the pandemic have been extended via the Consolidated Appropriations Act of 2023. These policies will continue until December 24, 2024.
- Medicare beneficiaries can receive coverage for telehealth services, regardless of the patient’s geographic area. Prior to the declaration, only those in rural areas could receive this coverage.
- Medicare coverage will include audio-only telehealth services (such as phone calls). Prior to the declaration, only two-way, realtime audio/video telehealth services were allowed. Although many people may prefer audio/video access, some individuals, particularly those with lower incomes, may not have consistent access to video.
- Hospice care providers may continue to recertify the patient’s eligibility via telehealth. Recertification is needed when someone enrolled in hospice continues to need hospice services after being enrolled in a hospice program for the initial six months.
While these extensions are positive steps for telehealth use related to end-of-life care, there are some areas that have not been expanded. Under the Ryan Haight Online Pharmacy Consumer Protection Act, medical providers are required to conduct an in-person patient examination prior to using telehealth to prescribe controlled substances. This requirement was waived under the COVID-19 Public Health Emergency Declaration. However, when the Emergency Declaration expires (and if this waiver has not otherwise been extended), that provision of the Ryan Haight Act will be in effect again.
The federal Drug Enforcement Agency (DEA) has proposed new regulations related to the Act. We are tracking the rulemaking process to ensure end-of-life options available by telehealth are protected (for example, adequate pain control, continuity of care, and palliative care access for patients in areas with provider shortages).
What is Compassion & Choices Advocating for Now?
Compassion & Choices submitted a comment to the DEA’s proposed rule advocating for an exemption for telemedicine services for people at the end of life. We also encouraged supporters and healthcare providers to let the DEA know that the proposed rule would lead to greater suffering for people at the end of life. Read more here.
Compassion & Choices supports legislation that makes permanent key healthcare provisions from the ‘‘Coronavirus Aid, Relief, and Economic Security Act’’ or “CARES Act” (H.R. 748). These key provisions include:
- Use of telehealth to certify and recertify hospice eligibility, which is necessary to allow continued Medicare coverage if an individual requires extended end of life services beyond the initial six months. (Sec 3706).
- Use of Health Resources and Services Administration (HRSA) grant programs that promote use of telehealth technologies (Sec 3212).
- Waiving of the deductible for healthcare and other remote services for employee benefit plans covered by Employee Retirement Income Security Act (ERISA) health plans. (Sec 3701)
- Expanding telehealth use for federally-qualified health centers and rural health clinics (Sec 3704), including payment for effective audio-only services.
- Expanding the type of providers allowed to conduct and bill for telehealth visits to include advanced practice registered nurses, registered nurses, nurse assistants and licensed vocational nurses (Sec 3703).
These changes will help ensure more people, particularly those most medically vulnerable, will have access to quality healthcare, without having to spend their final days and months burdened by countless unnecessary healthcare appointments or even worse, unable to access care at all.
Note: While telehealth is available for medical aid in dying in some jurisdictions, clinicians should be aware of residency requirements and related legal immunities.