Improving Rural Health and Telehealth Access
Signed: August 3, 2020
Published: August 6, 2020
Document Number: 2020-17364
📋Summary
This executive order directs the Department of Health and Human Services (HHS) to strengthen rural healthcare and expand access to telehealth, aiming to improve care quality and help rural hospitals and providers stay financially stable. It mainly affects rural patients, rural hospitals and clinics, and Medicare beneficiaries and providers, along with federal agencies involved in health and rural infrastructure. It requires HHS to quickly launch a new Medicare payment model for rural providers that offers more flexibility, more predictable payments, and incentives to deliver higher-value care. It also tells HHS and the Department of Agriculture to develop a strategy to improve rural health infrastructure (including communications/broadband), and directs HHS to report on steps to expand the rural workforce, reduce preventable deaths (including maternal mortality), and improve rural mental health. Finally, it instructs HHS to review temporary COVID-era Medicare telehealth and rural provider flexibilities and propose rules to extend appropriate measures beyond the public health emergency.
💼Business Impact
This order most directly affects rural hospitals/clinics, telehealth providers, home health agencies, behavioral health and maternal care providers, and the vendors that support them (telehealth platforms, EHR/IT, broadband/telecom, and medical device/remote monitoring companies). Businesses may see new reimbursement opportunities through a CMS rural payment model (more predictable payments and value-based incentives) and expanded Medicare telehealth coverage and rural staffing/supervision flexibilities beyond the public health emergency—requiring tighter compliance around Medicare billing, documentation, provider credentialing/scope-of-practice, and HIPAA/security for virtual care. Immediate actions: rural providers should track CMS/CMMI model announcements and prepare to participate (baseline quality/cost metrics, care coordination workflows, contracting), while telehealth/IT vendors should align products with Medicare requirements (eligible services, audit-ready records, security) and pursue partnerships with rural systems as USDA/HHS/FCC infrastructure funding and broadband buildouts roll out.
Full Text
Executive Order 13941 of August 3, 2020
Improving Rural Health and Telehealth Access
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1 . Purpose. My Administration is committed to improving the health of all Americans by improving access to better care, including for the approximately 57 million Americans living in rural communities. Americans living in rural communities face unique challenges when seeking healthcare services, such as limited transportation opportunities, shortages of healthcare workers, and an inability to fully benefit from technological and care-delivery innovations. These factors have contributed to financial insecurity and impaired health outcomes for rural Americans, who are more likely to die from five leading causes, many of which are preventable, than their urban counterparts. That gap widened from 2010 to 2017 for cancer, heart disease, and chronic lower respiratory disease.
Since 2010, the year the Affordable Care Act was passed, 129 rural hospitals in the United States have closed. Predictably, financial distress is the strongest driver for risk of closure, and many rural hospitals lack sufficient patient volume to be sustainable under traditional healthcare-reimbursement mechanisms. From 2015 to 2017, the average occupancy rate of a hospital that closed was only 22 percent. When hospitals close, the patient population around them carries an increased risk of mortality due to increased travel time and decreased access.
During the COVID-19 public health emergency (PHE), hospitals curtailed elective medical procedures and access to in-person clinical care was limited. To help patients better access healthcare providers, my Administration implemented new flexibility regarding what services may be provided via telehealth, who may provide them, and in what circumstances, and the use of telehealth increased dramatically across the Nation. Internal analysis by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services (HHS) showed a weekly jump in virtual visits for CMS beneficiaries, from approximately 14,000 pre-PHE to almost 1.7 million in the last week of April. Additionally, a recent report by HHS shows that nearly half (43.5 percent) of Medicare fee-for-service primary care visits were provided through telehealth in April, compared with far less than one percent (0.1 percent) in February before the PHE. Importantly, the report finds that telehealth visits continued to be frequent even after in-person primary care visits resumed in May, indicating that the expansion of telehealth services is likely to be a more permanent feature of the healthcare delivery system.
Rural healthcare providers, in particular, need these types of flexibilities to provide continuous care to patients in their communities. It is the purpose of this order to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth.
( printed page 47882)Sec. 2 . Launching an Innovative Payment Model to Enable Rural Healthcare Transformation. Within 30 days of the date of this order, the Secretary of HHS (Secretary) will announce a new model, pursuant to section 1115A of the Social Security Act (42 U.S.C. 1315a), to test innovative payment mechanisms in order to ensure that rural healthcare providers are able to provide the necessary level and quality of care. This model should give rural providers flexibilities from existing Medicare rules, establish predictable financial payments, and encourage the movement into high-quality, value-based care.
Sec. 3 . Investments in Physical and Communications Infrastructure. Within 30 days of the date of this order, the Secretary and the Secretary of Agriculture shall, consistent with applicable law and subject to the availability of appropriations, and in coordination with the Federal Communications Commission and other executive departments and agencies, as appropriate, develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.
Sec. 4 . Improving the Health of Rural Americans. Within 30 days of the date of this order, the Secretary shall submit a report to the President, through the Assistant to the President for Domestic Policy and the Assistant to the President for Economic Policy, regarding existing and upcoming policy initiatives to:
(a) increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals;
(b) prevent disease and mortality by developing rural-specific efforts to drive improved health outcomes;
(c) reduce maternal mortality and morbidity; and
(d) improve mental health in rural communities.
Sec. 5 . Expanding Flexibilities Beyond the Public Health Emergency. Within 60 days of the date of this order, the Secretary shall review the following temporary measures put in place during the PHE, and shall propose a regulation to extend these measures, as appropriate, beyond the duration of the PHE:
(a) the additional telehealth services offered to Medicare beneficiaries; and
(b) the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas.
Sec. 6 . General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
( printed page 47883)(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
THE WHITE HOUSE,
August 3, 2020.