As the government shutdown finally comes to a close, digital health policies are top of mind for many who work toward a better healthcare system. The work Congress and federal agencies do to promote digital health, value-based care, and health innovation is fundamental to improving the quality of care, lowering costs, and reducing provider burnout. But right now, many pieces of digital health policy are in danger of or have already expired. Partisan disagreements have blocked the road for consideration of these important policies, but the opportunity of the post-shutdown consideration of health policies gives Congress the chance to make meaningful strides forward on digital health.

There are a few main policies that are in danger during the lapse in waiver authority:

  1. Failure to update tax-advantaged accounts: Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) may be spent on a tax-advantaged basis on eligible medical care. Medical care now includes access to wearable devices and related digital health technologies. Unfortunately, the shutdown has contributed to the challenges the Internal Revenue Service (IRS) has encountered in modernizing FSAs’ and HSAs’ coverage to include digital health tools, especially those with multiple preventive and monitoring purposes. With the Secretary of Health and Human Services focused on enabling access to wearable devices for all Americans in four years, Congress now has an opportunity in government funding negotiations to clarify the eligibility of these crucial technologies for FSA and HSA expenditures.
  2. Medicare telehealth reimbursement: During the COVID-19 pandemic, Congress temporarily allowed the Department of Health and Human Services (HHS) to lift several outdated restrictions on the eligibility of telehealth services for reimbursement through Medicare. The main restrictions waived included originating site restrictions, requiring a patient to visit a qualified site to receive telehealth services rather than remaining in their homes; and geographic restrictions, limiting eligible services to patients who live in rural areas. On the same day as the government entered the shutdown, the temporary allowance for HHS to waive the restrictions expired, sunsetting a provision that otherwise could have been extended as part of a bill to fund the government. The lapse of these waivers forces patients to adjust their care plans and increases the load on overburdened healthcare providers, all for no evidence-backed reason. We urge Congress to extend the Medicare telehealth reimbursement waivers and work towards permanent support for Medicare telehealth services.
  3. Federally Qualified Health Centers and Rural Health Clinics: Another waiver for the provision of telehealth services allowed Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant site providers for telehealth services, opening up many low-income and rural patients to telehealth visits. These services resulted in increased show rates for appointments and better treatment for patients with sensitive concerns like depression. Without waivers for Medicare services and proper funding reimbursement from Medicaid, FQHCs and RHCs will be less able to support their patient populations. Congress must ensure that these health centers can continue to provide key telehealth services for their patients.
  4. Audio-only telehealth services: While Medicare allows reimbursement for two-way audio-visual telehealth services for many types of care, audio-only services have been more restricted. The pandemic-era waiver expanded audio-only services to a much wider range of care types. This category of services can be much more accessible for patients with limited broadband availability, without access to video call technology, or with low technical skills. Protecting these vulnerable patients is a necessity for Congress.
  5. In-person requirements for mental and behavioral health: Congress took a great step forward on digital health and telemedicine when they fully covered telehealth services for mental and behavioral health. Even though the other waivers have expired, this change remains permanent law. Unfortunately, one waiver is still necessary for full coverage: in-person visit requirements. If patients do not meet geographic requirements, they must meet in-person with a behavioral health professional to subsequently receive telehealth services. This friction point reduces the availability of mental and behavioral health for patients without reliable transportation, with mobility issues, or with erratic work schedules. Congress should ensure mental and behavioral health services remain available by extending the waiver on in-person visit requirements and pushing for their permanent elimination.

Congressional gridlock has allowed all of these important waivers to lapse for over a month. This inaction delays critical care, increases costs for patients, and decreases reimbursements for providers who treat these patients. But now, Congress has an opportunity to tackle these problems in the health debates upcoming before the end of the year. We must ensure that digital health can give healthcare providers the support they need to treat these patients and give patients the flexibility to engage with their healthcare.