Hardware

Agencies Re-Evaluate Telehealth Grants Beyond the Pandemic

Shifting federal priorities have the government focusing on digital equity and broadband grants and attempting to roll back certain pandemic-era telemedicine policies.

Dave Nyczepir

Dave Nyczepir is a Senior Editor for Manifest.

Michael Hickey

Michael Hickey is an Associate Editor at Manifest.

Agencies are re-evaluating telehealth grants because healthcare providers that took advantage of them during the COVID-19 pandemic are, in some cases, struggling to maintain or even use the technologies they bought with the funds.

Some agencies are asking whether the demand for telehealth exists, says Curtiss Strietelmeier, public sector funding strategist at CDW·G. The question stems from a persistent lack of broadband in rural areas and the fact that seniors, in particular, are seeking to return to face-to-face visits with their doctors.

Two large appropriations for telehealth funding were included in the Coronavirus Aid, Relief and Economic Security Act and the American Rescue Plan Act. Yet, the government isn’t pushing to replace those grants, despite the Biden administration’s intent to end the public health emergency declaration on May 11.

“There’s a lot of money being invested in things like digital equity and broadband build-out,” Strietelmeier says. “So, I think they’re going to go back and invest more in that, at least short-term build-out of backbone, before they come back and do telehealth.”

Without the COVID-19 telehealth grants, there’s a void in funding for wearable healthcare technology to monitor vital signs, and for supporting infrastructure such as Wi-Fi hotspots for the home. Those devices will likely fall under future digital equity grants, Strietelmeier says.

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Telehealth Grants That Care Providers Should Know

Care providers seeking federal grants to implement virtual care solutions should first familiarize themselves with the Healthcare Connect Fund Program. As part of the Federal Communications Commission’s annual $571 million Rural Health Care Program administered by the nonprofit Universal Service Administrative Company, the fund offers providers a 65 percent discount on the cost of high-capacity broadband connectivity.

“It’s probably the big one we focus on the most, because it’s the most easily accessible,” Strietelmeier says. “There’s a ton of money available, and it’s pretty broad use.”

The application period opens July 1 and closes June 30 of the following year.

First, care providers must check with USAC to find out if they qualify and then publicly post what they’re seeking to purchase for 28 days. Providers then pick a vendor and await funding approval. Any money that providers don’t spend goes back into the fund for the next year.

The second telehealth funding source care providers should know about are competitive Distance Learning & Telemedicine Grants.

Congress provided $60 million to the U.S. Department of Agriculture Rural Development program for the grants, which range from $50,000 to $1 million and require a 15 percent match to cover the purchase of:

Audio and video equipment
A certain percentage of broadband facilities for telemedicine
Computer hardware, network components and software
Limited technical assistance and instruction

The application window ran from Dec. 1 to Jan. 30 and is expected to open again in the fall.

Rural and tribal support are key determinants in which providers receive grants.

“Telemedicine is difficult in rural environments because your clients don’t necessarily have access to broadband,” Strietelmeier says. “You almost have to be rural, but not so crazy rural that it won’t work.”

Generally, rural areas 15 to 20 miles outside a major metropolitan area are seen as the sweet spot, since they are likely to have some broadband infrastructure already in place to support telemedicine.

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Providers Should Plan for Telehealth Grants in Advance

CDW·G helps care providers understand telehealth grants, eligibility, use and timelines, but applying falls to the providers themselves.

Strietelmeier’s advice for first-timers: “Have a two- to three-year plan, know what you want to do and start having those discussions.”

The government may ask for a unit diagram of an applicant’s network, and not having one ready to submit could result in rejection, he adds.

Smaller annual telehealth grants exist for, say, libraries to build out healthcare locations or school telemedicine clinics, but they’re harder to predict.

With any grant, applicants should be prepared to pay the total cost of the virtual care solutions they seek upfront, with the government reimbursing them later.

Telemedicine is difficult in rural environments because your clients don’t necessarily have access to broadband.”

Curtiss Strietelmeier Public Sector Funding Strategist, CDW·G

Agencies Want to Codify Pandemic Telehealth Flexibilities

The end of the COVID-19 public health emergency declaration may also result in the rollback of telehealth flexibilities.

Practitioners registered with the Drug Enforcement Administration are able to prescribe controlled substances to patients remotely through December 2024, but Congress would have to intervene to extend the date.

Aside from extending that flexibility, the 2023 Consolidated Appropriations Act ensured that:

People with Medicare can access telehealth anywhere in the U.S., not only in rural areas.
People with Medicare can stay at home for the telehealth visits it pays for.
Certain telehealth visits can be audio only, such as by telephone, if video is unavailable.

The Department of Veterans Affairs is working with other agencies to propose new regulations to Congress that would make these telehealth expansions permanent for veterans.

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Matt Rogers, director of VA’s National Clinical Resource Hub, said in a press conference that he’s looking to Congress for assistance “to ensure we can treat all veterans equitably when prescribing treatments through telehealth, irrespective of state lines.”

Both the Centers for Medicare & Medicaid Services and the Department of Health and Human Services released guidance detailing telehealth availability after the emergency declaration is over. While Medicare telehealth flexibilities will end in December 2024, those for Medicaid and the Children’s Health Insurance Program aren’t tied to the declaration and will vary by state.

Patients’ access to buprenorphine for opioid use disorder treatment through telehealth is up in the air. The Substance Abuse and Mental Health Services Administration began allowing patients to obtain a buprenorphine prescription via telehealth early in the pandemic.

HHS deemed the flexibility safe and effective, and SAMHSA in December proposed making it permanent as part of changes to federal regulations. However, other agencies have proposed changes that would restrict access to buprenorphine via telehealth.

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Proposed Telehealth Restrictions Face Pushback

VA and HHS worked closely with the Drug Enforcement Administration to propose permanent telehealth rule changes. These would extend some flexibilities adopted during the public health emergency but with increased restrictions.

The proposal singled out telemedicine consultations by a medical practitioner who has never evaluated the patient in person and those that result in the prescribing of a controlled medication. For these consultations, the new rules would allow the prescription of a 30-day supply of Schedule III-V non-narcotic controlled medications and a 30-day supply of buprenorphine for the treatment of opioid use disorder without an in-person evaluation.

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Most of the thousands of public comments on the proposed rules criticized their restrictions on telehealth.

Law firm Foley & Lardner issued a statement citing compelling comment letters from professional associations, think tanks and experienced clinicians noting that the proposed rule will result in:

Limitations on access to care
Harm to patients in rural and urban areas
Avoidable overdoses and deaths when patients are denied access to medications

“We are concerned that these limits are arbitrary, unnecessarily burdensome, and will reduce access to critical care,” the American Hospital Association said in a statement.