Legislation Required to Shield Rural Clinics and Federally Qualified Health Centers from Looming Medicare Clawback Payments

U.S Senators Cindy Hyde-Smith (R-Miss.) and Angus King (I-Maine) today introduced legislation to protect patients receiving care through telehealth services by shielding certain clinics in underserved communities from impending Medicare clawback payments.

The Improving Telehealth for Underserved Communities Act would provide payment parity for telehealth services provided to Medicare beneficiaries at rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs) during the COVID-19 pandemic.  This would fix an unintentional problem created in the CARES Act that will force most RHCs and all FQHCs to owe money back to Medicare in July for every telehealth service provided during the public health emergency.

“The benefits of telehealth in terms of protecting patients from the threat of infection during on-site visits, as well as economically have been proven during this terrible pandemic.  We cannot add new cost demands and bureaucratic complications that threaten these achievements,” said Hyde-Smith.  “This legislation will help ensure that telehealth is available to seniors in underserved communities as we battle our way through the coronavirus threat.”

“Telehealth is a lifeline for older Americans – particularly in rural communities – and in light of the coronavirus pandemic, this importance and utilization of this technology is only growing,” said King.  “That’s why it is so critical that we adjust federal policies to help this vital medical tool continue to support the health of the American people.  This legislation will offer major economic relief for healthcare providers who are following the best public health guidance to protect the health of patients and staff, so they can continue to put safety first.”

The CARES Act allowed RHCs and FQHCs to bill Medicare as distant site providers during the COVID-19 public health emergency.  However, the Centers of Medicare and Medicaid Services (CMS) wants to recoup the cost difference between a new payment methodology and current Medicare reimbursement mechanisms for telehealth services.

The CMS demand for the clawback payments would serve as a disincentive for clinics to treat patients using telehealth services in order to avoid revenue losses and added administrative paperwork burdens.

To correct the problem, this new legislation would allow RHCs and FQHCs to provide and bill for telehealth visits using normal reimbursement mechanisms through the end of the COVID-19 public health emergency.

The National Association of Rural Health Clinics and National Association of Community Health Centers, as well as the Mississippi Rural Health Association and the Community Health Center Association of Mississippi, endorse the measure.

A companion bill (HR.6792) is pending in the House of Representatives.

Click here for a one-page summary of the Senate legislation.

Press Release