[Congressional Record Volume 166, Number 135 (Thursday, July 30, 2020)]
[Senate]
[Pages S4635-S4637]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION

      By Mr. ALEXANDER:
  S. 4375. A bill to amend title XVIII of the Social Security Act to 
make permanent certain telehealth flexibilities under the Medicare 
program related to the COVID-19 public health emergency; to the 
Committee on Finance.
  Mr. ALEXANDER. Mr. President, I want to speak for a few minutes about 
the changes to telehealth during the last five months--one of the most 
dramatic developments in the delivery of medical services ever--and why 
we in Congress should make many of those changes permanent.
  I recently heard from a psychiatric nurse practitioner in Nashville 
who has been seeing patients during the COVID-19 pandemic using 
telehealth--which means she uses the Internet to see her patients over 
video or she calls them on the telephone.
  She told me about one of her elderly patients who, before the COVID-
19 pandemic, got to her appointments by walking from her high-rise 
apartment to Gallatin Road, catching a bus, and then walking from the 
bus stop to the clinic.
  When the patient got to the clinic, she had to wait for her 
appointment. Then, when the appointment was over, she had to do all of 
these steps in reverse to get back home.
  Because of telehealth, this nurse said that her patient was in tears 
out of appreciation that she could now have appointments from her own 
home. She had access to health care without the long journey, and she 
could still receive her medications.
  The nurse said that several of her other elderly patients have had 
similar experiences and have asked if they could continue to have 
access to telehealth in the future, even after the pandemic.
  Because of COVID-19, the health care sector and federal and state 
governments have been forced to cram 10 years' worth of telehealth 
experience into almost 5 months. In 2016, there were almost 884 million 
visits nationwide between patients and physicians, according to the 
Center for Disease Control and Prevention. Almost all of them were in 
person--online or remote visits were rare.
  During the last four months, the number of online or remote visits 
virtually exploded. According to Vanderbilt University Medical Center, 
Vanderbilt went from 10 telehealth visits a

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day before the pandemic to more than 2,000 telehealth visits a day 
across specialties, including primary care, pediatrics, and behavioral 
health. In less than 3 months, Vanderbilt has provided more than 
100,000 telehealth visits.
  Before COVID-19, approximately 13,000 Americans enrolled in the 
traditional Medicare program received telehealth services in an average 
week. In the last week of April, nearly 1.7 million Americans enrolled 
in traditional Medicare received telehealth services.
  In total, over 9 million Americans in traditional Medicare received a 
telehealth service between mid-March and mid-June.
  The Nashville Journal reports that Tennessee's Centerstone, which 
provides treatment for mental health and substance use disorders, says 
it is providing nearly 2,500 telehealth visits per day and 30 percent 
more of patients are keeping their appointments, which is key to 
treating these disorders. According to Bob Vero, Centerstone's CEO, 
``We've taken away a lot of the reasons people don't follow through 
with their care.''
  Tim Adams, the CEO of Ascension Saint Thomas Health, which has 9 
hospitals in Middle Tennessee and employs over 800 physicians, told me 
that he predicts that 15-20 percent of the system's visits between 
patients and physicians will be conducted through telehealth in the 
future.
  In that 15 to 20 percent holds true across the Nation because of 
telehealth expansion during COVID-19--it would produce a massive change 
in our health care system.
  Congress and the administration reacted to the pandemic by creating a 
regulatory environment that made the current telehealth boom possible 
by allowing: in-home virtual visits; telehealth for patients in rural 
areas at rural health clinics; telehealth from physical therapists, 
speech language pathologists and other providers; telehealth for many 
more services including emergency department visits; and allowing 
Medicare hospice and home dialysis patients to start their care with a 
virtual visit.
  Now Congress is beginning to build on what we've learned and make 
those changes permanent. Here are three steps Congress should take now, 
as a part of the COVID-19 legislation that we are working on:
  Step One is to pass the COVID-19 HEALS Act legislation that was 
introduced Monday, which:
  Provides telehealth access to part-time and hourly employees; extends 
the administration's telehealth flexibilities and waivers through the 
end of the Public Health Emergency, or through 2021; and allows Rural 
Health Clinics and Federally Qualified Health Centers to continue to 
provide telehealth to Medicare beneficiaries for 5 years beyond the 
public health emergency.
  Step Two is to pass the CONNECT for Health Act. That legislation 
explores ways to expand telehealth services and begins to permanently 
remove some of the restrictions on where a patient needs to be for 
telehealth access. The bill is already supported by a broad coalition 
in the Senate and the House.
  Here in the Senate, the CONNECT for Health Act has been led by 
Senators Roger Wicker (R-MS), Brian Schatz (D-HI), Cindy Hyde-Smith (R-
MS), Ben Cardin (D-MD), John Thune (R-SD), and Mark Warner (D-VA)--and 
today the bill has 38 cosponsors in the Senate.
  This bill was first introduced in 2016 and these senators deserve 
great credit for seeing the need to expand permanently telehealth 
services even before the pandemic forced a massive change in how 
Americans receive health care from their doctors.
  Step Three would be to pass the bill I'm introducing today which 
would go further than either of those first two steps and would make 
permanent in-home visits and rural telehealth access. The bill would 
also give the Secretary authority to make permanent other changes that 
the Administration has made over the last few months.
  Here's what the bill being introduced today does:
  Ensures that patients can access telehealth anywhere by permanently 
removing Medicare's so-called ``geographic and originating site'' 
restrictions, which required both that the patient live in a rural area 
and use telehealth at a doctor's office or clinic.
  Congress temporarily ended these restrictions in the Coronavirus 
Preparedness and Response Supplemental Appropriations Act that was 
signed into law on March 6, allowing millions of Americans to talk with 
their doctor virtually during the pandemic.
  Making this change permanent will ensure Medicare beneficiaries do 
not lose that ability when the pandemic ends.
  Protects access to telehealth for patients in rural areas. The bill 
makes permanent a change allowing Medicare beneficiaries to continue 
receiving telehealth services from Rural Health Clinics or Federally 
Qualified Health Centers.
  Telehealth access is especially important for patients in rural and 
other medically underserved areas because they no longer have to travel 
to see their primary care doctor.
  Those are two changes that this bill would make permanent.
  Then it would give the Secretary of Health and Human Services new 
authorities to do these three things:
  Help patients continue to access telehealth from physical therapists, 
speech language pathologists, and other health care providers.
  The bill gives authority to the Secretary of Health and Human 
Services to allow Medicare to permanently expand the types of health 
care providers that can offer telehealth services.
  Before COVID-19, only doctors, nurse practitioners, physician 
assistants, and certain other practitioners could deliver telehealth 
services.
  Today a much wider range of health practitioners are providing 
telehealth services.
  Help give Medicare recipients many more telehealth services.
  The bill gives authority to the HHS Secretary to give Medicare the 
flexibility to reimburse for more telehealth services.
  During the pandemic, Medicare has been reimbursing for 135 telehealth 
services, more than doubling the number of telehealth services covered 
before COVID-19. Examples include emergency department visits, home 
visits, and physical, occupational and speech therapy services. Help 
Medicare hospice and home dialysis patients begin receiving care 
through a telehealth appointment.
  Medicare requires a face-to-face visit when a patient begins hospice 
and home dialysis care, and this change would provide authority to the 
HHS Secretary to allow a telehealth visit to fulfill the requirement 
for an in-person visit. This will provide flexibility to improve access 
for these patients and account for individual circumstances. This 
legislation is the result of the Senate Health, Education, Labor and 
Pensions Committee hearing on June 17, during which senators asked 
health care experts about the 31 temporary Federal policy changes made 
in response to the COVID-19 pandemic.
  The legislation I am introducing today incorporates the 
recommendations of those experts to make permanent 5 of the most 
important changes--and helps to ensure that patients do not lose the 
benefits that they have gained from using telehealth during the COVID-
19 pandemic.
  This bill would make permanent the telehealth changes in the 
legislation introduced Monday as well as the CONNECT for Health Act. 
The best result for the American people would be for Congress to 
approve all three steps--the changes in the HEALS Act, the CONNECT for 
Health Act, and my legislation--in the next COVID-19 package so we 
don't miss the opportunity to support and encourage one of the most 
important changes in the delivery of medical services ever.
                                 ______
                                 
      By Mr. KAINE:
  S. 4390. A bill to establish a grant program to support schools of 
medicine and schools of osteopathic medicine in underserved areas; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. KAINE. Mr. President, communities of color and those living in 
rural and underserved area face significant barriers to healthcare, 
including physician shortages. Unfortunately, in many communities of 
color and rural areas, there are few pathways to enter the medical 
profession. Recent data shows that while medical school enrollment

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is up by 30 percent, the number of students from rural areas entering 
medical school declined by 28 percent between 2002 and 2017, with only 
4.3 percent of all incoming medical students coming from rural areas in 
2017. Similarly, Black, Hispanic/Latino, and Native American students 
face several barriers to matriculate and graduate from medical school. 
This exacerbates the barriers to care and the disparities in health 
outcomes that these communities experience. It is critical that we 
expand the diversity of our physician workforce to tackle the rampant 
disparities and systemic biases within our healthcare system.
  This is why I am introducing the Expanding Medical Education Act, 
which aims to tackle the lack of representation of rural students, 
underserved students, and students of color in the physician pipeline 
by encouraging the recruitment, enrollment, and retention of students 
from disadvantaged backgrounds. The bill would provide grants through 
the Health Resources and Services Administration, HRSA to colleges and 
universities to establish or expand allopathic or osteopathic medical 
schools in underserved areas or at minority-serving institutions, 
including historically Black colleges and universities, HBCU. These 
grants can be used for planning and construction of a medical school in 
an area in which no other school is based; hiring diverse faculty and 
staff; recruitment, enrollment, and retention of students; and other 
purposes to ensure increased representation of rural students, 
underserved students, and students of color in our physician workforce.
  Our rural communities and communities of color face significant 
challenges in access to healthcare. It is time our physician workforce 
reflected these communities. We need to diversify our physician 
pipeline and change the disparity in representation, and this bill will 
help get us there. I hope the Senate passes this legislation quickly to 
expand the diversity of the medical profession and to take a step 
towards improved access to care for our marginalized communities.

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