[Federal Register Volume 85, Number 152 (Thursday, August 6, 2020)]
[Presidential Documents]
[Pages 47881-47883]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-17364]


 
 
                         Presidential Documents 
 
 

  Federal Register / Vol. 85, No. 152 / Thursday, August 6, 2020 / 
Presidential Documents  

[[Page 47881]]


                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.

[[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.

[[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.


                    (Presidential Sig.)

                THE WHITE HOUSE,

                    August 3, 2020.

[FR Doc. 2020-17364
Filed 8-5-20; 11:15 am]
Billing code 3295-F0-P