[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