When the virus that causes COVID-19 was identified and studied, its extreme virulence was quickly recognized, along with the problems this created for healthcare facilities and providers. One response was to initiate emergency production of personal protective equipment.

Another was to ramp up telehealth services—methods of allowing patients to consult with providers without having to visit an office.

Modern technology has made telehealth possible for a few years now. Many people carry devices in their pockets that make high-resolution video conferencing possible, or at the very least can do it from a tablet, laptop or desktop computer.  Our association, along with sister organizations such as North Carolina AARP, the Rural Center, the Institute of Medicine and others, has advocated for the increased access to telehealth as well as relaxed approval requirements from public and private health insurers.  It’s working. Before the crisis, both Medicare and private health insurance providers were skeptical of telehealth, often refusing to pay for such services. Attitudes have now changed. Services are improving, and all that remains is facilitating better access to those who need telehealth services the most.

On May 2, the North Carolina General Assembly passed two bills that allocated more than $1.6 billion in federal funding provided by the CARES Act toward helping the people of this state to mitigate hardships caused by COVID-19.

Several provisions in these bills are related to promoting or expanding telehealth services in North Carolina. In addition, the use of telehealth technology was authorized for making decisions about involuntary commitments due to substance abuse or mental illness, and video conferencing for the purposes of witnessing signatures and notarization of legal documents was authorized.

Since March, Medicare has authorized and paid for telehealth visits on a much greater scale than ever before. Previously, they would only pay for such services under very narrow circumstances, and not at the same rate as office visits. These restrictions were removed in a March 13 emergency declaration by President Donald Trump.

The North Carolina State Health Plan has covered telehealth visits on the same basis as in-office visits for nearly two months.

In addition, North Carolina Medicaid has eliminated its own restrictions on telehealth services and now pays providers in a long list of healthcare disciplines, as long as the services are provided on HIPAA-compliant and secure devices. Nearly all modern smartphones, tablets and computers meet these requirements.

But there is more work to do.

All of these changes are positives and have provided greater benefit to tens of thousands of North Carolinians, but one serious problem remains, and in the eyes of numerous organizations advocating for rural and older citizens, is not being properly addressed even now. Much of North Carolina still does not have access to the high-speed Internet services needed to make use of telehealth services. The technology that allows for real-time video conferencing also requires Internet service at a high bitrate.

While such services are easily found and usually very affordable in urban areas, they are not as common, easily accessible, or affordable in many sections of rural North Carolina. Even if high-speed access is available, it may come at a higher price that makes it inaccessible to poor families or retirees on fixed incomes. While 89.5 percent of the state is covered by broadband of some sort, only 46.8 percent has access to low-price broadband plans.

The March 2 legislation passed by the General Assembly did allocate $9 million for improving rural broadband access, but this is nowhere near enough to solve the problem. Rural broadband is needed more than ever, both for access to telehealth services and for access to educational opportunities for children, especially if COVID-19 lingers and prevents schools from opening on time.

We’re working with sister organizations and the legislators to comprehensively address issues facing retirees during the crisis and after.

Resources

The NC Department of Health and Human Services has a comprehensive webpage covering telehealth services at https://medicaid.ncdhhs.gov/about-us/covid-19-guidance-and-resources/providers/covid-19-telehealth.

Current federal guidelines on telehealth coverage from Medicare can be seen here: https://www.medicare.gov/coverage/telehealth.

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