NARHC Sends Letter to Congress on Teleheath Issues



March 17, 2020

Dear Member of Congress:

In the past few days, we have seen Congress move expeditiously to expand our nation's capacity to deal with the Covid-19 pandemic including a significant expansion of the Telehealth benefit for Medicare patients. Unfortunately, this expanded telehealth authority does not extend to the patients of rural health clinics or community health centers in underserved rural and urban areas.

This means that Medicare patients served by our safety net providers ~ rural health clinics (RHCs) and community health centers (FQHCs) ~ are being forced to physically come into a RHC or FQHC to receive care. 

Federal law allows for "physicians" and "practitioners" to provide distant site services, just not "physicians" and "practitioners" who work in RHCs or FQHCs.

Thankfully, Section 7 of the bipartisan, bicameral CONNECT for Health Act would fix this issue. We strongly urge Congress to include this language in any legislation addressing the Covid-19 pandemic.

The Trump Administration sought to use their emergency waiver authority to allow for these telehealth visits, however the legal team at CMS has not yet found a way to use the waiver authority to make telehealth distant site services in RHCs and FQHCs a reality. To their credit, HHS tried to get this fixed, but unfortunately their efforts were hamstrung by technicalities in the RHC and FQHC statute/regulation that Sec. 7 of the CONNECT for Health Act would fix.

RHCs and FQHCs need the underlying statute to explicitly authorize them to provide distant site telehealth services.

Some have suggested that physicians and practitioners in RHCs and FQHCs can simply bill telehealth services to Part B on the fee schedule. This is not a viable option and it violates CMS rules on commingling. There is no failsafe billing mechanism that allows physicians and practitioners in RHCs or FQHCs to bill for distant site services through the physician fee schedule.

Patients in underserved rural and urban areas need Congress to step in and fix the law so that their providers in RHCs and FQHCs are able to provide telehealth visits during this pandemic.

Our medically underserved rural and urban communities need this policy changed as soon as possible. Should you have any questions or concerns please feel free to email or call Nathan Baugh at or (202) 543-0348.


Bill Finerfrock                                                          Nathan Baugh
Bill Finerfrock                                                              Nathan Baugh
Executive Director                                                        Director of Government Affairs
National Association of Rural Health Clinics              National Association of Rural Health Clinics