Elderly woman taking covid-19 vaccine in rural environment.

In an effort to close healthcare equity gaps in rural America, the Centers for Medicare & Medicaid Services (CMS) on Friday proposed a rule that will make sure people in underserved areas get access to behavioral health services through telemedicine. 

“CMS is taking action to ensure that people with Medicare in rural and underserved areas have improved access to high quality health care and to prepare for the next pandemic,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The proposals in this rule, if finalized, will expand access to care options in rural communities and permanently allow behavioral health services to be provided to people in their homes.” 

During the COVID-19 public health emergency, CMS implemented emergency rules that allowed more flexibility in the way providers delivered care to patients. Telehealth was one of the most highly used offerings. The proposed rule would continue payment for remote behavioral health services provided by clinical staff of hospital outpatient departments after the PHE expires. Last Friday, the Biden administration announced it will extend the PHE until Oct. 13, 2022. The proposed rule would ensure that rural patients continue to receive those services beyond that date.

Still, the rule doesn’t ensure that everyone in rural America who needs behavioral health services will be able to access them virtually, at least not immediately. While telehealth has boomed during the COVID-19 pandemic — increasing five-fold according to one study — a 2020 Federal Reserve study found about 20% of rural Americans lacked access to broadband compared to 10% of urban dwellers. The Biden administration is trying to address the problem by building out broadband services through the infrastructure bill signed into law late last year.

In addition to addressing behavioral health, the CMS rural health initiative also includes a provision that would ensure that healthcare providers in rural settings have access to National Institute for Occupational Safety and Health-approved N-95 respirators in future public health emergencies. CMS said it recognizes that hospitals may incur additional costs when trying to source that equipment and is proposing additional payments under the Inpatient Prospective Payment System and Outpatient Prospective Payment System to cover the costs.