House panels back bills on telehealth coverage, new plan flexibilities 

Two key House committees voted this week to send a series of health care bills to the House floor, including legislation to make permanent the ability of health savings account-qualifying high-deductible health plans (HSA-qualifying HDHPs) to cover telehealth and other remote care services on a predeductible basis. Originally enacted as part of the 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act, this flexibility was most recently extended as part of the 2023 Consolidated Appropriations Act, and now is set to expire on Dec. 31, 2024, for calendar-year plans (later for noncalendar-year plans).

The bipartisan measure, the Telehealth Expansion Act (HR 1843), was approved on June 7 by the Ways and Means Committee along with several other bills intended to support employer-sponsored health plans, including:

• The Chronic Disease Flexible Coverage Act (HR 3800) would codify 2019 IRS guidance (Notice 2019-45) that expanded the list of preventive care items and services for certain chronic conditions permitted to be provided on a predeductible basis by an HSA-qualifying HDHP.
• The Paperwork Burden Reduction Act (HR 3797) would, according to the bill sponsor’s summary, codify existing IRS rules to end the Affordable Care Act (ACA) requirement that employers furnish paper Forms 1095-B and/or 1095-C to employees. The bill allows employees instead to request Forms 1095-B and/or 1095-C online while allowing them the option of receiving a paper copy.
• The Employer Reporting Improvement Act (HR 3801) would amend the ACA employer reporting rules to allow for any covered individual's full name and date of birth to be substituted for the individual's full name and taxpayer identification number (TIN) if the reporting entity is unable to collect such individual’s TIN. Current rules allow reporting entities to substitute birthdates for TINs if they are unable to collect individuals' TINs through “reasonable efforts,” which generally include three attempts. The bill also generally codifies current IRS rules on electronic delivery of Forms 1095-B and C to employees and gives employers more time – specifically 90 days – to respond to proposed IRS assessments (via Letter 226-J) for alleged violations of employer-shared responsibility rules.

Additional legislation approved on June 6 by the Education and Workforce Committee focuses on helping small employers by (i) making it easier to self-fund their health coverage by protecting access to purchase stop-loss insurance (Self-Insurance Protection Act; HR 2813), and (ii) facilitating easier access to Association Health Plans (Association Health Plans Act; HR 2868).

Due to jurisdictional issues with another House panel, however, the committee did not hold a planned vote on bipartisan legislation – the Telehealth Benefit Expansion for Workers Act (HR 824) – that would expand and make permanent the pandemic-related relief that treats stand-alone telehealth as an excepted benefit. Bill supporters hope to resolve those issues and advance the bill in coming weeks, but long-term prospects for the measure are clouded by opposition from patient-advocacy groups and some Democrats.  

Those groups submitted a joint statement for the record ahead of a recent House hearing detailing their concerns that extending relief from many ACA and ERISA requirements for stand-alone telehealth beyond the pandemic could encourage smaller employers to offer telehealth instead of major medical and cause confusion among workers who may think they have more comprehensive coverage.

The pandemic-related flexibility treats telehealth and remote care services like an excepted benefit, allowing employers to offer telehealth arrangements to benefits-ineligible employees like part-time or seasonal workers. This coverage does not need to comply with many ERISA and ACA group health plan mandates (e.g., first-dollar coverage of ACA-mandated preventive care). While this temporary policy is tied to the public health emergency that ended on May 11, employers now offering this stand-alone telehealth benefit may continue to do so through the end of the plan year that began before May 11 (e.g., through Dec. 31, 2023, for calendar year plans).  

Unlike the current temporary policy, the Telehealth Benefit Expansion for Workers Act would let all employers offer excepted-benefit stand-alone telehealth arrangements to all employees (including benefit-eligible opt-outs), not just those ineligible for benefits.

House Republican leaders are expected to package many of these proposals into a single health care bill for House consideration later this year, though timing and substance are uncertain at this point.