Press Releases

Congresswoman Teresa Leger Fernández (NM-03) introduced the Telehealth Access for Tribal Communities Act of 2024, crucial legislation designed to protect access to essential healthcare services through audio-only telehealth for Medicare beneficiaries in tribal communities.

The bill seeks to extend the COVID-19 Public Health Emergency (PHE) provision that allows audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or urban Indian organizations beyond 2024. This provision addresses the persistent challenge of access to healthcare in Indian Country where many residents face long drives to see a medical professional and millions don’t have access to reliable high-speed internet. As the COVID-19 Public Health Emergency (PHE) expired in May 2023, IHS patients used audio only services 60% of the time and video 39% of the time.

“Not everyone has access to Zoom or the internet. Indeed, the folks most in need of healthcare services don’t. Access to healthcare should not be determined by zip code or internet speed,” said Congresswoman Leger Fernández. “For many tribal communities, audio-only telehealth services are a lifeline, providing vital access to medical professionals without the burden of travel. While audio-only telehealth should not be the only way to access healthcare services, it should be protected for those who may not have other options. The Telehealth Access for Tribal Communities Act will ensure that our elders, families, and those living in remote areas continue to receive the care they need.”

The bill is co-sponsored in the House by Congressman Raúl M. Grijalva (AZ-07), Congresswoman Gwen Moore (WI-04), and Congressman Raul Ruiz (CA-25).

Background: 

Audio-only telehealth involves real-time interactive voice-only discussions between a patient and a provider, requiring only a working phone. 

According to the Government Accountability Office (GAO), in 2020, 18% of people living on tribal lands couldn't access broadband service, compared to 4% of people in non-tribal areas.

During the COVID-19 Public Health Emergency (PHE), Medicare began reimbursing the Indian Health Service (IHS) for specific audio-only telehealth services provided to Medicare beneficiaries. This included allowing patients to receive care from the comfort of their homes. Although the PHE ended on May 11, 2023, Congress extended this flexibility through December 31, 2024, under the Consolidated Appropriations Act. Without further extension through this new legislation, Medicare may cease to reimburse IHS for these essential services, jeopardizing healthcare access for tribal communities.

The bill removes originating site requirements, allowing Medicare beneficiaries to remain in their homes for audio-only telehealth visits, rather than needing to travel to a healthcare facility.

The Telehealth Access for Tribal Communities Act has garnered strong support from a range of organizations, including:

• Northwest Portland Area Indian Health Board
• American Telemedicine Association
• National Indian Health Board
• National Council of Urban Indian Health
• Jemez Health and Human Services Department in NM 
• President Buu Nygren of The Navajo Nation (letter of support submitted)
• Health, Education and Human Services Committee (HEHSC) of the 25^th Navajo Nation Council (letter of support submitted)
• Alliance for Connected Care
• National Congress of American Indians (letter of support submitted)
• National Council for Mental Wellbeing
• Colville Reservation
• The Great Plains Tribal Leaders Health Board 
•  COLT (Coalition of Large Tribes) (letter of support submitted)

“Audio-only telehealth services remain a vital option for medical and behavioral health providers in rural New Mexico as the digital divide continues to marginalize many tribal communities.  At times, the Jemez Health and Human Services providers continue to rely on audio only telehealth services to reach clients who are otherwise unable to make needed medical and behavioral health appointments.  Supporting the continuation of tribal programs to bill for these critical health services under the authorities of Medicare will help to sustain these services into the foreseeable future as communication options are limited, at times, amongst the native populations,” said Floyd Thompson, Clinical Operations Officer, Jemez Health and Human Services. 

The National Congress of American Indians (NCAI) extends its support for the Telehealth Access for Tribal Communities Act of 2024 in its goal of ensuring that Indian Country communities are given permanent access to telehealth care. These services are essential for addressing critical healthcare services in appropriate manners that fit every unique Tribal Nation’s healthcare systems. We hope to see Congress build upon the healthcare infrastructure capacities for all Tribal citizens across the United States and continue improving access to care for generations to come,” said Larry Wright Jr., Executive Director, National Congress of American Indians. 

“The National Council of Urban Indian Health is pleased to endorse the Telehealth for Tribal Communities Act introduced by Representative Leger Fernandez. This legislation is critical to increase access to care for our American Indian and Alaska Native communities. Maintaining the Public Health Emergency’s Medicare reimbursement of audio-only telehealth demonstrates a commitment to addressing health disparities in Native communities. I urge Congress to swiftly pass this bill, which is critical to ensure our patients have continuous access to culturally competent care wherever they reside,” said Francys Crevier (Algonquin), CEO, National Council of Urban Indian Health. 

“Telehealth has been a lifeline to many in tribal communities, improving access to care for those facing issues like geographic isolation and lack of technology infrastructure. We support the Telehealth for Tribal Communities Act, which would ensure Medicare beneficiaries can continue to receive audio-only telehealth services, even when broadband is not available. We are grateful for the ongoing bipartisan support for telehealth services and thank Congresswoman Teresa Leger Fernández and her Congressional colleagues for advancing this important legislation,” said Kyle Zebley, Senior Vice President, Public Policy, American Telemedicine Association and Executive Director, ATA Action. 

“This legislation allows Indian health programs and the individuals they serve the permanent flexibility to use telehealth services under Medicare. Telephonic telehealth has been a popular and critical access point for care for rural patients, including our Elders who live in some of the most remote parts of Indian Country. Without broad access to reliable broadband services, telephonic telehealth will continue to be an important access point for Medicare services. NIHB is proud to support this much needed legislation,” said William Smith, Chairman, National Indian Health Board.  

“The Telehealth Access for Tribal Communities Act is an important part of creating a comprehensive and accessible health care system for all American Indians and Alaska Natives receiving healthcare services at IHS and Tribal Health Programs. We raise our hands to Rep Leger-Fernandez for her commitment to improving the health and well being of our people,” said Nickolaus Lewis, Chair, Northwest Portland Area Indian Health Board.