	Introduction

Telehealth is "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration." Th ough "telehealth" may refer to non-clinical services that are provided remotely, such as training, administrative meetings, and continuing education, some individuals may use the term "telemedicine" to describe the use of telecommunications technologies in clinical situations that include patient diagnosis, prescriptions, and treatment at a distance. The 114 th Congress has witnessed the introduction of a number of telehealth-related pieces of legislation that address a wide range of issues that have the potential to impact access to, along with the cost and quality of care under various federal programs, including Medicare. In recent years, the federal government has embarked on various initiatives to increase access to telehealth services (as well as to improve the underlying technological infrastructure that supports telehealth) at more than 20 federal agencies. The Centers for Medicare and Medicaid Services (CMS) (of the Department of Health Human Services (HHS)) reported a total of $17.6 million in Medicare (Part B) payments to providers for 192,692 telehealth visits in CY2015. Though providers are using telehealth to overcome barriers to health care access created by geography and time, the evidence-base for its use, including issues related to cost and quality, are strong in some areas and weak in others. Roadmap

This report describes telehealth activities at selected federal agencies, and the evidence available to assess telehealth through the lenses of health care access, cost, and quality. Department of Veterans Affairs

The VA operates the largest integrated health care delivery system in the United States. In 2015, VA providers delivered 2.1 million telehealth consultations to more than 677,000 veterans via videoconferencing, home telehealth, and store-and-forward telehealth that were provided through one or more of those systems. For example, the Medicare Access and CHIP Reauthorization Act (MACRA) established a new Merit-Based Incentive Payment System (MIPS). Although many studies have been published on the quality of telehealth activities under the federal Medicare program, fewer studies have been published on state Medicaid programs. Agency for Healthcare Research and Quality (AHRQ)
Centers for Disease Control and Prevention (CDC)
Centers for Medicare & Medicaid Services (CMS)
Department of Agriculture (USDA)
Department of Labor (DOL)
Department of the Army (Telemedicine & Advanced Technology Research Center [TATRC])
Department of the Army (Army Medical Department (AMEDD))
Department of the Navy National Center for Telehealth & Technology (T2)
Department of Transportation (DOT)
Department of Veterans Affairs (VA)
Federal Bureau of Prisons (BOP)
Federal Communications Commission (FCC)
Food and Drug Administration (FDA)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
International Trade Administration (ITA)
National Aeronautics and Space Administration (NASA)
National Institutes of Health (NIH) 
National Institute of Justice (NIJ)
National Institute of Standards and Technology (NIST)
National Science Foundation (NSF)
Office of the Assistant Secretary for Preparedness and Response (ASPR)
Office of the National Coordinator for Health Information Technology (ONC)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Appendix C. ACA and Telehealth
The ACA created several incentives for telehealth advancement, mainly through Medicare and Medicaid pilots and programs. For example, the ONC coordinates some telehealth-related activities throughout HHS.
Telehealth is the use of electronic information and telecommunications technologies to support remote clinical health care, patient and professional health-related education, public health, and other health care delivery functions. A narrower concept, telemedicine, refers to clinical services that are provided remotely via telecommunications technologies. Some sources use the two terms interchangeably, and there is no consensus among federal programs and among health care providers on the definition of either term.
Federal involvement in telehealth is varied. As of 2014, more than 20 federal agencies were engaged in some aspect of telehealth. For example, in FY2015, the Department of Veterans Affairs (VA) was the largest telehealth provider in the federal government, providing 2.1 million telehealth consultations to some 677,000 veterans. In contrast, the Medicare (Part B) program, covering more than 52 million beneficiaries, the number of telehealth visits increased fivefold from 38,000 telehealth consultations (or visits) in 2009 to 192,692 in 2015. The VA, the Centers for Medicare and Medicaid Services (CMS), the Institute of Medicine, and other stakeholders have identified barriers associated with the use of telehealth, notably that some telehealth modalities have a stronger evidence base than others. Furthermore, according to the Agency for Healthcare Research and Quality (AHRQ), key issues requiring additional research are the impact of telehealth on individual and population health, and on moving away from traditional fee structures toward rewarding clinicians for value versus volume of care.
Telehealth has been an active legislative issue thus far in the 114th Congress. For example, in February 2016, bipartisan legislation was introduced to expand telehealth reimbursement for remote patient monitoring under the Medicare program. In December 2015, the Senate Committee on Finance published options for expanding telehealth utilization for Medicare beneficiaries with chronic conditions. H.R. 6, the 21st Century Cures Act (as passed by the House), would require CMS and the Medicare Payment Advisory Commission to submit programmatic information to Congress on telehealth. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) includes a provision that encourages the use of telehealth as an element in the new Merit-Based Incentive Payment System and requires the Government Accountability Office to study telehealth and its use under the Medicare program.
This report identifies telehealth activities at select federal agencies along with an assessment of the evidence regarding the potential impact of telehealth on health care access, cost, and quality.