Ensuring lifesaving telehealth services for tribal nations: A look at the 2024 bill

In an effort to safeguard healthcare access for tribal communities, Congresswoman Teresa Leger Fernández (NM-03) has introduced the Telehealth Access for Tribal Communities Act of 2024. The bill seeks to permanently extend telehealth provisions first authorized during the COVID-19 pandemic, with a particular focus on audio-only telehealth services for Medicare beneficiaries receiving care from Indian Health Service (IHS) providers or urban Indian organizations.

Audio-only telehealth—defined as real-time voice-only communication between patients and healthcare providers—has become a crucial mode of delivering care in remote and underserved Native communities. With broadband access still limited in many parts of Indian Country, this legislation aims to preserve an option that many consider a lifeline.

According to IHS data, 60% of telehealth visits during the COVID-19 public health emergency (PHE) were audio-only, with video comprising only 39%. These figures reflect both a preference and a necessity in regions where video consultations are not feasible due to infrastructure limitations.

A response to ongoing infrastructure gaps

One of the main motivations behind the bill is the significant digital divide between tribal and non-tribal areas. The Government Accountability Office (GAO) found that 18% of people living on tribal lands lacked broadband access in 2020, compared to just 4% in non-tribal areas. This disparity continues to obstruct timely and consistent access to healthcare.

Rep. Leger Fernández stated that access to healthcare should not be determined by ZIP code or internet speed. She emphasized that for many tribal communities, audio-only telehealth services are a lifeline, offering essential access to medical professionals without the need for travel.

This challenge is compounded by the fact that many tribal residents must travel long distances to reach clinics or hospitals. Audio-only services remove this barrier, making it possible for patients—particularly elders and those with mobility issues—to receive care from the comfort of their homes.

Legislative framework and long-term vision

This Act builds on previous federal efforts to expand telehealth, particularly during the COVID-19 pandemic. Under the Public Health Emergency, Medicare began reimbursing IHS and urban Indian health programs for audio-only telehealth services. Patients’ homes were also temporarily allowed as “originating sites,” enabling care delivery without a physical clinic visit.

Although the PHE expired in May 2023, Congress extended these flexibilities until December 31, 2024, through the Consolidated Appropriations Act. Further continuing resolutions extended the provisions until September 30, 2025. Without this new legislation, these pandemic-era allowances will sunset—potentially leaving tribal communities without reimbursement for audio-only services.

Key Provisions in the Proposed Bill

The Act introduces several significant changes to existing Medicare regulations under Section 1834(m) of the Social Security Act.

Elimination of originating site restrictions: The bill allows telehealth services to be provided from any location where the patient is located at the time of service. This ensures patients can continue receiving care from home or any non-clinical setting.

Permanent reimbursement for audio-only services: The legislation mandates that urban Indian health programs and Medicare reimburse IHS for audio-only services used to diagnose, evaluate, and treat health conditions—if all clinical conditions are met.

Covered services: Examples include behavioral health counseling, group therapy, and other services already approved under the Medicare Physician Fee Schedule as of the bill’s enactment.

These provisions aim not just to preserve access but to institutionalize audio-only telehealth as a permanent healthcare delivery model in tribal regions.

Endorsements and community backing

The legislation has received widespread support from tribal leaders, health organizations, and telemedicine advocates.

Some of the key supporters include National Council for Mental Wellbeing, National Council of Urban Indian Health, National Indian Health Board, The Great Plains Tribal Leaders Health Board, National Congress of American Indians, Confederated Tribes of the Colville Reservation, The Navajo Nation, Northwest Portland Area Indian Health Board, and American Telemedicine Association.

Floyd Thompson, Clinical Operations Officer of Jemez Health and Human Services, emphasized the importance of maintaining audio-only access. “Our providers still rely on phone-based services to reach patients who otherwise cannot attend appointments,” he noted.

Larry Wright Jr., Executive Director of the National Congress of American Indians, emphasized that the bill ensures access to care that respects the diverse healthcare delivery systems of each Tribal Nation.

Broader implications for tribal health equity

Building sustainable healthcare systems: Audio-only telehealth shouldn’t replace in-person or video visits, but it is crucial in areas with limited infrastructure. It helps achieve health equity and cultural competence, especially for tribal elders and those in remote areas.

Telehealth’s flexibility has been vital for addressing both medical and behavioral health needs. For many tribal patients, audio-only visits offer privacy, accessibility, and familiarity, improving care outcomes without the need for travel or high-speed internet.

As digital health regulations evolve, telehealth’s role in addressing disparities grows. Ensuring its continuation requires ongoing adjustments to telemedicine regulations and compliance in health tech.

Economic and administrative considerations: The bill offers economic benefits by allowing Indian health programs to bill Medicare for services, ensuring financial sustainability. Without reimbursement, these programs risk operating at a loss, threatening staffing and availability.

Congresswoman Leger Fernández, with co-sponsors Rep. Raúl Grijalva, Gwen Moore, and Raul Ruiz, is pushing for bipartisan support. As more tribal and health organizations back the bill, momentum continues to grow.

Closing the digital divide: The bill highlights the ongoing need to close the digital divide in tribal communities, with expanding broadband infrastructure remaining a key goal. Until then, telephonic telehealth continues to be crucial for those unable to access video calls. William Smith of the National Indian Health Board emphasized its importance for rural patients, particularly elders in isolated areas.

A step toward permanent solutions

This 2024 Act is more than a policy fix—it’s a reflection of ongoing efforts to meet the healthcare needs of underserved populations through flexible, inclusive solutions. By recognizing the challenges of geography, infrastructure, and cultural context, the bill aims to preserve a form of care that has proven essential during one of the most trying periods in public health history.

As Congress debates its future, advocates urge swift action. The stakes are clear: without intervention, thousands of tribal Medicare beneficiaries could lose access to a healthcare service that has become a reliable and, in many cases, necessary tool for wellness. For now, the phone line remains open. But whether it stays that way may depend on what lawmakers do next.