2019 KICKS OFF WITH EXPANDED REIMBURSEMENT ANTICIPATED IN MEDICARE ACOs & CA MEDICAID (Medi-Cal)

ACO Telehealth Expansion in Medicare Shared Savings Program

As required by the Bipartisan Budget Act, CMS has finalized their rule to broaden telehealth reimbursement for Medicare Accountable Care Organizations (ACOs) in the Shared Savings Program under the BASIC track (under a two sided model) and ENHANCED track when the ACO elects prospective assignment.  The finalized regulation allows eligible physicians and practitioners in the applicable ACOs to be reimbursed regardless of the geographic location of the patient and allows the home to be the originating site.  If the home was the originating site, there would be no facility fee allowed.  Other locations, besides the patient’s place of residence, would not qualify for reimbursement under the new rule, such as a school.  Other Medicare telehealth requirements would still apply, such as provider type and service code limitations.  Additionally, CMS also clarifies in the rule that in the case where the beneficiary’s home is the originating site, Medicare will not pay for telehealth services that are inappropriate to be furnished in the home even if the services are on the approved list of telehealth services, such as inpatient hospital visits.  The change would not be applicable until plan year 2020.

To learn more, read the full text of the rule.

California Medicaid Conducts Webinar on Proposed Telehealth Changes

 

In late 2018, the Department of Health Care Services (DHCS), which administers California’s Medicaid program (Medi-Cal), released proposed updates to their telehealth policy manuals, including those for fee-for-service, managed care, Indian Health Services, Family Plan, Access, Care and Treatment (Family PACT), dentistry and FQHC/RHCs.  Among the most intriguing and exciting proposal is allowing the distant site/treating provider to decide when it is appropriate for telehealth to be used and whether it should be via live video or store-and-forward.  E-consult (provider to provider consultation), falling under the auspice of store-and-forward, would also be reimbursed, making California along with Connecticut the only state Medicaid programs in the country reimbursing for that particular service.  The proposals also allows for the home as an originating site as well as what appears to be other non-clinical locations. After accepting and reviewing comments from stakeholders, DHCS held a webinar to respond to questions and comments on December 17, 2018 regarding the proposals.  During the webinar, they clarified and responded to several key areas of interest among commenters.

 

For more information, see the complete DHCS PowerPoint Slide Deck, and stay tuned for future updates and a more in-depth CCHP summary and analysis of DHCS’ responses to all of the comments they received. 

 

FQHC/RHC Medicare Benefit Policy Manual Update

In December, CMS released their update to Chapter 13 of their Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual.  The telehealth related changes are consistent with the changes made in the Calendar Year 2019 Physician Fee Schedule, specifying that Medicare will reimburse RHCs and FQHCs for communication based technology and remote evaluation services not already captured in the RHC AIR or FQHC PPS payment, waiving the face-to-face requirement.  FQHCs and RHCs must meet certain requirements to bill for the virtual communication services, including furnishing at least five minutes of communications-based technology or remote evaluation services that has a billable visit within the previous year; and only for medical discussion or remote evaluation for a condition not related to an RHC or FQHC service provided within the previous 7 days and does not lead to a service within the next 24 hours or soonest available appointment.  In the case of the latter, the practitioner’s time would be included in the RHC AIR or the FQHC PPS payment and is not separately billable. FQHCs and RHCs are not, however, eligible for reimbursement of the interprofessional internet consultation.
Read the full text of the manual update for more information.  

 

NIST Report Shows Potential Security Concerns in First Responder Technology

In December, the National Institute of Standards and Technology (NIST) released their Draft NIST Interagency/Internal Report 8196, Security Analysis of First Responder Mobile and Wearable Devices*. The draft report highlights security issues regarding mobile devices and wearable technology used by first responders. These security issues include the potential misuse and sharing of devices by personnel and interception of personal information collected and shared across mobile communications devices. According to the report, unencrypted or poorly encrypted communications between emergency medical service, fire service, and law enforcement have a relatively high likelihood of being intercepted and revealing sensitive information regarding the location of the emergency and personnel or details of the personal health information of those receiving care from first responders. The report states that little guidance exists to mitigate the highlighted threats, but provides some security objectives for addressing them, including authentication procedures, and improving confidentiality among others.
For more information about the report, the full draft* is available through the NIST website. 
(*
Please note that due to a lapse in government funding, this page may currently be unavailable). 

 

FDA Approves Mobile Application for Improved Opioid Use Disorder Treatment Retention

 

The U.S. Food and Drug Administration (FDA) has approved a mobile application intended to increase patient retention in treatment programs for individuals with opioid use disorder (OUD). The app, called reSET-O, serves as a prescription-only cognitive behavioral therapy and is intended to be used in conjunction with outpatient treatment including buprenorphine and contingency management. Patients using the app receive training and reminders while providers monitor the patient’s adherence to the program. In the FDA’s 12-week clinical trial of 170 patients, use of the desktop computer version of the reSET-O program showed significantly greater retention at the end of the 12-week period with 82.4% of test group participants completing the 12-week treatment compared to 68.4% in the control group.
Further information can be read in the FDA’s press announcement regarding the app. 

 

Government Funding Needed to Expand Telehealth Access in Rural Texas

While Texas policy permits the use of telemedicine, many rural areas of the state lack the broadband capacity necessary to implement it. There have been efforts to expand rural broadband, such as the Federal Communications Commission’s decision last year to expand funding for the Rural Health Care Program to $571 million (up from $400 million previously). However, according to a report by Politico’s Renuka Rayasam, state and federal efforts to expand broadband have not been well coordinated in Texas. The article suggests that there is little private sector interest in expanding broadband connectivity across rural Texas, leaving any expansion to government funding. The 2019 Texas legislature is expected to explore solutions and propose bills to assist with the rural expansion of broadband services. Policy efforts will need to be well coordinated with local governments and organizations to ensure that any potential funding is used to expand services into areas with less access to health care.

 

STATE LEGISLATION
TEXAS:

SB 71- Establishes the statewide telehealth center for sexual assault forensic medical examination to expand access to sexual assault nurse examiners for underserved populations.   VIEW BILL INFO  (Status: 11/12/18 Introduced)

SOUTH CAROLINA
H.3399/S.132 – 
Establishes requirements for physician assistants utilizing telemedicine, including establishing a patient relationship and prescribing.  VIEW H.3399 or S.132 INFO  (Status: H. 3399 – Committee on Medical, Military, Public and Municipal Affairs/S. 132 – Referred to Committee on Medical Affairs)

INDIANA:
HB 1197 –
Permits a physical therapist licensed in another state to provide professional opinions or advice via telemedicine to a physical therapist or professional health care provider located in Indiana.  VIEW BILL INFO  (Status: 1/10/19 Introduced)

NORTH DAKOTA:
SB 2173 – 
Enters North Dakota into the Interstate Medical Licensure Compact. VIEW BILL INFO (Status: 1/8/19 Introduced)

VIRGINIA:
HB 1970/SB 1221 – 
Establishes requirement that insurers, corporations, or health maintenance organizations that cover telemedicine services must cover remote patient monitoring as part of those services to the fullest extent to which they are available. Designates that the telemedicine service occurs where the practitioner is located at the time of service provision. VIEW HB 1970 or SB 1221 INFO (Status: HB 1970 – 1/4/19 Committee Referral Pending/SB 1221 – 1/4/19 Referred to Committee on Education and Health)

 

For more information on state legislation
and regulations,visit
CCHP’s legislative tracking webpage.