From Broadband to Medicare Reimbursement, Federal Policies Look at Expanding Access Through Telehealth

Original Source: Center for Connected Health Policy

 

CY 2020 Final Physician Fee Schedule Released
The Center for Medicare and Medicaid Services (CMS) published their final CY 2020 Physicians Fee Schedule (PFS) in the first week of November. CMS has finalized the addition of three new codes for a bundled episode of care for treatment of opioid use disorder to the list of services that are eligible for telehealth reimbursement.   CMS is allowing these services to be delivered at any telehealth originating site, including the patient’s home without regard for the geographic requirement, in accordance with the SUPPORT Act. Additionally, CMS has adopted a bundled payment structure for opioid use disorder (OUD) treatment by opioid treatment programs (OTPs), which would allow for the counseling and therapy components to be delivered via live interactive video.  CMS has also taken steps to further refine its transitional care management (TCM) and chronic care management (CCM) codes, and create new codes for principal care management (PCM) services for patients that have only one serious chronic condition.  They also issued a clarification for federally qualified health centers (FQHCs) and rural health clinics (RHCs) that remote physiologic monitoring codes are not reimbursable in FQHC or RHC settings because it is considered included in their RHC All-Inclusive Rate (AIR) or FQHC Prospective Payment System (PPS) sum.  Finally, based on feedback CMS received that obtaining consent for each and every communication technology-based service is burdensome, they have revised this policy for CY 2020 to only require consent once a year for technology-based services.

Newly Proposed Stark Regulations 
In early October, the Department of Health and Human Services (HHS) announced proposed reforms to current regulations implementing the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute (AKS), in an effort to remove impediments to value-based purchasing arrangements for providers and suppliers participating in federal health care programs, as well as commercial entities. Among the changes, HHS proposes several amendments related to the beneficiary inducements civil monetary penalties including adding an exception for telehealth technologies furnished to certain in-home dialysis patients to the definition of “remuneration.”
For more information, see the proposed rule, and HHS Office of the Inspector General Fact Sheet on the rule.


Challenges to Broadband Availability Report

 

In October, the Congressional Research Service (CRS) released a report of current issues surrounding broadband availability data and mapping techniques. The report finds that this data, based on maps developed by the Federal Communications Commission (FCC), National Telecommunications and Information Administration (NTIA), and the Rural Utilities Service (RUS) as well as Form 477 filings, may be incomplete or inaccurate. For example, the FCC’s Fixed Broadband Deployment Map is updated once every six months, however the map utilizes data which is approximately one year old. Data collected through the FCC’s Form 477 may also be inaccurate as reporting entities are required to submit their maximum upload and download speeds which may differ greatly from the speeds actually available to customers. Additionally, data collected through Form 477 is not validated by an agency outside of the FCC.

On August 1, 2019, the FCC adopted a Report and Order to introduce a new Digital Opportunity Data Collection (DODC). The DODC is intended to produce more accurate and reliable data by:

  • Requiring all fixed providers (those providing services to homes and businesses) to submit broadband coverage polygons depicting areas where they actually have broadband-capable networks and make fixed broadband service available to end-user locations
  • Reflecting the maximum download and upload speeds actually made available in each area, the technology used, and differentiations between types of customers
  • Incorporating public feedback on fixed broadband coverage
  • Requiring verification of broadband data by the Universal Service Administration Company (USAC)

Under DODC, fixed broadband service will be considered available in an area if a broadband service provider either has an active broadband connection in the area or if it could provide a connection within 10 business days following a customer request if doing so would not result in “extraordinary commitment of resources, and without construction charges or fees exceeding an ordinary service activation fee.” The FCC is seeking comments on how best to collect mobile broadband data, however the August 2019 Report and Order proposed revising Form 477 for mobile providers to transition mobile broadband deployment data to a USAC-administered portal, maintaining current Form 477 data collection for mobile broadband and voice data, and reducing the burden on service providers required to submit the form.
For more details read the full report


J.D. Power Releases Telehealth Satisfaction Study
J.D. Power has released a press release announcing some of the key findings of their 2019 telehealth satisfaction study. These findings include:

  • Satisfaction among telehealth consumers is high when compared to the results of other J.D. Power service industry studies, with only direct banking consumer satisfaction ranking higher
  • 65% of telehealth users utilized the service based on the recommendation of a family member, friend or colleague, a health plan, a primary care doctor, an employer, or a hospital or other provider.
  • 29% of consumers who have not used telehealth report that it is unavailable to them and 37% do not know if it is offered by their health care provider
  • 84% of telehealth users resolved their medical concerns during their visit and 73% experienced no issues during the service.
  • The average reported telehealth encounter took approximately 44 minutes in total, with 17 minutes to complete the enrollment process, 9 minutes to wait for a health care provider, and 18 minutes to complete the consultation.

More information on the study is available through J.D. Power.


DEA Misses Deadline for Special Registration

Last year, Congress passed the SUPPORT for Patients and Communities Act as part of an effort to combat the opioid epidemic. The act required the Drug Enforcement Administration (DEA) to issue regulations on a special registration process that would allow providers to prescribe controlled substances through telemedicine under certain circumstances. The DEA has officially missed its deadline, set at one year from the passing of the Act on October 24th. The directive originated from the Special Registration for Telemedicine Clarification Act of 2018, which was adopted into the final opioid package, and was intended to ensure compliance with the Ryan Haight Act while expanding access to controlled substances, especially medications used in medication assisted therapy and psychiatric care. There has been no further indication as to when the special registration process will be finalized.


FCC Modifies Rural Health Care Program

The FCC has posted in the Federal Register a notice to make changes to the Universal Service Fund’s Rural Health Care (RHC) Program. The measures are intended to “promote transparency and predictability, and further the efficient allocation of limited Rural Health Care Program resources while guarding against waste, fraud and abuse.” Some of the intended changes include:

  • Defining geographic contours used for determining rates based on the Census Bureau’s designation of “urbanized areas” and establishing three tiers of rurality
  • Requiring the Administrator to determine the urban rate based on a median of available rates for similar services across all urbanized areas of a state
  • Eliminating the “no higher than the highest publicly available rate” restriction on urban rate determination
  • Eliminating the current standard urban distance demarcation
  • Establishing a single method for determining the rural rate to be the median of all rates charged for a similar service in the same rural tier of the state where the provider is located
  • Creating a publicly available database of urban and rural rates to be updated periodically
  • Prioritizing Rural Health Care Program funding for rural and medically underserved areas

Additional changes are aimed at streamlining and clarifying application processes, deadlines and funding amounts granted under the RHC Program and related funds.

For more information on the changes, check the FCC’s notice in the Federal Register.

CA Telehealth Policy Coalition Legislative Briefing

On Thursday, October 31, the California Telehealth Policy Coalition hosted a legislative briefing at the California State Capitol to educate legislative staff and other key audiences on how telehealth can be used to improve patient experience and health outcomes and improve health equity.  The briefing also highlighted the current California telehealth landscape as well as policy opportunities.  The agenda featured a robust conversation between consumer, payer, provider and health system groups.  While panelists acknowledged the landmark year it has been in California for telehealth legislation, including the passage of AB 744, which requires payment parity for telehealth and AB 1264, which allows a prior examination to be conducted over telehealth (just to name a few) they also acknowledged the need for help in implementation and education on the issue of telehealth within communities and among providers.
Visit CCHP’s webpage on the CA Telehealth Policy Coalition to learn more.


FEDERAL LEGISLATION

Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (CONNECT Act)
S. 2741 (Sen. Schatz) and HR 4932 (Rep. Thompson) – The CONNECT Act would address barriers to telehealth access by allowing the Secretary to waive any of the current restrictions (geographic, originating site, modality limitation, provider type and service requirements) applicable to telehealth if the waiver would not deny or limit the coverage or provision of benefits and the Secretary determines that the waiver is expected to reduce spending without reducing the quality of care or improve quality of care without increasing spending; or would apply to telehealth services furnished in originating sites located in a high need health professional shortage area.

The CONNECT Act also would create an exception for mental health services from the geographic requirement and allow the home to serve as an originating site.  Other circumstances that would warrant an exception from the geographic requirement would include emergency medical care (when furnished in a critical access hospital, hospital or skilled nursing facility), services in federally qualified health centers (FQHCs), rural health clinics (RHCs), and Native American health service facilities and national emergencies.  FQHCs and RHCs would also be allowed to serve as distant site providers under the Act.  The CONNECT Act also addresses alternative payment models and the process by which CMS approves new codes for telehealth reimbursement.  For more information, see the full text of the bill and reference CCHP’s factsheet and comparison chart outlining the different elements of the bill.  (Status:  S. 2741: 10/30/19 – Read twice and referred to Senate Committee on Finance; HR 4932:  10/30/19 – Referred to House Committee on Energy and Commerce, and House Committee on Ways and Means)

Telebortion Prevention Act 
HR 4935 (Rep. Wright) – Representative Wright announced on Twitter through a press release the introduction of the Telebortion Prevention Act, which would prohibit the prescribing of abortion inducing medication, without first physically examining the patient, the practitioner being physically with the patient during ingestion and scheduling a follow-up visit. (Status:  10/30/19 – Introduced in House)

Sexual Assault Victims Protection Act of 2019 
HR 4758 (Rep. Griffith) – Creates a National Sexual Assault Task Force that would assist and standardize State level efforts to improve medical forensic evidence collection relating to sexual assault.  The Task Force would be required to make recommendations for improving access to medical forensic examinations, including determining the feasibility of, or barriers to, utilizing mobile units and telehealth services.  (Status:  10/18/19 – Introduced in House)

Specialty Treatment Access and Referral (STAR) Act 
Representative Harder announced through a press release plans for the Specialty Treatment Access and Referral (STAR) Act, which would create a grant program to help health care organizations establish information-sharing and connectivity infrastructure to provide eConsults and other telehealth services.  Stay tuned for more information once the bill is formally introduced.
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STATE LEGISLATION

MASSACHUSETTS
HD 4547 – Requires insurers to implement procedures, so that the insurer shall not decline to provide coverage for health care services solely on the basis that those services were delivered through the use of telehealth by a contracted health care provider. It also provides for practice standards when providing services through telehealth and when an appropriate relationship can be established. (Status: 10/28/19 – Senate Concurred)

NEW HAMPSHIRE
HB 483 – Enters New Hampshire into the Psychology Interjurisdictional Compact (PSYPACT).  (Status: 10/22/19 – In Executive Session)

PENNSYLVANIA
SB 857 – Requires health insurance policies to provide coverage for telemedicine services consistent with the insurer’s medical policies. Provides standards for the delivery of telemedicine services. (Status: 10/31/19 – Referred to House Committee on Insurance)

WISCONSIN 
AB 438 – Enters Wisconsin into the Physical Therapy Licensure Compact. (Status: 10/29/19 – Public Hearing Held)