Category

National Telehealth Policy Resource Center Blog

2018 IN REVIEW: STATE & FEDERAL TELEHEALTH POLICY

By | National Telehealth Policy Resource Center Blog

It was an active year for state telehealth legislation in 2018.  Among 39 states and DC, 65 legislative bills passed in the 2018 legislative session, up slightly from 62 bills in 2017.  Additionally, 49 telehealth related regulations were finalized in 38 states related to telehealth.  The enacted legislation this year focused mainly on broadening Medicaid policy, establishing regulatory requirements and enacting interstate licensure compacts.  In general there has been a slowing of enacted legislation addressing private payer reimbursement of telehealth.  Adopted regulation focused on telehealth practice standards by professional boards.

Read More

Continued Telehealth Developments as 2018 Comes to a Close

By | National Telehealth Policy Resource Center Blog

Medicare Report Reveals Medicare Telehealth Utilization, Barriers & Opportunities
In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing telehealth utilization, activities by the Center for Medicare and Medicaid Innovation, and opportunities and barriers to the use of telehealth within Medicare.  Utilizing data from Medicare fee-for-service between 2014 and 2016, the report revealed that although overall use of telehealth has increased, the rate of adoption is still limited.  Mental health and therapy sessions were the most common service types, with beneficiaries with a mental health diagnosis among the highest utilizers of telehealth delivered services.  Services targeting chronic diseases and behavior modification (such as smoking cessation) were also among the more popular telehealth delivered services.  The analysis determined that there are 19 additional high volume services for outpatient and inpatient visits and therapy that are either similar to those that are already on Medicare’s list or that are typically provided in settings that do not meet Medicare’s originating site requirements that would be suitable for telehealth delivery.  CMS concludes that restrictions on eligible telehealth originating sites is the greatest barrier preventing the expansion for telehealth within Medicare.

For more details and further statistics on telehealth in Medicare,
see the full report.

Read More

CCHP Issues Assessment of Payer Compliance with Texas Law Requiring Web Publication of Telehealth Policies

By | National Telehealth Policy Resource Center Blog

CCHP has released a report based on research completed between June-August 2018 which examines compliance with one specific provision in Texas enacted legislation SB 1107 (2017), which requires health benefit plan issuers (referred to as “issuers”) to adopt and display in a conspicuous manner the issuer’s policies and payment practices for telemedicine medical services and telehealth services on their websites, effective Jan. 2018.  This is the first law in the country to place such a requirement on issuers.  The issuers included in the sampling were chosen from the Texas Department of Insurance (DOI)’s website, and narrowed to those that were shown to hold 1 percent or more of the market share.  Because many of the issuers listed were subsidiaries of other companies in the sample group, the total issuers in the sample were further tapered to 18.  Three CCHP researchers examined each issuers’ website and telehealth policy (if found), scoring issuer policies utilizing a Public Health Law Research model (see report and codebook for details).  The questions addressed through the research and coding process included the following:

Read More

Medicare Releases Mandated Report on Medicare Telehealth Utilization, Barriers & Opportunities

By | National Telehealth Policy Resource Center Blog

In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing the four required elements, including the following:

  1. Identification of Medicare beneficiaries whose care may be improved most by telehealth services;
  2. Activities by the Center for Medicare and Medicaid Innovation that examines the use of telehealth;
  3. The types of high-volume services that might be suitable to be furnished using telehealth; and
  4. The barriers that are preventing telehealth’s expansion.

The document employs data from Medicare Fee for Service (FFS) between 2014 and 2016, reporting that although overall use of telehealth has increased, the rate of adoption is still limited.  For example, in 2016, approximately 90,000 Medicare beneficiaries utilized 275,199 telehealth services which constitutes just one-quarter of a percent of the 35 million FFS Medicare beneficiaries.  Mental health and therapy sessions were the most common service types, with beneficiaries with a mental health diagnosis among the highest utilizers of telehealth delivered services.  Services targeting chronic diseases and behavior modification (such as smoking cessation) were also among the more popular telehealth delivered services.  One of the most illuminating findings from the report was that if only 1% of Medicare’s in-person visits occurred over telehealth, it would result in a thirteen fold increase in telehealth delivery.  The analysis determined that there are 19 additional high volume services for outpatient and inpatient visits and therapy that are either similar to those that are already on Medicare’s list or that are typically provided in settings that do not meet Medicare’s originating site requirements that would be suitable for telehealth delivery.

The report also recognizes the role telehealth could play in fighting substance use disorder, citing studies that indicate improved results for telehealth SUD treatment programs’ completion rates compared to in-person programs.  The report states that “telehealth seems to provide the intervention most similar to office-based treatment, and research shows that telehealth patients, while not specific to Medicare, have satisfaction levels and outcomes similar to those of clients receiving in-person therapy.”

CMS concludes that restrictions on eligible telehealth originating sites is the greatest barrier preventing the expansion for telehealth within Medicare.  Specifically the requirement the beneficiary be located in a rural area and excluding the home as an originating site (with the exception of certain conditions) has resulted in the low utilization levels.  The report acknowledges telehealth’s potential not only for Medicare rural beneficiaries but also to those in non-rural areas, racial and ethnic minorities and the elderly with multiple chronic conditions many of whom are currently restricted from accessing telehealth solely by their physical location.
For more details and further statistics on telehealth in Medicare, see the full report.

POLICY ADVANCEMENTS FOR TELEHEALTH AT CMS AND CA MEDICAID

By | National Telehealth Policy Resource Center Blog

CMS Proposes Changes to Medicaid Network Adequacy Standards

In a proposal released on Nov. 8, 2018, CMS proposed changes to regulations on network adequacy standards. The changes would allow states to elect alternative quantitative standards to measure network adequacy, including but not limited to, minimum provider-to-enrollee ratios; maximum travel time or distance to providers, maximum wait times for an appointment, and other quantitative standards. Currently, regulations require states to establish network adequacy standards by developing and enforcing time and distance requirements for specified specialty providers. States have commented that these measurements are sometimes inaccurate, especially in locations where telehealth services are heavily used, where a provider-to-enrollee ratio provides a more accurate representation of access.
Read More

BIG CHANGES IN 2019 FOR MEDICARE TELEHEALTH POLICY

By | National Telehealth Policy Resource Center Blog

Last week CMS released its finalized Calendar Year (CY) 2019 Physician Fee Schedule containing momentous changes for Medicare, aiming to modernize the healthcare system and help “restore the doctor-patient relationship” by reducing administrative burden. Among the changes, the proposed rule not only expands telehealth reimbursement, but communicates a new interpretation by CMS of the applicability of their statutory requirements for reimbursement of telehealth. Telehealth-delivered services under Medicare is limited in statute by 1834(m) of the Social Security Act which limits the use of telehealth to certain services, providers, technology (mainly live video) and patient locations (needing to be in certain types of healthcare facilities in rural areas). CMS, in their rule, expresses concern that these requirements may be limiting the coding for new kinds of services that utilize communication technology.

Read More