CMS Begins Virtual Communication Reimbursement as States Take Different Approaches to Telehealth Policy

Original Source: Center for Connected Health Policy

CMS Releases Virtual Communication FAQs & MLN Matters Guidance for RHCs and FQHCs

Beginning January 2019, the Centers for Medicare and Medicaid Services (CMS) began reimbursing for certain kinds of services furnished remotely using communications technology that are not considered “Medicare telehealth services.” Because they are not defined specifically as telehealth, the limitations and restrictions generally applicable to telehealth in Medicare do not apply.  These services include “virtual communication services” including communication technology-based services (HCPCS code G2012) and remote evaluation services (HCPCS code G2010).  However, due to the unique rules that apply to federally qualified health centers (FQHCs) and rural health clinics (RHCs), CMS has assigned a new code (G0071) specifically for these safety-net clinics to utilize for virtual communication services as they are not eligible to bill G2010 or G2012.  As a result of this policy change, CMS has released an FAQ document on the topic to help clarify any confusion around the use of the new code for FQHCs and RHCs.  View the FAQs for the full scope of the questions and concerns answered through the document.

Additionally, a Medicare Learning Network (MLN) Matters document was also released with instructions for FQHCs and RHCs billing Medicare Administrative Contractors (MACs) for communication technology-based services.  The document stipulates that the payment rate for G0071 is set at the average of the Physician Fee Schedule (PFS) non-facility payment rate for communication technology-based services and remote evaluation services, and that the face-to-face requirement that normally applies to RHCs and FQHCs is waived for these services.  For more information on the requirements, see the full MLN Mattersdocument.

AMA Survey Finds Smaller Practices Less Likely to Utilize Telehealth
In the Health Affairs telehealth edition, released in December 2018, the American Medical Association published an article in which they reported their estimates of the number of physicians using telemedicine services, based on data from the AMA’s 2016 Physician Practice Benchmark Survey.  Some of the more significant findings included that 15.4 percent of physicians worked in practices that utilized telemedicine for patient care, which included those that utilized radiologists via the store-and-forward modality.  They also found that telemedicine use was often associated with larger practices that may have the financial capacity to take on such programs.  Thus, the AMA notes that the financing of telemedicine programs may be a continuing barrier for smaller practices.
To learn more, read the full article with a subscription to Health Affairs.
CMMI to Test New Medicare Advantage Health Plan Innovations

The CMS Center for Medicare and Medicaid Innovation (CMMI) will be testing Medicare Advantage (MA) health plan innovations during the Value-Based Insurance Design (VBID) model for CY 2020. The purpose of the VBID model is to test the impact of allowing MA plans to offer reduced cost sharing or additional supplemental benefits to enrollees with chronic conditions. The innovations being tested during CY 2020 are available to MA health plans in all 50 states and territories as well as Regional Preferred Provider Organizations (RPPO) and chronic condition, dual eligible, and institutional Special Needs Plans (SNP). CMS has extended the performance period of the VBID through 2024 to allow for sufficient time to evaluate the impact on cost and quality of these approaches.

The CY 2020 VBID application period is open through March 1, 2019 and eligible MA organizations may apply for any combination of the following:

  • Value-Based Insurance Design by Condition, Socioeconomic Status, or Both
  • Medicare Advantage and Part D Rewards and Incentives Programs
  • Telehealth Networks
  • Wellness and Health Care Planning (required for all VBID participating MA plans)
Among plans that apply for the telehealth networks innovation, CMS plans to observe how different service delivery innovations in telehealth may be used alongside an MA plan’s current network and providers and how telehealth may allow plans to expand their services to underserved areas. Plans testing this innovation may propose using telehealth in place of in-person services for the purpose of meeting network adequacy requirements. Those plans would be required to maintain an enrollee’s choice if that enrollee prefers to opt-out of a telehealth visit.
For further information about the CY 2020 Value-Based Insurance Design model, visit the CMS newsroom.
CCHP Analysis of Occupational and Physical Therapy Policy
Last year, CCHP conducted a 50-state scan of occupational therapy and physical therapy policies that was published in the fall 2018 edition of theInternational Journal of Telerehabilitation. The survey results show the current level of adoption of both laws and regulations that allow physical and occupational therapists to use telehealth to engage in patient care services as of August 2018. CCHP found that twenty-seven states had enacted at least one policy that allows patient-to-provider or provider-to-provider services in occupational therapy, while twenty-eight states had done the same for physical therapy. Overall, CCHP found that there was no observable preference between regulations and laws for the policies among states.
Free access to the full article, including the 50-state scan and links to each policy found, is available at the website for the International Journal of Telerehabilitation.  
Lawsuit Filed Against Wisconsin Regarding Requirement for Physical Presence for Abortion Services

Late last month a lawsuit was filed by Planned Parenthood against the state of Wisconsin, arguing that the requirement that a doctor be physically present when performing a medication abortion is “unduly restrictive because it precludes offsite clinicians from supervising the provision of medication abortion drugs using videoconferencing and/or web-based communication tools.”  The lawsuit cites studies which have found no difference in the outcomes for patients that receive telemedicine based services compared to those that received those same services in-person.  Planned Parenthood also argues that the requirement for the physician’s physical presence during a medication abortion violates the US Constitution by treating medical professionals who use telemedicine to provide abortion services differently than medical professionals who use telemedicine to provide other comparable services.

Meanwhile, a judge in Kansas has ruled that a law barring telemedicine abortions that was set to take effect in January has no legal force.  This has prompted the Kansas Attorney General to file an appeal to allow the telemedicine abortion ban within the state.

For more information on the Wisconsin case,read the full lawsuit filed by Planned Parenthood, and for more information on the Kansas case, read thefull appeal.  Stay tuned for future updates from CCHP!
Participate in a National Technology Survey

The National Telehealth Technology Assessment Center (TTAC) invites you to participate in their biennial technology survey.

TTAC is a proud member of the National Consortium of Telehealth Resource Centers (NCTRC), of which CCHP is also a member.  In their capacity as the national telehealth technology assessment resource center, TTAC aims to create better-informed consumers of telehealth technology by assisting in selecting appropriate technology for telehealth programs.  Information gathered through the survey will help them in determining the following:

  1. Telemedicine technologies that are currently being used in telemedicine programs
  2. Telemedicine technologies that may be of interest for future implementation
  3. How TTAC can best provide relevant information and technology resources to telemedicine users
TTAC uses this information to direct their assessment and outreach efforts.
Click here to participate in the survey.
CCHP Releases January Legislative/Regulatory Updates by Region

In addition to providing daily updates on federal state legislation and pending regulation through CCHP’s 50 State Map Tracker, CCHP also provides reports by telehealth resource center (TRC) region on a monthly basis during legislative sessions.  The reports provide a breakdown of legislation by region, along with summary charts of the topic areas and status in the legislative process.
Visit CCHP’s legislative and regulatory updates resource webpage to access the reports and find out what has been going on in YOUR region!
STATE REGULATIONS
NEW YORK:
Office of Mental Health proposes Amended Telepsychiatry Guidance:  New York’s Office of Mental Health (OMH) has proposed amendments to their telepsychiatry services, which currently establishes standards and parameters to approve the use of telepsychiatry in certain OMH-licensed programs that elect to offer the service.  The proposed amendments would replace the term “telepsychiatry” with the broader term “telemental health” and expand telemental health services to psychologists, social workers and mental health counselors (in addition to psychiatrists and nurse practitioners who are already covered under current regulation).  Under the proposed language, a telemental health provider must be approved by the Office of Mental Health to provide telemental health services. The regulation would also clarify that an originating site for telemental health services can be within the state of New York, or another temporary location within or outside the state.   VIEW FULL PROPOSED REGULATION TEXT
MARYLAND: 
Board of Examiners of Psychologists and Board of Professional Counselors and Therapists propose amendments to telepsychology and teletherapy standards of practice:  The Maryland Secretary of Health has proposed to adopt regulations under a new chapter for telepsychology. This will replace telepsychology regulation proposed in January, 2018. The new regulations would define the term “telepsychology” and require an individual to be licensed with the Board as a psychologist or psychology associate in order to engage in the practice of psychology via telepsychology. The provider would be required to be physically located in Maryland to use telepsychology and must first evaluate the patient to determine if telepsychology is appropriate. The regulation also creates standards of practice for telepsychology, including proper procedures and informed consent requirements.  VIEW FULL PROPOSED REGULATION TEXT

NEWLY INTRODUCED STATE LEGISLATION
ARIZONA:
SB 1089- Amends Arizona’s telemedicine private payer law, eliminating the list of specialties that the law is limited to. It also prohibits an insurer from imposing any originating site restrictions, distinguishing between patients in rural or urban locations or limiting coverage to a subset of medical conditions, specialties or settings. The definition of telemedicine is also amended to include asynchronous store-and-forward technology and remote patient monitoring technologies.  VIEW BILL INFO  (Status:  1/22/2019 – In Senate, Second Reading)
ARKANSAS:
HB 1220 – 
Amends rules for establishing a professional relationship over telemedicine. Allows a professional relationship to exist through telemedicine as long as the standard of care has been met in the opinion of the healthcare professional and the professional has access to the patient’s medical history. VIEW BILL INFO  (Status: 1/22/2019 – In House Committee on Public Health, Welfare and Labor)NEW YORK:
SB 879 –
Requires comprehensive motor vehicle reparations and workers’ compensation coverage of health care services delivered by means of telehealth.  VIEW BILL INFO  (Status:  1/9/19:  In Senate Committee on Insurance)

WASHINGTON:
SB 5385 – 
Removes the requirement for store-and-forward that there must be an associated office visit between the health plan beneficiary and the referring health care provider. VIEW BILL INFO (Status: 1/30/19: Scheduled for public hearing in Senate Committee on Health & Long Term Care)

OREGON:
HB 2693/SB 126 – 
Provides a definition for telemedicine and requires health benefit plans to reimburse for services delivered via telehealth if the service is covered when provided in-person. Requires that telemedicine services be reimbursed at a specified minimum percent of the in-person rate. VIEW HB 2693 orSB 126 INFO (Status: HB 2693- 1/30/19: In House, public hearing scheduled, SB 126- 1/15/19: Referred to Senate Committee on Health Care)

OKLAHOMA:
HB 2351 – 
Adopts the Interstate Medical Licensure Compact. VIEW BILL INFO(Status: 2/5/19: In House, Referred to Public Health Committee )

OKLAHOMA:
HB 1057 – 
Adopts the Psychology Interjurisdictional Compact. VIEW BILL INFO(Status: 2/4/19: In House, First Reading)