FCC, CMS, California Medicaid All Take Steps to Expand Telehealth Utilization

Original Source: Center for Connected Health Policy
FCC Pilot Up for Public Comment & FCC Voting to Overhaul Rural Health Care Program

Last month the Federal Communications Commission (FCC) released their proposed ruleto establish the Connected Care Pilot Program to support the development of telehealth services and delivery for low-income Americans, especially among rural and veteran populations. A Notice of Inquiry for comments on the program was originally made in July 2018.  The FCC is proposing to adopt a $100 million budget, and would fund up to 20 connected care projects with a three-year funding period, though all costs of a pilot would not be fully funded by this program. The pilot would give health care providers the flexibility to determine health conditions and geographic areas that they would like to focus on. The program would be limited to only health conditions that typically require at least several months or more of treatment, such as behavioral health, opioid dependency, chronic health conditions and high risk pregnancies. The proposed rule was published in the Federal Register on July 30, 2019 and comments are due August 29, 2019.  FCC’s responses to public comments are expected on or before September 30, 2019.

Additionally, in July the FCC voted to adopt a Report and Order which indicates they will be reforming the way they distribute funding in the Rural Health Care Program, amidst growing demand and an effort to reduce inefficiencies and waste.  A major component of the Rural Health Care Program involves subsidizing the cost of broadband services for rural participants. The FCC plans to prioritize its support through the program based on “rurality tiers” as well as if the Health Resources and Service Administration (HRSA) designates the area as a medically underserved population, with those classified as “extremely rural” receiving the highest priority.

To learn more about the FCC’s Report and Order and other planned changes, see the full document.

JD Power Telehealth Satisfaction White Paper Highlights Adoption Challenges

JD Power has recently published a white paper, entitled Technology and Methodologies Mature, Consumer Adoption Emerges as Key Challenge for Providers.  The paper gives an overview and highlights some preliminary key findings in a study conducted by JD Power on patient satisfaction, due to be released in November 2019.  Titled U.S. Telehealth Satisfaction Study, the soon to be released report is expected is to measure patients’ experience with 31 providers across 15 performance metrics, and examine over thirty behaviors that drive overall satisfaction, advocacy and brand loyalty.  Some of the findings highlighted in the white paper include the following:

  • Only 9.6% of consumers have used telehealth in lieu of a doctor’s office, urgent care or emergency room visit in the previous 12 months.
  • 74.3% of consumers reported that their health system or insurance provider does not offer telehealth coverage or are unaware of the service.
  • Usage of telehealth is higher among sub-urban and urban residents compared to rural patients.
  • Only 13.3% of consumers perceive that telehealth is more expensive than a doctor’s visit.
To learn more about their preliminary findings, read the full white paper, and stay tuned for their full study in November.

CY 2020 Physician Fee Schedule Telehealth Changes – Comments Due Sept. 27

On July 29, 2019, the Center for Medicare and Medicaid Services (CMS) published their CY 2020 proposed revisions related to the Physicians Fee Schedule (PFS).  The proposal includes 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 is proposing 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 is also taking steps to further refine its transitional care management (TCM) and chronic care management (CCM), and create new codes for principal care management (PCM) services for patients that have only one serious chronic condition.  Finally, CMS is requesting comments on consent requirements for technology-based communication services, after receiving feedback from practitioners that obtaining consent for each and every communication technology-based service is burdensome.

For more information, read the full text, and see CCHP’s factsheet on the proposal.  Comments are due September 27, 2019.

ClearHealth Quality Institute Releases Draft Accreditation Standards

The ClearHealth Quality Institute (CHQI) has announced the release of a draft set of accreditation standards for a new aspect of its Telemedicine Accreditation Program. The new aspect, the Telemedicine Outcomes Supplement, is an optional component of their accreditation program to demonstrate enhanced implementation, analysis and reporting of specific telemedicine program outcomes. The new standards are open for public comment between August 7th and September 7th. The draft standards are available upon request sent to telemed@chqi.com.

The Telemedicine Outcomes Supplement was developed using recommendations from a National Quality Forum report on development measures for telehealth. The CHQI Telemedicine Outcomes Workgroup created the draft standards using input from a diverse range of stakeholders who participate in the group. The accreditation standards, when finalized, are intended to validate five measurements of telemedicine programs. These include access to care, clinical effectiveness, clinical experience/satisfaction, financial impact and operational benchmarks.

For more information about the draft accreditation standards and to learn how to submit comments, request more information at telemed@chqi.com. During previous CHQI comment requests for telehealth accreditation standards, requests for draft comments have taken up to a week to receive.

NIH Issues RFI for Guidance on Use of Telemental Health for Suicide Prevention in the Emergency Department Setting

In June the National Institute of Health (NIH) issued a request for information (RFI) for guidance on current clinical experience in the use of telemental health for suicide prevention in emergency department (ED) settings.   The purpose of the RFI is to identify ways telehealth can be used in the ED to reduce suicide ideation and behavior, and to identify research gaps in the evidence base for providing this type of care.  Information is sought from ED providers as well as telemental health services providers.

See the full text of the RFI for more information.  The due date for responses is August 30, 2019. 

Penn State University Adopts Telehealth to Increase Access to Sexual Assault Nurse Examiners

Pennsylvania State University has partnered with three hospitals in rural Pennsylvania to provide telehealth access to services provided by its team of sexual assault nurse examiners (SANE). In 2017, the university launched the Penn State Sexual Assault Forensic Examination Telehealth (SAFE-T) Center, which includes a team of forensic SANE nurses who are trained to oversee forensic examinations of victims of sexual assault. Recently the program has expanded to utilize its telehealth capabilities to provide access to forensic nurses across rural Pennsylvania, where access to these specialized nurse examiners remains low to nonexistent.

The SAFE-T Center uses telehealth to connect SANE nurses to rural clinics with live video, allowing the nurses to see the exam in progress and provide feedback and assistance in real-time. The program is intended to ensure that expert care is provided to victims of sexual assault while also providing multiple avenues of access to these specialized nurse examiners.

The SAFE-T Center program is part of a growing trend of using telehealth to provide access to SANE nurses and is a response to a shortage of these nurses documented by the Government Accountability Office in a 2016 report. Similar programs have been established in Texas, at the state level as well as St. Peter’s Health Partners in Albany, NY and the UC Davis health system in California.

For more information on how the SAFE-T Center provides sexual assault nurse examiner services via telehealth, visit their website.

Medi-Cal Telehealth Fee-For-Service Policy Update 

On July 29, 2019, the California Department of Health Care Services (DHCS) which oversees the state’s Medicaid program (Medi-Cal), released their final telehealth policy update for fee-for-service.  A copy of the final fee-for-service policy is available on the DHCS website though it is still labeled “DRAFT.”  The Department states that while this is the final policy, the official version of the policy will be published on their site later this month along with the updated manuals for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Indian Health Services (IHS) and Family Planning, Access, Care and Treatment (FPACT).

On August 5, an All Plan Letter (APL) was issued to all Medi-Cal managed care health plans reflecting the revised Medi-Cal policy.  When all manuals have been released, CCHP will do an in-depth analysis of all of the new policies.  In the meantime, CCHP has provided a side-by-side comparison of Medi-Cal’s previous policy, the October 2018 proposal and the final proposal as well as highlighting some of the changes in the final policy.  CCHP will also be holding an informational webinar in the Fall to go over these exciting changes in Medi-Cal’s policies.

Stay tuned for more information.
FEDERAL LEGISLATION
TELEMEDICINE ACROSS STATE LINES ACT
S 2408 establishes a National Telehealth Program to create a set of best practices for federal telemedicine programs, forms a five year grant program to incentivize expansion of telemedicine programs in rural communities and instructs the Center for Medicare and Medicaid Innovation (CMMI) to create a model to incentivize the adoption of telemedicine and increase access to care in rural areas. For more information see Senator Blackburn’s press release on the bill. (Status: In Senate Committee on Health, Education, Labor and Pensions)TELEHEALTH INNOVATION and IMPROVEMENT ACT
HR 4013 requires the Center for Medicare and Medicaid Innovation to test the effect of including telehealth services in Medicare health care delivery reform models. For more information see Congressman Curtis’ press release on the bill.  (Status: In House Committee on Energy and Commerce; Ways and Means)METH ADDICTION ACT
S. 2244 amends the Controlled Substances Act to allow community addiction treatment facilities and community mental health facilities to register to dispense controlled substances through the practice of telemedicine. (Status: In Senate Committee on Health, Education, Labor and Pensions)
STATE LEGISLATION
DELAWARE
SB 83 – Adopts the Physical Therapy Licensure Compact. (Status: 7/30/19 – Enacted)ILLINOIS
SB 0167 – Amends the Illinois Dental Practice Act to include a definition of teledentistry. (Status: 7/26/19 – Enacted)MASSACHUSETTS
H 1916 – Permits dental therapists to provide procedures and services permitted under general supervision when a dentist is available for consultation and supervision if needed through telemedicine or by another means of communication. (Status: 8/1/2019 Discharged to the Committee on Health Care Financing)NEW HAMPSHIRE
SB 258 – Requires Medicaid coverage of telemedicine or telehealth services under certain circumstances, and amends their current telehealth private payer law to clarify that covered services include remote patient monitoring and store and forward. (Status: 6/27/2019 Passed House)

NEW HAMPSHIRE
SB 178 – Allows for the prescription of spectacle lenses by a provider through face-to-face interactive 2-way, real-time communication, or telemedicine when certain conditions are met.  (Status: 7/10/2019 Signed by Governor)

NORTH CAROLINA
SB 361 – Adopts the Psychology Interjurisdictional Licensure Compact and establishes compact privileges related to the interstate practice of telepsychology. This bill also makes other reforms to increase health care access in North Carolina. (Status: 8/8/19 – Adopted amendment and Passed Second reading in House)

OHIO
HB 166 – Requires a health benefit plan to provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage in person. (Status: 7/18/2019: Enacted)

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STATE REGULATIONS
COLORADO 
Division of Workers Compensation – Treatment Guidelines:
Removes the definition of telehealth from the workers’ compensation program, leaving only the term telemedicine and makes revisions to the service codes that may be provided through telemedicine. (Initial Proposal: 7/23/19)WASHINGTON
Department of Health:
Expands upon the allowable duties a dentist may delegate to a licensed dental hygienist under general supervision. The regulation states that this may provide more opportunities for teledentistry when a dentist is not required to be on site. (Initial Proposal: 7/18/19)
WASHINGTON
Department of Health:
Expands upon the allowable duties a dentist may delegate to a licensed dental hygienist under general supervision. The regulation states that this may provide more opportunities for teledentistry when a dentist is not required to be on site. (Initial Proposal: 7/18/19)