Federal Policies Race Towards Telehealth Expansion

Original Source: Center for Connected Health Policy

Bill to Reinstate Net Neutrality Sees Progress

 

Last month, members of Congress introduced H.R. 1644, known as the Save the Internet Act of 2019. If passed, the bill would reinstate the net neutrality rules enacted by the Open Internet Order in 2015 which were subsequently redacted in 2017 by the Federal Communications Commission’s (FCC) Restoring Internet Freedom Order. The act would also prohibit the FCC from reissuing the same or a new order that is substantially the same as the Restoring Internet Freedom Order. The three rules that would be reinstated with the passing of the Act prevent broadband internet services from blocking or throttling lawful content, applications, services, and non-harmful devices and prohibit paid prioritization of broadband services.

H.R. 1644 was introduced to the House on March 8th and has since passed review (yeas 18, nays 11) by the House Energy and Commerce Subcommittee on Communications and Technology. As of March 26th, the bill is awaiting further action by members of the House. In a memorandum, Chairman Pallone of the Committee on Energy and Commerce stated that the repeal of the 2015 Open Internet Order removed protections for people with disabilities and the assurance of fair access. By reinstating the order, he stated the FCC will again have the authority to prohibit blocking, throttling and paid prioritization as well as to stop future harmful practices by broadband internet service providers.
Further information on the progress of H.R. 1644 is available through the Congress website.

CMS Finalizes Policies to Expand Telehealth Services in Medicare Advantage

 

CMS finalized final rules to allow Medicare Advantage (MA) plans to include more expansive telehealth-delivered services in their policies.  Under the Bipartisan Budget Act of 2018 , MA plans are allowed to include “additional telehealth benefits” (benefits that go beyond what is allowed in Original Medicare) starting in 2020.  While MA plans could offer these additional benefits, they were not required to do so.
For more information read CMS’ final rule
Check out next week’s edition of CCHP’s “Issue In-Focus” for an in-depth analysis of the final rule.

 

Mental Health Telemedicine Expansion Act

 

In February, H.R. 1301, the Mental Health Telemedicine Expansion Act, was introduced to Congress. The bill would amend section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) which covers payment for telehealth services and list specific requirements for the use of telehealth for Medicare providers. In addition to current reimbursement codes, psychotherapy services, as identified by current procedural terminology (CPT) codes 90834 and 90837, would become reimbursable when delivered via telehealth.

The Mental Health Telemedicine Expansion Act would also add specific requirements for providers using telehealth to deliver services using those codes. Providers would need to conduct an in-person assessment of the patient’s need for the service, prior to providing mental health telehealth services and subsequently reassess those needs at a frequency that is specified by the Secretary of Health and Human Services. However, the geographical limitations that telehealth services in Medicare currently face would not apply to these services. The patient’s home would be considered an eligible originating site in the delivery of these services, however there will be no facility fee available for the patient’s home or any other originating site that is not described in the original telehealth statute.

 

CMS Issues Technical Correction to CPT Code 99457;
Effective Immediately 

A technical correction by the Center for Medicare and Medicaid Services (CMS) for remote physiologic monitoring treatment management service code 99457 was issued clarifying “incident to” services billed by physicians and non-physician practitioners.  The correction clarifies that auxiliary personnel may provide these services but must be directly supervised by the physician which would require the physician to be in the same building at the time the service is delivered.
For more information read the CMS guidance document.

 

Florida Proposes Bill to Incentivize the Expansion of Telehealth

A recent telehealth bill in Florida may expand telehealth adoption by providing a tax credit to health insurers and health maintenance organizations (HMO) that cover services provided via telehealth. HB 23 would establish the telehealth tax credit, beginning on January 1, 2020. The credit would amount to one tenth of one percent (0.1%) of total insurance premiums received and may be applied against the corporate income tax or insurance premium tax. If unused, the credit would carry over each year for a period not exceeding five years.

HB 23 also includes certain provisions for defining telehealth and establishes both practice standards and restrictions regarding its use. Although Florida does not currently define telehealth in statute, the bill would define it as “the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services. It does not include audio-only telephone calls, e-mail messages, or facsimile transmission.” The new provisions would permit out-of-state telehealth providers to provide health care services to patients located in Florida if such a provider registers with the applicable board or department.

As of March 29th, HB 23 is awaiting movement after passing votes by both the House Health and Human Services Committee and Ways and Means Committee.

 

Further information on the bill may be found through the Florida Senate’s bill page

 

Congressional Telehealth Caucus Seeks Comments to Inform Upcoming Telehealth Legislation

 

The Congressional Telehealth Caucus, formed in 2017, recently sought comments from stakeholders to inform the creation of a new legislative package to expand upon changes made by the CONNECT for Health Care Act of 2017 and Bipartisan Budget Act of 2018. The Caucus is especially interested in recommendations that would:

  • Expand access to telehealth and remote patient monitoring, especially in rural or otherwise underserved communities;
  • Improve patient outcomes, whether by expanding access to specialists or other providers or by easing the day-to-day patient experience;
  • Encourage easier and expanded use of existing telehealth and remote monitoring technologies, many of which suffer from low uptake rates; and 
  • Reduce healthcare costs for both patients and federal programs, including Medicare.

Submissions were due Monday, April 1st and are now closed. The Center for Connected Health Policy (CCHP) submitted a letter to discuss some of the existing barriers to telehealth that exist in current Medicare policy.
For more information view CCHP’s submitted letter.

 

Veterans Affairs Requests Additional Funding to Expand Coverage to Veterans 

 

After achieving more than one million telehealth encounters with veterans during FY 2018, Department of Veterans Affairs (VA) Secretary Robert Wilkie is requesting additional federal funding to further expand the department’s telehealth networks. In a testimony before the House Committee on Appropriations held in late March, Secretary Wilkie requested an additional $1.1 billion for telehealth services, which Is a 10.5 percent increase compared to current 2019 estimates. According to his testimony, the additional funding could be used to further expand the VA’s Anywhere to Anywhere initiative, which allows veterans to receive services from telehealth providers located anywhere in the United States.

Within the next five years, Secretary Wilkie states, the VA hopes to increase the quantity of veterans receiving services from 13 percent to 20 percent through the use of telehealth. To achieve this goal, the VA is actively implementing its authorities under the MISSION Act to increase the VA’s recruitment and retention of medical providers as well as implementing additional initiatives to enhance the workforce.
For more information on the VA’s request for additional funding, read Secretary Wilkie’s House testimony.

 

STATE LEGISLATION

FLORIDA:

SB 1526- Establishes provisions related to telehealth. Prohibits Medicaid managed care plans from using providers who exclusively provide services through telehealth to achieve network adequacy. Defines the terms “telehealth” and “telehealth provider.” Creates practice standards for telehealth services and providers. Prohibits telehealth providers from using telehealth to prescribe a controlled substance. Provides certain exceptions.   VIEW BILL INFO  (Status: 3/25/19 – In Senate Appropriations Subcommittee on Health and Human Services)

MINNESOTA
HF 551 – 
Permits health maintenance organizations that demonstrate that there are no providers of a specific type or specialty in a county to receive a waiver allowing the health maintenance organization to address the network inadequacy in that county by providing for patient access to providers of that type or specialty via telemedicine.  VIEW BILL INFO  (Status: 3/18/19 – Referred by Chair to Health and Human Services Finance Division )

GEORGIA:
SB 133 –
Requires that every health benefit policy that is issued, amended, or renewed shall include payment for services covered under such health benefit policy and are appropriately provided through telehealth in accordance with current law and generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided.   VIEW BILL INFO  (Status: 3/29/19 – Passed House; Senate agreed with House amendments and substitutions)

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