Guidance to States and School Systems on Addressing Mental Health

Original Source: Center for Connected Health Policy

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS) issued a Joint Informational Bulletin to provide information about addressing mental health and substance use issues in schools.  The guidance includes some innovative approaches for mental health and substance use disorder (SUD) treatment services in schools and Medicaid programs, and summarizes best practices.  The guidance identifies telemental health as a method to expand access to mental health services across settings, and in particular when access is difficult.  It also suggests the use of telehealth care extension strategies including the Extension for Community Health Outcomes (ECHO) model.  It directs readers to HRSA’s National Consortium of Telehealth Resource Centers, as well as the Center for Connected Health Policy for additional information.

To learn more, read the full bulletin.

Federal Bill Would Expand Telehealth Mental Health Service in Medicare 

In late June the Beneficiary Education, Tools, Telehealth, and Extender Reauthorization (BETTER) Act of 2019 (HR 3417) was introduced by US Reps. Richard Neal (D-MA) and Kevin Brady (R-TX).  Most significantly for telehealth, it would expand reimbursement for certain types of telehealth delivered services in Medicare.  Specifically, it provides an exemption for CPT codes 90834 and 90837 (both individual psychotherapy codes), from Medicare’s requirement that the beneficiary be located in a geographically rural area at the time services are delivered.  It would also allow the service to be delivered to a patient when they are at home.  The bill does also place some additional requirements around payment for mental health telehealth services, requiring an in-person assessment of the needs of the individual within 6 months prior to the provision of mental health telehealth services by a physician or practitioner. A reassessment must occur at a frequency specified by the Secretary.  Other restrictions in Medicare on telehealth, such as the modality and provider type limitations would still apply.

To learn more, see the full text of the bill.


Amendment Adds Telemedicine Funding to FDA Funding Bill

On June 25th, the US House passed the 2020 Appropriations Act for the Departments of Commerce, Justice, Science and Related Agencies (HR 3055), moving it to the Senate.  In a last minute amendment, the Distance Learning, Telemedicine and Broadband Program budget was increased by $5 million for additional funding for Community Connect Grants.  The program helps fund broadband deployment into rural communities where it is not yet economically viable for private sector providers to deliver services.

More information on HR 3055 can be reviewed here.


Minnesota Court Case Has Implication for Patient-Provider Relationship

Recently, in the case Warren v. Dinter, the Minnesota Supreme Court reversed an earlier decision by a lower court regarding a plaintiff who filed a professional negligence suit against a hospitalist and hospital, deciding in favor of the defendants and concluding that a doctor-patient relationship did not exist.  The Minnesota Supreme Court disagreed, noting that the physician-patient relationship is not a necessary element of a claim for professional negligence, holding “(1) a physician owes a duty of care to a third party when the physician acts in a professional capacity and it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care; and (2) it was reasonably foreseeable that the patient in this case would rely on the hospitalist’s acts and be harmed by a breach of the standard of care.”  It was noted in the ruling that other states have made similar decisions regarding a provider’s duty and the reliance of a patient on a provider’s actions.

Review the case summary for more information.


American Well Survey Shows Seniors Willing to Use Telehealth

A survey conducted by American Well shows that over half of U.S. residents aged 65 and older are willing to use telehealth for some medical services. The data is based off of a 2019 consumer survey which included 2,002 adults, 20% of whom were over the age of 65. Seventy-five percent of those seniors reported using Medicare as their primary health insurance.

While only 1% of seniors reported ever having a telehealth visit, 52% were willing to use telehealth for prescription refills (84%), chronic care management (67%), and surgery or in-patient follow-up (60%). Seniors cited various reasons for being willing to have a telehealth visit, including:

  • Faster service (73%)
  • Time savings/convenience (58%)
  • Cost savings (54%)
  • Better access to healthcare professionals (53%)
  • More comfortable experience (43%)
  • More time with the doctor (37%)

The survey also shows that seniors are increasingly becoming more comfortable with health care technology with 25% of seniors using a mobile health application on their smartphone. As many as 63% of seniors have also used a personal health monitoring device, such as a blood pressure monitor or wearable devices.

To read the full survey results, which includes American Well’s strategies to increase telehealth adoption among seniors, access the full report on their website.


Infectious Disease Society of America Releases Position Statement in Favor of Telehealth

The Infectious Disease Society of America (ISDA) has published a position statement on the use of telehealth in infectious disease practice. The statement, published in the journal Clinical Infectious Diseases, is in favor of the appropriate and evidence-based use of telehealth. The ISDA announced its support for telehealth in areas including HIV care, directly observed treatment for tuberculosis management, antimicrobial stewardship programs, and infection prevention and control. The ISDA lists these as established use cases that demonstrate the ability of telehealth to improve access to care, patient satisfaction, outcomes, and reduce costs. Other topics ISDA offers its position on include licensing and credentialing, reimbursement, liability, and patient engagement.

The full statement is available for free in the May 2019 issue of Clinical Infectious Diseases.


STATE LEGISLATION

Georgia
HB 26:  Enters Georgia into the Psychology Interjurisdictional Compact.  The Compact allows a psychologist to practice in another state that has adopted PSYPACT through an E.Passport when the psychologist initiates client/patient contact via telecommunications technology and complies with other rules.  A Commission established under the legislation would create additional rules and mechanisms for issuing the E.Passport.  The passage of this law in Georgia gives PSYPACT the seven required states necessary to make it operational.  (Status: 4/24/19 – Enacted)

Maine
LD 1263:  Repeals current statute for the coverage of telemedicine services and enacts new statute.  Specifically, it requires insurers to provide coverage for telehealth if the health care service would be covered in-person.  It also requires coverage for telemonitoring services under certain conditions as well as telephonic services when telehealth services are unavailable and telephonic services are medically appropriate.  (Status:  6/13/19 – Enacted)

District of Columbia
B 23-0362 – Establishes the Center on Maternal Health and Wellness. The Center would assist pregnant individuals through the various stages of pregnancy, provide a space for community support, and promote access to services. It would also make services available to individuals regardless of their physical presence in the Center, including through telehealth and online. (Status: 6/25/19 – Under Health Council review)

Florida
HB 23 – Establishes telehealth practice standards.  It also prohibits providers from prescribing a controlled substance while using telehealth except for the treatment of a psychiatric disorder, inpatient treatment at certain kinds of hospitals, treatment of patients receiving hospice services or a resident of a nursing home.  It also allows out-of-state telehealth providers to provide services within the state if they register with the appropriate health care professional board. (Status: 6/26/19 – Enacted)
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PROPOSED STATE REGULATIONS

New Jersey
Medical Board: Requires full New Jersey licensure for physicians and podiatrists who are physically located in New Jersey and providing services via telehealth or telemedicine to patients in other states.  Providers located in other states using telehealth/telemedicine to treat patients located in New Jersey would also be required to have a New Jersey license.  (Proposed: 5/5/19)

Maryland
Department of Health: Provides licensure requirements and practice standards for licensed certified social worker-clinicals (LCSW-C) and licensed masters social workers (LMSW) under the supervision of an LCSW-C for providing behavioral health services via telehealth. (Proposed: 6/21/19, Comment deadline: 7/22/19)