Newly Released RAND Reports
Two new reports were recently released by RAND. The first report, Experiences of Medicaid Programs and Health Centers in Implementing Telehealth was commissioned by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to explore the experiences of state Medicaid programs and federally qualified health centers (FQHCs) in utilizing telehealth. RAND researchers conducted telephone discussions with representatives of seven state Medicaid programs and 19 urban and rural FQHCs in the same states. The findings from the report included that Medicaid policies varied across numerous areas and that FQHCs encountered barriers in reimbursement, workflow and provider willingness. The second report was also commissioned by ASPE and is the Report to Congress: Current State of Technology-Enable Collaborative Learning and Capacity Building Models. The report was required under the 2016 “Expanding Capacity for Health Outcomes (ECHO)” law. The findings included that evidence of the impact of ECHO on patient and provider outcomes remains modest and an absence of standardization in the collection of information.
Visit the RAND website for more information.
MassHealth Adding Reimbursement for Telehealth
Massachusetts recently announced that the state’s Medicaid plan, MassHealth, is offering teletherapy and telepsychiatry services to members. The details of the service are outlined in MassHealth’s All Provider Bulletin 281, which states that as of January 1, 2019, Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers may deliver specified services via telehealth. These services include:
- All services listed in 101 CMR 306.00
- Counseling for Opioid Treatment Services
- Outpatient Counseling and Clinical Case Management for Ambulatory Services
- Outpatient Services for Pregnant/Postpartum Clients
While licensure and programmatic requirements apply, there are no other geographic or facility requirements on the originating or distant site. These services must meet all applicable licensure regulations and requirements and may be delivered by any qualified MassHealth provider who meets the additional requirements for provider training. Providers are required to have a telehealth training program in place to ensure staff competency in the delivery of telehealth services. The services may be reimbursed using a Place of Service Code 02 for the same rate payable for services delivered through in-person methods.
Additional information on the update can be found in the MassHealth press release.
Skilled Nursing Facility Telemedicine Standards & Guidebook
In the February 2019 edition of The Journal of Post-Acute and Long-Term Care (JAMDA), Medicine, researchers from the University of Rochester School of Medicine, and other institutions, published a set of standards to guide the use of telemedicine by skilled nursing professionals. Specifically, the standards offer guidance on the use of telemedicine to improve the delivery of medically necessary evaluations and management of change of condition for nursing home residents. The standards were developed through meetings with The Society for Post-Acute Long-Term Medicine and are based on current research as well as the experience and expertise of the workgroup’s members. The article is available with limited text on the JAMDA website.
West Health recently released a Practical Guide to Telehealth: Implementing Telehealth in Post-Acute and Long-Term Care Settings. This telehealth implementation guide for post-acute and long-term care settings covers a range of topics including implementation, needs assessment, policy and financial models specifically tailored to this audience.
Visit the West Health Website to download a free copy of the guide.
New Net Neutrality Bill Introduced
Congressional Democrats introduced a net neutrality bill that would repeal the Federal Communications Commission’s (FCC) 2017 repeal and restore the 2015 regulations. S 682 was introduced by Senator Edward Markey (D-MA). The bill is similar to last year’s House Bill HR 4585, in that it would not only restore the earlier net neutrality regulations and treat the internet as a Title II utility, but would also establish rules that would prevent the FCC from reversing its decision as it did in 2017.
VA Reports Increase in Video Visits
The Department of Veterans Affairs reports that it experienced a 19% increase in video-based telehealth visits during fiscal year 2018, compared to the previous year. Approximately half of the 2.3 million telehealth visits conducted between October 2017 and September 2018 were delivered using real-time interactive video to connect to patients at a clinic or their home. The other telehealth visits were comprised of remote patient monitoring and store-and-forward services to track vital patient data and provide assessments. Additionally, over 105,000 video visits were conducted through the VA’s own telehealth application, VA Video Connect, which uses veterans’ own mobile devices or personal computers.
More details about the VA’s recent telehealth growth are available in their press release.
Many Health Systems Offer On-Demand Telemedicine, or Plan to Soon
Zipnosis has published results from a survey indicating increasing acceptance of on demand telemedicine services within health centers. In their report they detail data gathered from 56 respondents working for healthcare organizations ranging from hospitals to practices of less than 15 in staff. Respondents answered questions related to virtual care operations, technology and clinical outcomes. The survey was distributed online nationwide but over half of respondents came from the Midwest region of the United States and 41% were from independent health systems (not affiliated with a national IDN or government agency). Survey results found that 70% of respondents currently offer an on-demand virtual care service, and that of the 30% that currently do not, 40% plan to launch such a program in the next twelve months.
To learn more about the results of the Zipnosis survey, sign up to receive their full report.
CCHP Releases Series of Factsheet Updates on Telehealth Policy and Reimbursement
CCHP has released updated versions of its Telehealth Policy and Telehealth Reimbursement factsheets. The Telehealth Factsheet gives a broad overview of the main policy concerns that relate to telehealth, including reimbursement, malpractice coverage, licensing, privacy and security, prescribing and more. Also included are the topic areas CCHP receives the most inquiries about as the federally designated National Telehealth Resource Center on Policy (NTRC-P). The second factsheet focuses solely on reimbursement and is a deeper dive into the policy concerns related to Medicare, Medicaid and private payer telehealth coverage.
Updates on both factsheets center on the changes made by Medicare in their Calendar Year 2019 Physician Fee Schedule, in which they added coverage for remote communication technology as a service separate from telehealth as well as provided some exemptions from CMS’ typical telehealth geographic and originating site requirements for end-stage renal disease visits, acute stroke treatment and substance use disorders and co-occurring mental health conditions. Additionally, CCHP also updated shortened versions of the policy and reimbursement factsheets developed specifically for distribution by the National Consortium of Telehealth Resource Centers (NCTRC).
To view all of CCHP’s factsheets, visit CCHP’s Resources webpage.
Joint Commission Addresses Telemedicine Use for In-Person Evaluation Requirement for Individuals in Restraint/Seclusion
In a recent FAQ added to the Joint Commission website, they address whether the in-person evaluation of a person in restraint or seclusion required to be conducted by a licensed independent practitioner (LIP) can be done through a telemedicine link. The answer to the question is that this is not allowed, as telemedicine does not fulfill the in-person requirement by a physician, clinical psychologist or other LIP to conduct the evaluation. They also clarify that the evaluation must be completed within one hour of the initiation of restraint or seclusion. This should help guide professionals seeking clarity as to whether telemedicine is acceptable for fulfilling this requirement.
For more information, see the FAQ or contact the Joint Commission directly.
Medi-Cal Explained: An overview of Program Basics
The California Health Care Foundation (CHCF) held a briefing on February 25, 2019 in Sacramento. CHCF provided an extensive overview of the California Medicaid Program, Medi-Cal, and included presentations on eligibility and enrollment, Medi-Cal expanded services, and Medi-Cal finance and managed care imbursement. The event was capped off with a discussion of Medi-Cal’s future in the perspective of the Department of Health Care Services provided by Jennifer Kent, Director of the Department of Health Care Services and Chris Perrone, Director of Improving Access at CHCF. For more information on this event watch the full recording of the briefing, download the event PPT, and review the “Medi-Cal Facts and Figures; Crucial Coverage for Low-Income Californians” document and its accompanying quick reference guide.
For more information visit the CHCF Medi-Cal Explained webpage.
HRSA Announces School-Based Health Center Grant Awardees
The US Department of Health and Human Services’ Health Resources and Services Administration (HRSA) announced in February that it has awarded $11 million in grant funding to school-based health centers to improve facilities through minor alterations and renovation activities, including the purchasing of telehealth equipment. The funding is shared by 120 school-based health centers across the country and will fund increased access to mental health, substance abuse, and childhood obesity-related services within these facilities.
For a list of award recipients, visit HRSA’s award listing.
Industry Comments on Medicare Advantage Changes for 2020
In January, CMS released its notice of draft changes for calendar year 2020, which introduced changes to the Medicare Advantage capitation rate methodology and risk adjustment methodology under Part C and proposed changes to payment methodology for Part D. In the notice, CMS identifies several services that meet the criteria to qualify as a follow up service after an emergency department visit for patients with multiple chronic conditions. HIMSS and the Personal Connected Health Alliance have commented on the notice, stating that remote physiologic monitoring should be included in the list due to the impact they identify with the service leading to reductions in rehospitalization, costs, and improved outcomes. The deadline for additional comments was Friday, March 1st.
CMS will announce the final policies on Monday, April 1, 2019.
New Medicare Telehealth Payment Eligibility Analyzer
The Medicare Telehealth Payment Eligibility Analyzer can now be found in a new location on the Health Resources & Services Administration website. The analyzer is a helpful tool for verifying if an address is an eligible originating site for telehealth delivered services in the Medicare program.
Bookmark the tool on your computer for easy reference https://data.hrsa.gov/tools/medicare/telehealth
HB 23- Provides practice standards and specific restrictions related to telehealth services. Provides that health insurers or HMOs are allowed a tax credit against specified taxes imposed if it covers services provided by telehealth providers. VIEW BILL INFO (Status: 3/7/19 – In House; Sent to Ways & Means Committee)
HB 392 – Requires the Utah Medicaid program to reimburse for certain telemedicine services at the same rate that the program reimburses for other health care services and requires the Public Employees’ Benefit and Insurance Program to reimburse for certain telemedicine services at ‘commercially reasonable rates. VIEW BILL INFO (Status: 3/5/19 – In House; Sent to House Public Utilities, Energy, and Technology Committee)
HB 1738 –Stipulates that the Medicaid remote patient monitoring program may provide home telemonitoring services to a pediatric patient with chronic or complex medical needs who is being currently treated by at least three medical specialists, is diagnosed with end-stage solid organ disease, has received an organ transplant, or is diagnosed with severe asthma. Also states that the executive commissioner shall establish an enhanced Medicaid reimbursement rate for home telemonitoring services related to the management of a person’s medication, establish billing codes and a fee schedule for Medicaid reimbursement for home telemonitoring services provided by a federally-qualified health center, develop a process to prevent fraud, and allow for reimbursement for home telemonitoring services provided for a period of at least 120 days per episode. VIEW BILL INFO (Status: 3/4/19 – In House; read first time and referred to Public Health Committee)
SB 5828 – Requires that the home health reimbursement rate for services delivered to Medicaid recipients equal not less than one hundred percent of the Medicare home health payment and requires reimbursement for a social worker or telemedicine ordered by a physician or authorized health care provider. VIEW BILL INFO (Status: 3/1/19 – In Senate; Passed to Rules Committee for second reading )
SD 920 – Requires that any carrier or other entity which contracts with the Group Insurance Commission to provide health benefits to Employees and Retirees and their eligible dependents shall not decline coverage for health care services solely on the basis that those services were delivered through the use of telemedicine by a contracted health care provider. Also requires such carriers and entities to not meet network adequacy requirements through significant reliance on telemedicine providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner, upon request. VIEW BILL INFO (Status: 2/28/19 – In Senate; Referred to Committee on Financial Services)
AB 744 – Requires a contract issued, amended, or renewed on or after January 1, 2020 to specify that the health care service plan or health insurer reimburse a health care provider for the diagnosis, consultation, or treatment through telehealth service on the same basis and to the same extent that the health care service plan or health insurer is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment. Authorizes a health care service or health insurer to offer a contract or policy containing a deductible, copayment, or coinsurance requirement for a healthcare service delivered through telehealth services, subject to specified limitations. Prohibits a policy or health plan from imposing an annual or lifetime dollar maximum for telehealth services as well as from imposing a deductible, copayment, or coinsurance or other durational benefit limitation or maximum for benefits or services that are not equally imposed on all terms and services covered under the contract. VIEW BILL INFO (Status: 2/28/19 – In Assembly; Referred to Committee on Health )
For more information on state legislation
CCHP’s legislative tracking webpage.