January Newsletter

Orignal source: Center for Connected Health Policy
NICHM Funds CCHP Policy Research on FQHCs Utilizing Telehealth for Opioid Use Disorder Services
The Center for Connected Health Policy (CCHP) has received funding from the National Institute for Health Care Management Foundation (NIHCM) to conduct research on policy changes that need to be made in order for federally qualified health centers (FQHCs) to utilize telehealth to address the opioid crisis. With opioid overdose being classified by the Department of Health and Human Services (HHS) as a nationwide epidemic, and FQHCs often serving as the first line of defense in rural and underserved communities, many clinics are looking to telehealth to help address opioid use disorders (OUD) and deliver Medication Assisted Treatment (MAT), a best practice treatment for opioid addiction which combines medication and behavioral therapy.  However, many FQHCs find themselves restricted from establishing a telehealth program to treat OUD given an array of unique and complex policy barriers, both on the federal and state policy levels.  Through this project, CCHP will chronicle the policy obstacles FQHCs face in implementing a telehealth MAT program in 5 to 7 states where the Health Resources and Services Administration (HRSA) has awarded grants to address the OUD crisis and which have high incidents of OUD.  The findings will be disseminated through an issue brief which will also provide insight for both FQHCs and policy makers into how to overcome policy barriers in order to implement a sustainable and innovative OUD program utilizing telehealth.

Telehealth Featured in CMS Grant Program for Maternal Opioid Misuse (MOM) Model 
The Centers for Medicare & Medicaid Services (CMS) announced in December ten states selected to receive funding under the Maternal Opioid Misuse (MOM) Model. These states include Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas and West Virginia.

The MOM Model is a five-year program intended to foster the quality of care and reduce costs for pregnant and postpartum women with opioid use disorder (OUD), expand access, service-delivery capacity, and infrastructure based on needs, and create sustainable coverage and payment strategies to support ongoing coordination and integration of care. In a press release from the Maine Department of Health and Human Services, it was noted that one of the critical components of the MOM Model is the inclusion of a “no wrong door” system which would include, among other strategies, the inclusion of telehealth as a method of increasing access to screening and engaging women in care.

Implementation of the MOM Model began January 1, 2020 and states will have two years to fully integrate the new model of care. More detailed information on each state awarded funding for the model is available here. For more information about the award, read the official press release by CMS.

Telehealth Featured in CMS Grant Program for Maternal Opioid Misuse (MOM) Model 
The Centers for Medicare & Medicaid Services (CMS) announced in December ten states selected to receive funding under the Maternal Opioid Misuse (MOM) Model. These states include Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas and West Virginia.

The MOM Model is a five-year program intended to foster the quality of care and reduce costs for pregnant and postpartum women with opioid use disorder (OUD), expand access, service-delivery capacity, and infrastructure based on needs, and create sustainable coverage and payment strategies to support ongoing coordination and integration of care. In a press release from the Maine Department of Health and Human Services, it was noted that one of the critical components of the MOM Model is the inclusion of a “no wrong door” system which would include, among other strategies, the inclusion of telehealth as a method of increasing access to screening and engaging women in care.

Implementation of the MOM Model began January 1, 2020 and states will have two years to fully integrate the new model of care. More detailed information on each state awarded funding for the model is available here. For more information about the award, read the official press release by CMS.

AMA Council on Medical Service Report on Interstate Medical Licensure Compact
A report prepared by the American Medical Association (AMA)’s Council on Medical Service, and accepted at the 2019 Interim Meeting in November recommends the AMA work with state associations to encourage states to join the Interstate Medical Licensure Compact (IMLC) if they have not already done so.   The IMLC provides an expedited medical licensure process with the goal of allowing physicians to become licensed in multiple states more easily, while protecting patient safety.  The IMLC has been enacted in 29 states, the District of Columbia and the Territory of Guam.  In the report, the Council states that “the Compact creates another pathway for licensure and does not otherwise change a state’s medical practice act.”  It also notes that physicians would be bound to comply with the statutes, rules and regulations of each Compact state they choose the practice in, allowing states to maintain their authority to regulate the practice of medicine within their borders.  For more information on the Council’s recommendations, read the full report.
U.S. Department of Agriculture Invests in Telehealth in Rural Nevada
In December of 2019, the U.S. Department of Agriculture announced that a $987,745 grant has been awarded to three telehealth projects located in rural Nevada. The grants are awarded to organizations that provide education or healthcare services through telecommunication facilities and must benefit rural areas with populations of 20,000 or less.
  • Nevada Health Centers, Inc. (NVHC), a nonprofit federally qualified health center was awarded $489,070 which it will use to provide distance learning for health professionals and increase telemedicine access to health care for approximately 63,000 people living in Nevada. Specifically, the funded project will connect 10 urban health centers with seven rural schools to deliver primary care and behavioral health services to students in rural areas.
  • Renown Health, a local nonprofit healthcare network located in Reno, NV, was awarded $228,300 for improvements to an existing telehealth network at 12 sites in Nevada. The funds will support the establishment of three new locations at remote tribal reservations. The expansion is expected to affect over 264,000 residents in nine counties of northern Nevada.
  • Hazel Health, which provides school health services, is receiving $270,375 to expand access to healthcare for children through their school telehealth program. Through partnerships with school nurses at nine rural schools, the program aims to improve student health and reduce absenteeism by granting access to medical professionals at schools using live video telehealth.
For more information on the grant and its awardees, read the official announcement.
Compilation of CMS Letters and Resources
The Center for Connected Health Policy (CCHP) has gathered telehealth related information and guidance issued by the Centers for Medicare and Medicaid Services (CMS) and combined the materials into a single resource compilation.  Medicare telehealth policy is generally detailed in the Medicare Learning Network (MLN)’s Booklet on Telehealth Services issued at the beginning of each year. However, occasionally questions are raised regarding telehealth reimbursement that are not addressed in the Booklet, or CMS issues supplemental MLN documents, Medicare manual sections or Frequently Asked Question (FAQ) documents to address specific topic areas that require specialized direction (such as FQHC/RHC billing). The purpose of CCHP’s compilation is to consolidate all of this information into one reference resource.  Download CCHP’s full compilation of CMS telehealth resources, and if you are a recipient of one of the telehealth-related letters described above, please feel free to forward it to [email protected] who will include it in future versions of this resource.
CCHP 2019 State Legislative Roundup
In mid-December CCHP released its annual legislative roundup of state approved legislation.  2019 proved to be an active year in state legislation.  Among 35 states, 113 legislative bills passed in the 2019 legislative session, up significantly from 65 bills in 2018.  Additionally, 54 telehealth related regulations were finalized in 35 states related to telehealth.  The large leap in the numbers of bills passed was partially due to the increased passage of cross-state licensing legislation enacting interstate licensing compacts.  While the cross-state licensing topic area had 10 bills enacted in 2018, it more than doubled to 23 bills in 2019.  There was also large increases in the passage of bills establishing telehealth demonstrations, pilots and grant programs, as well as bills addressing regulatory professional board practice standards and prescribing. Bills related to both Medicaid and private payer reimbursement also both had an increase since 2018, although the number of bills passed has remained low comparatively.  CCHP’s 2019 roundup of state approved legislation, which includes a detailed listing of all bills by topic area and state, is now available!
FEDERAL LEGISLATION
Lower Health Care Costs Act 
S 1895 (Sen. Alexander) establishes a grant program to evaluate, develop and as appropriate expand the use of technology enabled collaborative learning and capacity building models to increase access to health care services, such as chronic disease and conditions, mental health, substance use disorder and prenatal and maternal health among others.  The bill defines ‘technology-enabled collaborative learning and capacity building model’ as a “distance health educational model that connects health care professionals, and particularly specialists, with multiple other health care professionals through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning disseminating best practice, and evaluating outcomes.”  (Status: 7/2/19: On Senate Legislative Calendar under General Orders)

Enhance Access to Support Essential (EASE) Behavioral Health Services Act 
HR 5473 (Rep. Bilirakis) provides an exception from Medicare’s geographic restrictions for telehealth services that are behavioral health services furnished on or after July 1, 2020 to eligible telehealth individuals, including initial patient evaluations, follow up medical management and behavioral health services.  It also amends the SUPPORT for Patients and Communities Act which requires the Secretary to issue guidance to states regarding federal reimbursement for furnishing services and treatment for substance use disorders under Medicaid using telehealth, to also include guidance on mental health disorders and behavioral health disorders.  (Status: 12/18/19: Referred to Committee on Energy and Commerce, and Committee on Ways and Means)

Teleabortion Prevention Act  of 2019
HR 4935 (Rep. Wright) as proposed by Rep. Wright, would place a $1000 fine or 2 year prison term on any healthcare provider who knowingly provides a chemical abortion without physically examining the patient, without being physically present at the location of the chemical abortion or without scheduling a follow-up visit for the patient not more than 14 days after the administration or use of the drug to assess the patient’s physical condition.  For further information on HR 4935, see the full text of the bill.  (Status:  12/18/19: Referred to House Subcommittee on Crime, Terrorism and Homeland Security)

Telehealth Expansion Act of 2019 
HR 5257 (Rep. Cox) creates the Expanding Telehealth Program in order to support connected care services for low income individuals, individuals residing in rural areas and veterans, defray the cost of internet service to these populations with conditions such as behavioral health conditions, opioid dependency, chronic conditions, mental health conditions, cancer and high risk pregnancies, to promote innovative telehealth services and to gather data and information.  (Status: 11/22/19:  Referred to House Committee on Energy and Commerce)
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STATE LEGISLATION
NEW HAMPSHIRE
SB 555 – Requires New Hampshire Medicaid to provide coverage and reimbursement for health care services on the same basis it is provided for health care services provided in person. The combined amount of the distant and originating site fees shall not be less than the total amount allowed for health services delivered in person. It also requires health plans to provide coverage and reimbursement of health care services provided over telemedicine on the same basis as services provided in person. (Status: 1/2/20 – Introduced and Referred to Commerce Committee)

FLORIDA
SB 926 – Enters Florida into the Interstate Medical Licensure Compact. (Status: 12/13/19 – Referred to Senate Committees on Health Policy; Appropriations)

HAWAII
HB 1020 – Establishes the state Telehealth Advisory Council and State Telehealth Coordinator as permanent resources to establish telehealth within Hawaii. (Status: 12/1/19 – Carried over to 2020 Regular Session)

INDIANA
SB 19 – Removes restrictions on the prescribing of ophthalmic devices through telemedicine and sets conditions on when a provider may, through the use of telemedicine, prescribe medical devices. Prohibits the Indiana Optometry Board from setting standards for the practice of ocular telemedicine or ocular telehealth that are more restrictive than the standards established for in person practice. (Status: 1/6/20 – First reading; referred to Committee on Health and Provider Services)

VIRGINIA
HB 1332 – Requires the Board of Health to develop and maintain an Emergency Telehealth Plan to promote rapid patient access to emergency medical physicians through telehealth and telemedicine services. The plan must include the establishment of a statewide emergency telehealth program and telemedicine services in the delivery of emergency medical services; the promotion and inclusion of telehealth and telemedicine services and technologies in operating procedures of emergency medical services agencies; a uniform set of proposed criteria for the use of telehealth and telemedicine services for prehospital and inter hospital triage and transportation of patients in need of emergency medical services; a strategy for integration of the Emergency Telehealth Plan with the Statewide Emergency Medical Services Plan, the Statewide Trauma Triage Plan, and the Stroke Triage Plan; and provisions for collection of data regarding the use of telehealth and telemedicine services and technologies in the delivery of emergency medical services to determine the effect of use of telehealth and telemedicine services on the emergency medical services system. (Status: 1/8/20 – Prefiled and ordered printed)

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