A recent trend among states is the introduction of legislation to adopt interstate licensure compacts. Interstate licensure compacts allow special licensure or exceptions to state licensing requirements for specific health care providers to practice across state lines in other states that have adopted the same compact as long as certain requirements are met. Current compacts include the Physical Therapy Compact, Nurse Licensure Compact, Interstate Medical Licensure Compact and the Psychology Interjurisdictional Compact. One such compact that has received less attention, but has been gaining traction lately is the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA). REPLICA is a multi-state compact that allows emergency medical services (EMS) personnel in REPLICA member states to respond to calls and transport patients across state lines and provide emergency services before returning to their home state without having to apply for a separate license in another REPLICA member state. It is not considered a separate license, but rather is an extension of a privilege for EMS personnel to practice on a short-term, intermittent basis under certain circumstances including:
- Response areas that cross state lines
- Staffing for large scale responses that are not at the level of a governor’s declaration of a disaster
- Staffing for large scale planned special events such as concerts or sporting events
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.
Last year, Nebraska and Colorado based Visiting Nurse Associations (VNA) partnered with telehealth software company Health Recovery Solutions (HRS) to launch pilot health intervention programs to improve care management and coordination among patients receiving home health services, especially those living with heart disease. The programs are designed to improve care management and coordination by complementing traditional home health care.
It was an active year for state telehealth legislation in 2018. Among 39 states and DC, 65 legislative bills passed in the 2018 legislative session, up slightly from 62 bills in 2017. Additionally, 49 telehealth related regulations were finalized in 38 states related to telehealth. The enacted legislation this year focused mainly on broadening Medicaid policy, establishing regulatory requirements and enacting interstate licensure compacts. In general there has been a slowing of enacted legislation addressing private payer reimbursement of telehealth. Adopted regulation focused on telehealth practice standards by professional boards.
Medicare Report Reveals Medicare Telehealth Utilization, Barriers & Opportunities
In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing telehealth utilization, activities by the Center for Medicare and Medicaid Innovation, and opportunities and barriers to the use of telehealth within Medicare. Utilizing data from Medicare fee-for-service between 2014 and 2016, the report revealed that although overall use of telehealth has increased, the rate of adoption is still limited. Mental health and therapy sessions were the most common service types, with beneficiaries with a mental health diagnosis among the highest utilizers of telehealth delivered services. Services targeting chronic diseases and behavior modification (such as smoking cessation) were also among the more popular telehealth delivered services. The analysis determined that there are 19 additional high volume services for outpatient and inpatient visits and therapy that are either similar to those that are already on Medicare’s list or that are typically provided in settings that do not meet Medicare’s originating site requirements that would be suitable for telehealth delivery. CMS concludes that restrictions on eligible telehealth originating sites is the greatest barrier preventing the expansion for telehealth within Medicare.
For more details and further statistics on telehealth in Medicare,
see the full report.