Telehealth Policy This Month

The US Department of Veterans Affairs (VA) has reported a 17% increase in fiscal year (FY) 2019 in telehealth delivered services, verses FY 2018.  That amounts to more than 900,000 veterans taking advantage of telehealth services.  This comes on the heels of the VA completing their first year of the Anywhere to Anywhere Initiative, which allows VA health care providers to treat veterans in any US state, regardless of their state of licensure.  The VA also experienced a huge increase in use of their Video Connect App, which 99,000 veterans used to access care from their home.  Approximately two thirds of the 294,000 Video Connect appointments were for mental health conditions.  To learn more about the VA report and its findings, see the press release.

Last year, Congress passed the SUPPORT for Patients and Communities Act as part of an effort to combat the opioid epidemic. The act required the Drug Enforcement Administration (DEA) to issue regulations on a special registration process that would allow providers to prescribe controlled substances through telemedicine under certain circumstances. The DEA officially missed its deadline, set at one year from the passing of the Act on October 24th. A recent regulatory posting suggests the DEA plans to publish a proposal for the special registration in December, although there is no definitive timeline outlined for the rule’s publication.

The directive originated from the Special Registration for Telemedicine Clarification Act of 2018, which was adopted into the final opioid package, and was intended to ensure compliance with the Ryan Haight Act while expanding access to controlled substances, especially medications used in medication assisted therapy and psychiatric care.

Montana Governor Steve Bullock recently announced a $10 million, 5-year federal grant which will be used to fund the Montana Obstetric and Maternal Support (MOMS) program, aimed at addressing disparities in maternal health and to improve health outcomes for pregnant and postpartum women across rural Montana. Expected to launch in early 2020, the program intends to incorporate existing telehealth efforts with a focus on specialty care, obstetric-focused training opportunities, expanding mental health and substance use counseling, and establishing medication-assisted treatment specific to pregnant and parenting women experiencing addiction.

Using Project ECHO (Extension for Community Healthcare Outcomes), the program will connect urban OB/GYN professionals with rural providers treating at-risk and postpartum women for mentoring, guidance, and education. During a second phase in late 2020, OB/GYN physicians from urban centers will provide live consultation remotely to rural providers. Such consultations are planned to occur during both emergency visits and scheduled appointments. For more information on the program, see this press release from the Office of Governor Bullock.

A recent study published in JAMA Cardiology demonstrates a new approach to atrial fibrillation (AF) detection. The study states that current methodology can only screen one patient at a time, however, the findings suggest the possibility of a new low-cost approach that allows for the screening of multiple individuals. The researchers tested the use of high-throughput AF detection by analyzing facial photoplethysmographic (FPPG) signals from multiple patients concurrently using a smartphone camera and a pretrained deep convolutional neural network.Out of a total of forty-four patients and an average of seven recordings per individual, the researchers indicate a test-retest reliability of 95.4% for the FPPG. Patients also underwent an electrocardiogram (ECG) for reference. The FPPG and ECG showed 95.9% agreement in results. The researchers indicate that this new approach could save time and reduce work for clinical staff while requiring minimal effort from patients. However, they state that the predictive value will likely be lower in practice as AF prevalence is lower among the general population compared to the study group which was comprised of approximately half of individuals with permanent AF. For more information about the study, the full article is available for purchase through the JAMA Network.

Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (CONNECT Act)
S. 2741 (Sen. Schatz) and HR 4932 (Rep. Thompson) – The American Medical Association are among the more than 100 organizations supporting the CONNECT Act, in order to curb some of the geographic and originating site requirements currently in Medicare.  The AMA President Patrice A. Harris, MD, MA commented in a press release that “This legislation would benefit patients by removing antiquated restrictions in the Medicare program that prevent physicians from using widely available medical technology that has become commonplace in the past decade.”Specifically, the CONNECT Act would address barriers to telehealth access by allowing the Secretary to waive any of the current restrictions (geographic, originating site, modality limitation, provider type and service requirements) applicable to telehealth if the waiver would not deny or limit the coverage or provision of benefits and the Secretary determines that the waiver is expected to reduce spending without reducing the quality of care or improve quality of care without increasing spending; or would apply to telehealth services furnished in originating sites located in a high need health professional shortage area.

The CONNECT Act also would create an exception for mental health services from the geographic requirement and allow the home to serve as an originating site.  Other circumstances that would warrant an exception from the geographic requirement would include emergency medical care (when furnished in a critical access hospital, hospital or skilled nursing facility), services in federally qualified health centers (FQHCs), rural health clinics (RHCs), and Native American health service facilities and national emergencies.  FQHCs and RHCs would also be allowed to serve as distant site providers under the Act.  The CONNECT Act also addresses alternative payment models and the process by which CMS approves new codes for telehealth reimbursement.  For more information, see the full text of the bill and reference CCHP’s factsheet and chart outlining the different elements of the bill.  (Status:  S. 2741: 10/30/19 – Read twice and referred to Senate Committee on Finance; HR 4932:  10/30/19 – Referred to House Committee on Energy and Commerce, and House Committee on Ways and Means)

The Specialty Treatment to Access and Referrals Act of 2019 (STAR Act)
HR 5190 (Rep. Harder) – In late November, HR 5190, the Specialty Treatment to Access and Referrals Act of 2019 (STAR Act) was introduced by Representative Harder.  The bill seeks to provide assistance for health centers and rural health clinics to implement electronic provider consultation and related telehealth services by establishing a grant program to help healthcare providers develop and start up an E-Consult program. As proposed, the grant program would run from 2021 through 2025 and would award grants not to exceed $200,000 to health centers or clinic facilities ($5,000,000 for health center controlled networks) that demonstrate that they lack sufficient access to medical specialty care and have not already implemented an E-Consult or related telehealth services program.  Money from the grant could be used to pay for software, infrastructure and equipment, and costs associated with integrating an EHR technology with the system, among other items.  For further information on HR 5190, see CCHP’s factsheet on the bill, or see the bill’s full text. (Status: 11/20/19: Introduced in House, referred to House Committee on Energy and Commerce)

Teleabortion Prevention Act 
HR 4935 (Rep. Wright) – The Teleabortion Prevention Act of 2019, HR 4935, 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:  10/30/19: Introduced in House, referred to House Committee on Judiciary)

ECHO Act of 2019
HR 5199 – The ECHO Act of 2019, HR 5199, would require the Secretary, as appropriate to award grants to evaluate, develop and expand the use of technology enabled collaborative learning and capacity building models to improve retention of health care providers and increase access to health care services.  For further information on HR 5199, see the full text of the bill.

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