Telehealth Policy This Month

Original Source: Center for Connected Health Policy

 

HRSA Program Assistance Letter to Funded Health Centers
In late January the Health Resources Services Administration issued a Program Assistance Letter to highlight some of the significant issues and clarifications for health centers to consider when utilizing telehealth to increase access to patient care.  The letter emphasizes that telehealth is not a service or a service delivery method requiring specific HRSA approval, but rather is a mechanism or means for delivering a health service to health center patients using telecommunications technology or equipment. HRSA encourages health centers to consider the range of issues that would support successful telehealth implementation, including:
  • Provider licensure/scope of practice
  • Facility licensing requirements
  • Equipment/training
  • Privacy/confidentiality & medical records
  • Patient consent
  • Billing and third-party payments
  • Liability Coverage
The letter also provides a table with examples of how a health center would accurately reflect sites, services and service delivery methods in a health center’s scope of project.  For more details, see the full letter.

Senators Express Concern Over Lack of DEA Telemedicine Registry Regulations
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 24, 2019. A December regulatory posting suggested the DEA plans to publish a proposal, however there is no definitive timeline outlined for the rule’s publication.  In response to the lack of action by the DEA, Senate Health, Education, Labor and Pensions (HELP) Committee members, Senators Warren, Murray, and Kuster sent a joint letter urging the Acting Administrator of the DEA to issue regulations as soon as possible, so that access to medication assisted treatment could be expanded for those that need it.  Likewise, Senator Warner, who helped draft the original legislation, also sent a similar letter to the DEA as well.
Recent Next Gen ACO Program Evaluation Suggests No Savings to Medicare  
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) launched the Next Generation Accountable Care Organization (ACO) model in January of 2016. The model was intended to expand opportunities for care coordination among providers and beneficiaries and allow provider groups to assume higher levels of financial risk to test whether that risk would provide stronger incentives to improve health outcomes and lower expenditures for Medicaid fee-for-service beneficiaries. Recent evaluation data has led some to believe that the program may not continue into 2021. The evaluation concludes that the Next Gen ACO model has not been associated with reduced Medicare spending in its first two years. CMS has stated, however, that there can be no determination until additional performance years are evaluated.
NIST Cybersecurity Framework 
The National Institute of Standards and Technology (NIST) has released a cybersecurity framework to promote the protection of critical infrastructure. The framework includes standards, guidelines, and practices to guide owners and operators in managing cybersecurity-related risks. It consists of three primary components including the Core, Implementation Tiers, and Profiles. The Core complements organizations’ existing cybersecurity and risk management processes to further guide the management and reduction of cybersecurity risks. Implementation Tiers are used to assist organizations to determine the appropriate level of cybersecurity. Finally, Profiles represent an organization’s requirements and objectives, risk appetite, and resources.  To learn more about the Framework explore the tool on the NIST website.

NIH Physical Therapist Grant

According to an article in mHealth Intelligence, the Center for Neurorehabilitation at Boston University is using a $3.2 million grant from the National Institutes of Health to continue studies on the use of an mHealth app in the improvement of care management for patients with Parkinson’s disease. The study is based on research published by the Center in the February 2019 issue of the Journal Physical Therapy, which showed statistically significant improvements in overall mobility scores among patients using the app, compared to those without the intervention. The continuing research would further determine the effectiveness of the intervention by comparing increases in real-world walking activities.

FEDERAL LEGISLATION
National Telehealth Strategy and Data Advancement Act 
HR 5763 (Rep. Gianforte) – Requires the Secretary to develop a plan (updated every two years) for the adoption, advancement and coordination of telehealth by Federal agencies.  The Secretary should also make recommendations to improve access to telehealth, coordination of telehealth and health outcomes.  See bill text for specific requirements of the recommendations and other agencies the Secretary would be required to consult with.  Other requirements would include standardizing the federal grant processes and data reporting, providing assistance to regional and national entities to enable greater use of telehealth, providing federal governance and oversight of federal expenditures on telehealth and broadband, and ensuring that there is information sharing and collaboration across federal agencies.  HR 5763 also requires a public comment period for the recommendations, and makes appropriations for telehealth-related grants and activities. (Status: 2/5/20: Introduced and referred to House Committee on Energy and Commerce)

Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 
S 785 (Sen. Tester) – Includes various provisions for reporting on the use of telehealth and telemedicine in mental health services, including recommendations for how to improve such services when delivered to veteran populations.  (Status: 1/29/20: Committee on Veterans’ Affairs.  Ordered to be reported with an amendment in the nature of a substitute favorably)

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)

Medicare-X Choice Act of 2019
HR 2000 (Rep. Delgado) – Requires the Secretary to establish a coordinated and low-cost health plan known as the ‘Medicare Exchange Health Plan.’ Individuals would be eligible for the plan if they qualify within section 1312 of the Patient Protection and Affordable Care Act and are not eligible for benefits under the Medicare Program under title XVIII. The Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the health plan, including telehealth and remote patient monitoring. The Secretary must also ensure the integration of telehealth tools that increase patient access to medical care, particularly in remote or underserved areas if such integration would reduce spending without reducing quality of care or improve the quality of care without increasing spending. (Status: 12/10/19: Subcommittee on Health Hearing Held)

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STATE LEGISLATION
TENNESSEE
SB 1892 – Alters reimbursement requirements for telehealth delivered services, including requiring reimbursement of a facility fee. It also requires coverage of remote patient monitoring if covered by Medicare. (Status: 1/30/20:  Passed on Second Consideration, refer to Senate Commerce and Labor Committee)

NEW MEXICO
SB 212 – Defines the “originating site” of teledentistry as the site where the dentist provides the service. It also allows for asynchronous communication if paired with live video. (Status: 1/29/20: Introduced)

CALIFORNIA
AB 2007 – Provides that an FQHC or RHC “visit” includes an encounter between an FQHC or RHC patient and a health care provider using telehealth by synchronous real time or asynchronous store-and-forward. The bill would clarify, for purposes of an FQHC or RHC visit, that face-to-face contact between a health care provider and a patient is not required for an FQHC or RHC to bill for telehealth by synchronous real time or asynchronous store-and-forward if specified requirements are met. (Status: 1/28/20: Introduced)

MARYLAND
SB 502 – Requires the Maryland Medical Assistance Program to provide mental health services appropriately delivered through telehealth to patients in their home. Also changes the definition of telehealth for insurers to include the delivery of mental health care services to the patient in their home setting. (Status: 1/31/20: Read first time, Hearing scheduled for 2/19/20)

WASHINGTON
HB 2770 – Requires health plans, including Medicaid managed care plans, to reimburse a provider for health care services provided through telemedicine at the same rate as if the service was provided in-person by the provider. Permits hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers to negotiate a reimbursement rate for telemedicine services that differs from the reimbursement rate for in-person services. Directs the Collaborative for the Advancement of Telemedicine to study store-and-forward technology to examine utilization, whether it should be paid for at parity with in-person services, the potential for it to improve rural health outcomes in Washington state, and ocular services. (Status: 1/21/20: Read first time, referred to Committee on Health Care & Wellness)

MICHIGAN
HB 5413 – Adds store-and-forward to the list of eligible modalities identified in the definition of telemedicine. (Status: 1/28/20: Introduced and read first time, referred to Committee on Health Policy)