Telehealth Policy This Month

Original Source: Center for Connected Health Policy

In May 2019, the University of Michigan National Poll on Healthy Aging conducted a national poll on the experiences and opinions of telehealth from adults age 50-80 years. The poll asked participants to share their opinions on telehealth compared to in-person office visits, such as the perceived levels of convenience and expressed concerns.

Only 14% of respondents reported that their providers offered telehealth visits through smartphones or computers and only 4% reported having a telehealth visit within the last year. However, interest in telehealth was relatively high. Among respondents, 47% believed that the overall convenience of a telehealth visit would be better than an in-person office visit while 36% believed the in-person visit would be more convenient and 18% believed there would be no difference. Additionally, among respondents whose providers do not offer telehealth visits, 48% expressed interest in having a telehealth visit with their primary care provider, 40% with a specialist, and 35% with a mental health professional.

Older adults showed some concerns with telehealth with 56% believing that they would feel better cared for from an in-person office visit. 71% indicated being concerned that health care providers would not be able to do a physical exam, 68% that care would not be as good, and 49% that there were concerns with privacy.

For more information, the full report is available from the University of Michigan Library.

Thirty-five Professionals Charged in Genetics Testing Medicaid Fraud Involving Telemedicine Companies
A press release issued last month by the U.S. Department of Justice announced that federal law enforcement have issued charges against 35 medical professionals associated with a Medicare fraud scheme in which more than $2.1 billion were billed to Medicaid over medically unnecessary cancer genetic tests. Additionally, the Centers for Medicare & Medicaid Services Center for Program Integrity has announced that it took adverse administrative action against cancer genetic testing companies and medical professionals involved in the submission of over $1.7 billion in Medicare claims. The fraud scheme was brought to light through a federal investigation on an alleged scheme in which cancer genetic laboratories provided illegal kickbacks and bribes in exchange for the referral of Medicaid beneficiaries for the medically unnecessary cancer genetics tests. Many of the referrals were issued by medical professionals working with fraudulent telemedicine companies.
Additional information is available in the press release on the Department of Justice website.

Manatt Telehealth ROI White Paper 
In September Manatt Health Strategies released a white paper presenting a framework for evaluating the return on investment (ROI) for telehealth.  The paper presents different considerations certain types of providers may want to focus on when evaluating their ROI.  For example, the ROI analysis framework may be different for an academic medical center versus a community hospital or primary care clinics.

In general the paper lays out guiding questions in the following broad topic areas:

  • Patient acuity mix:  How might patient acuity levels shift with the addition of the telehealth program?
  • Cost savings: Is there expected cost savings?
  • New-patient volume:  Will the program attract new patients?
  • Patient retention:  Will the program result in higher patient retention rates?
  • Reimbursement or contract revenue:  How will services be paid for? Medicaid, Medicare, private payers or patient out-of-pocket payments?
  • Technology: What are the hardware and software costs?
  • Program and program management:  What are the costs for program design, implementation and operation?
  • Staffing:  What would be the training costs?  Would it enable the increased use of mid-level providers?

The white paper also presents two case studies, one for a rural community hospital telecardiology model and the second for a capitated hospital system pre-transfer video consultation program.
To see the detailed breakdown of the ROI analysis for each of the case studies, request the full white paper from Manatt for free.

CMS Issues RFI for Information on Addressing the Opioid Crisis
The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) seeking feedback from the public regarding ways for CMS to address the opioid crisis.  The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (“SUPPORT Act”), which passed into law last year, directs the Health and Human Services (HHS) Secretary, in collaboration with the HHS Pain Management Best Practices Inter-Agency Task Force (PMTF), to develop an Action Plan to “prevent opioids addictions and enhance access to medication-assisted treatment (MAT).” As part of the Action Plan, the Secretary must include a review of Medicare and Medicaid payment and coverage policies for MAT and the treatment of acute and chronic pain, emphasizing treatment that minimizes the risk of opioid misuse and opioid use disorders (OUD). The comments from this RFI will ultimately be incorporated into the Action Plan.

Questions in the RFI specifically ask what actions CMS can take to enhance access to both appropriate care for acute and/or chronic pain, as well as access to treatment of substance use disorder (SUDs) (including OUD), in Medicare and Medicaid including through remote patient monitoring, telehealth and other telecommunications technologies.
For additional information, see the entire RFI Request.


AB 744 – Requires a contract issued, amended, or renewed on or after January 1, 2021 to specify that the health care service plan or health insurer reimburse a healthcare provider for the diagnosis, consultation, or treatment through telehealth services 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. 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. Final amendments included qualified autism service providers/professionals within scope; specifies that AB 744 does not affect network adequacy; and specifies that payment parity would not apply to Medi-Cal managed care plans. (9/25/19: Enrolled and Presented to Governor)

S 612 – Requires both private payers and Massachusetts Medicaid to provide coverage for telemedicine, however prohibits the plans from meeting network adequacy through significant reliance on telemedicine providers.  In this bill, telemedicine is defined to include both synchronous and asynchronous audio, video or other electronic media.  It also may include text only email for purposes of patient management in the context of a pre-existing physician patient relationship. (9/18/19: In Committee on Financial Services, Hearing held 10/1)

SB 857 – Requires health insurance policies to provide coverage for telemedicine services consistent with the insurer’s medical policies. This includes coverage for telemedicine services delivered by a participating network provider who provides the service consistent with the insurer’s medical policy. (9/19/19: Referred to Committee on Banking and Insurance)

AB 410 / SB 380 – Requires the Department of Health Services (DHS) to provide Medicaid reimbursement for any benefit that is covered under the Medicaid program, delivered by a certified program, and provided through telehealth. The amount paid for such a service provided by a distant site provider is equal to the amount the provider would receive under Medicaid when providing the service through a method other than telehealth. DHS would also be required to provide as a benefit and reimburse for provider-to-provider telehealth consultations, remote patient monitoring, and store-and-forward services provided through communication technology that are covered under Medicare. (AB 410: 9/18/19 In Assembly, amendment offered, Public hearing held on 9/24/19; SB 380: 9/18/19 In Senate, amendment offered)



Telehealth Practice Standards – Board of Social Work Examiners:
Creates standards for utilizing telehealth for social work examiners.  Requires licensees to obtain informed consent, assess whether the client is appropriate for telehealth and utilize best practices for telehealth to ensure client confidentiality and security of communication when utilizing telehealth.  It also requires licensees to make reasonable efforts to become and remain knowledgeable about the advantages and drawbacks of professional online relationships.  (Comment Deadline: 10/11/19)

Telemedicine Eligible Providers – State Medical Board:
Specifies that a physician or physician assistant prescribing, dispensing, or furnishing a prescription medication through telemedicine without first conducting a physical examination of the patient and without patient-physician or patient physician-assistant relationship is not considered professional misconduct. (Comment Deadline: 10/30/19)