Biden-Harris Administration Announces Availability of Up To $500 Million in Emergency Rural Health Care Funds Under the American Rescue Plan U.S. Department of Agriculture August 2021 Funding Will Expand Access to COVID-19 Vaccines, Health Care Services and Food Assistance in Rural America The Biden-Harris Administration today announced that the United States Department of Agriculture (USDA) is making up to $500 million available in grants to help rural health care facilities, tribes and communities expand access to COVID-19 vaccines, health care services and nutrition assistance. President Biden’s comprehensive plan to recover the economy and deliver relief to the American people is changing the course of the pandemic and providing immediate relief to millions of households, growing the economy and addressing the stark, intergenerational inequities that have worsened in the wake of COVID-19. “Under the leadership of President Biden and Vice President Harris, USDA is playing a critical role to help rural America build back better and equitably as the nation continues to respond to the pandemic,” Agriculture Secretary Tom Vilsack said. “Through the Emergency Rural Health Care Grants, USDA will help rural hospitals and local communities increase access to COVID-19 vaccines and testing, medical supplies, telehealth, and food assistance, and support the construction or renovation of rural health care facilities. These investments will also help improve the long-term viability of rural health care providers across the nation.” Background: Beginning today, applicants may apply for two types of assistance: Recovery Grants and Impact Grants. The Biden-Harris Administration is making Recovery Grants available to help public bodies, nonprofit organizations and tribes provide immediate COVID-19 relief to support rural hospitals, health care clinics and local communities. These funds may be used to increase COVID-19 vaccine distribution and telehealth capabilities; purchase medical supplies; replace revenue lost during the pandemic; build and rehabilitate temporary or permanent structures for health care services; support staffing needs for vaccine administration and testing; and support facility and operations expenses associated with food banks and food distribution facilities. Recovery Grant applications will be accepted on a continual basis until funds are expended. The Administration also is making Impact Grants available to help regional partnerships, public bodies, nonprofits and tribes solve regional rural health care problems and build a stronger, more sustainable rural health care system in response to the pandemic. USDA encourages applicants to plan and implement strategies to: -develop health care systems that offer a blend of behavioral care, primary care and other medical services; -support health care as an anchor institution in small communities; and -expand telehealth, electronic health data sharing, workforce development, transportation, paramedicine, obstetrics, behavioral health, farmworker health care and cooperative home care. Impact Grant applications must be submitted to your local USDA Rural Development State Office by 4:00 p.m. local time on Oct. 12, 2021. For additional information, please see the notice (PDF, 343 KB) in today’s Federal Register. USDA encourages potential applicants to review the application guide at www.rd.usda.gov/erhc. USDA Rural Development is prioritizing projects that will support key priorities under the Biden-Harris Administration to help rural America build back better and stronger. Key priorities include combatting the COVID-19 pandemic; addressing the impacts of climate change; and advancing equity in rural America. For more information, visit www.rd.usda.gov/priority-points. Under the Biden-Harris Administration, Rural Development provides loans and grants to help expand economic opportunities, create jobs and improve the quality of life for millions of Americans in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural, tribal and high-poverty areas. For more information, visit www.rd.usda.gov . If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page. USDA touches the lives of all Americans each day in so many positive ways. Under the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov . < Previous News Next News >

Epic research shows telehealth efficacy, makes case for more reimbursement Andrea Fox December 15, 2022 The study of 35 million telehealth visits found that most patients did not require in-person visits within 90 days of online appointments, indicating virtual visits as an effective "alternative, rather than duplicative" care modality. A dual team study of in-person, same-specialty follow-up rates after telehealth appointments published by Epic Research examined the cadence of care and found virtual medicine to be an effective tool. WHY IT MATTERS Analyzing the effectiveness of different methods for delivering care is important to guide decisions about how to allocate resources, according to the study's key findings report. To determine which specialties were able to fulfill patient needs using telehealth and which required in-person follow-up visits more often, two teams of researchers examined more than 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022. What they found, according to the report, is that high in-person follow-up rates within three months were present only in specialties that require regular hands-on care, such as obstetrics and surgery. Follow-up visits within 90 days of telehealth appointments were not, by and large, instances of duplicative care, but a method of care delivery that can increase healthcare access, the researchers say. "Healthcare providers should continue to educate policymakers and administrators on the function telehealth plays as an alternative, rather than duplicative, encounter," they said in the report, adding that payers should extend telehealth visit coverage. The researchers also found that genetics and nutrition are the specialties that made the most efficient use of telemedicine. And while 15% of mental healthcare and psychiatry telehealth appointments required in-person follow-up in the next three months, that specialty had the largest volume of all studied for telehealth utilization. Of the more than 4.3 million telehealth visits during the study period, nearly 3.7 million mental health and psychiatry telehealth visits did not require in-person follow-up. THE LARGER TREND While telehealth use increased during the COVID-19 pandemic, one study of 40.7 million adults found telehealth comparable for chronic conditions. However, some experts quickly found telemedicine well-suited for use in behavioral health after the onset of the pandemic. Also, the COVID-19 public health emergency eliminated the requirement to have an in-person visit with a patient before prescribing medication-assisted treatment (MAT) for opioid use disorder (OUD). While an end to the PHE would signal a return to the in-person visit requirement for OUD prescriptions, several healthcare organizations have urged the U.S. Justice Department and the Drug Enforcement Agency to revise telehealth controlled substance rules. In rural areas, telehealth has increased access to care, including the ability to treat OUD with MAT. "Telehealth flexibilities and ePrescribing waivers have been crucial in enabling providers to care for patients during the pandemic and have greatly expanded access to care in situations where patients were unable or unwilling to travel to a physical location," Dr. Maroof Ahmed, co-founder of Quit Genius, told Healthcare IT News by email in October. ON THE RECORD "These findings suggest that, for many specialties, telehealth visits are typically an efficient use of resources and are unlikely to require in-person follow-up care," according to the researchers' key findings report. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org Healthcare IT News is a HIMSS publication. See original article: https://www.healthcareitnews.com/news/epic-research-shows-telehealth-efficacy-makes-case-more-reimbursement < Previous News Next News >

Academy Health Report Addresses Medicaid Directors Perspective on Telehealth Center for Connected Health Policy May 2021 Views on telehealth since the COVID-19 Public Health Emergency (PHE) began In March 2021, Academy Health released a report detailing results from an environmental scan and discussions with Medicaid Medical Directors (MMDs) on their views on telehealth since the COVID-19 Public Health Emergency (PHE) began. MMDs are physicians and clinical leaders in different specialties who advise Medicaid programs on clinical matters. During the pandemic, many have weighed in on telehealth and how it should be deployed in their states Medicaid program. The report breaks down views of Medicaid directors and resulting recommendations into three topic areas: Equity, Quality and Payment. Examples of recommendations made in the equity category include: 1. Medicaid programs should clearly communicate temporary telehealth policies and when those policies will expire. 2. Medicaid programs should support expansion of telehealth for purposes of equitable access if clinically appropriate and makes sense in terms of cost and quality. 3. Medicaid programs should work to reduce barriers to telehealth, including addressing the technology divide, digital literacy and underlying health disparities. For more details and recommendations related to quality and payment, read the full report. < Previous News Next News >

COVID-19 Policy Playbook Recommends Removal of Telehealth Restrictions for OUD Treatment Center for Connected Health Policy May 2021 Legal recommendations for a safer more equitable future Researchers from the Network for Public Health Law have published a COVID-19 Policy Playbook, that outlines legal recommendations for a safer more equitable future. Chapter 18 of the playbook features access issues to treat individuals with opioid use disorder (OUD). The chapter outlines several of the federal concessions made for telehealth during the PHE, including the ability to utilize non-public facing audio-visual communication technology regardless of their level of HIPAA compliance, and the ability to prescribe controlled substances, particularly buprenorphine via telemedicine. They also note that states have made similar flexibilities available at the state level in many cases. The chapter concludes with a list of recommendations, including the following: *The Secretary of Health and Human Services (HHS) should permit treatment to be initiated via telehealth *Restrictions should be removed on who can receive treatment via telehealth. *States should authorize provision of buprenorphine via telehealth where applicable. COVID-19 Policy Playbook: https://static1.squarespace.com/static/5956e16e6b8f5b8c45f1c216/t/6064ad386b6e756cabb56f96/1617210684660/COVIDPolicyPlaybook-March2021.pdf < Previous News Next News >

Increased Access to Care Via Telehealth in CHCs: NACHC Survey on Audio-Only Telehealth and Health Centers Center for Connected Health Policy July 2021 The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Temporary telehealth policies during the pandemic, particularly those related to audio-only, highlighted the capacity of community health centers (CHCs) to increase patient access to care in underserved communities. The National Association of Community Health Centers (NACHC) recently released a report on their survey of CHCs to assess their telehealth experiences over the course of the public health emergency and determine what the effects would be upon termination of temporary policies, and how that would impact their providers and patients. The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Overall, the report suggested that losing audio-only coverage would likely exacerbate existing health disparities. Prior to the pandemic, health centers faced numerous federal restrictions that limited their ability to use telehealth. According to the report, previously only around 40% had used telehealth and audio-only modalities. Once allowed during the pandemic, however, nearly all CHCs utilized telehealth and delivered critical health care services to 30 million patients. Urban health centers and those serving low-income populations were also found to have higher rates of providing services via telehealth and audio-only, and 92% of health centers said audio-only improved patient access to care. To continue to provide this expanded access to care post-pandemic via telehealth the report discussed the need for Congressional action to permanently remove restrictions around use of audio-only and originating/distant site limitations, as well as ensuring reimbursement parity. In addition, as many states struggle to determine their post-pandemic policies related to telehealth, it has become apparent that the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) must also clarify whether states can continue to allow audio-only coverage under Medicaid and still receive federal matching funds. The value and necessity of audio-only was stressed throughout the survey. Benefits of audio-only telehealth included: *Reduced no-show rates *Improved patient/provider relationships *Better coordination of care amongst providers and families *Improved chronic care management The report concludes that without continued telehealth coverage for CHCs, all of the stated benefits will disappear, create a barrier to the provision of quality health care, and negate the ability for health centers to bring equity and access to underserved communities that would otherwise likely go without needed services. The authors urge the federal government to act and preserve access to care via telehealth in health centers across the country. Currently, there is active legislation federally and in many states that seeks to expand and extend telehealth and audio-only policies, including those for health centers. The fate of these bills remains unknown, but it is clear that the ideal resolution would need both federal direction and state engagement. A small but limited step was taken with CMS’s newly proposed physician fee schedule (PFS) for 2022. CMS is proposing to expand the definition of a “mental health visit” for CHCs by including mental health services provided through “interactive, real-time telecommunications technology”, including audio-only if the patient is not capable or does not consent to the use of live video. Additionally, the rate paid for eligible services would be at parity. This proposal is still rather narrow, but many of the existing restrictions, as mentioned previously, live in federal statute and must first be addressed by Congress. < Previous News Next News >

Final CY 2023 PHYSICIAN FEE SCHEDULE FACT SHEET CCHP November 1, 2022 On November 1, 2022, the Center for Medicare and Medicaid Services (CMS) released their final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS had previously released their proposed version on July 7, 2022. After receiving submitted feedback from the public during the comment period, CMS published the final version that, unless otherwise stated, will have policies going into effect January 1, 2023. Much of what was proposed in July remains in this final version. End of the Public Health Emergency (PHE) CMS is going forward with the policies required of the Medicare program that were in the 2022 Budget Act. These policies included allowing some of the temporary telehealth COVID policies to continue through a 151-day grace period after the end of the PHE and delaying other permanent policies: • Federally qualified health centers (FQHCs), rural health clinics (RHCs), physical therapists, occupational therapists, audiologists and speech-language pathologists remain eligible providers to be reimbursed by Medicare if they provide certain services via telehealth during this grace period. • The patient may be in the home when receiving these services and the geographic limitation would also not apply during the 151 day grace period. • Policies around the provision of mental health via telehealth that were put into law by the Consolidated Appropriations Act (CAA) passed in December 2020 and administrative policies from the 2022 PFS are also delayed during this 151 day grace period. • The temporary telehealth eligible services COVID-19 list will remain fully available during this 151-day grace period. See full fact sheet: https://www.cchpca.org/2022/11/FINAL-2023-MEDICARE-PHYSICIAN-FEE-SCHEDULE.pdf < Previous News Next News >

River Valley Counseling Center boosts productivity and experience with telehealth Bill Siwicki June 01, 2022 From putting band-aids on decades-old computers to conducting high-quality telemedicine visits, the mental health organization is making its clinicians and patients happy. River Valley counseling Center's Holyoke Clinic in Holyoke, Massachusetts, always was trying to make ends meet with its technology. THE PROBLEM Its efforts to revamp and improve its technology were merely trial and error. Staff were putting band-aids on their technologies, struggling to figure out what the root of the issues were when disruptions would occur. Was it the computer itself? Network connectivity? A glitch in the signal? To put the extent of the issues in perspective, some hardware was more than a decade old; it could easily take clinicians five minutes just to reach the login screen. "When we thought one thing was addressed, another hurdle would pop up," recalled Chassity Crowell-Miller, LICSW, a clinical social worker at the clinic. "This element of touch and go was particularly challenging for mental healthcare, in which providers may be helping with sensitive, traumatic issues and were unnecessarily disrupted and inhibited by the outdated technology. "Overall, our clinicians' ability to help, as well as our patients' treatment and overall experiences, were negatively impacted," she added. It's important to note that the organization's Holyoke Clinic tends to an underserved population, with many patients being of low socioeconomic status. Across the community, there are high poverty, school dropout, substance abuse and violence rates. "For providers in our community and beyond, the past two years have been like nothing they have ever seen in the field," Crowell-Miller observed. "At the onset of COVID, while many organizations and communities were able to transition seamlessly to virtual learning and working in order to continue their work, River Valley counseling Center's Holyoke Clinic was not set up for this abrupt move to technology. "While telehealth has improved access to many outpatient services, marginalized patients – rural, poor, older and minority patients – may not have benefited equally from telehealth's expansion," she continued. "With all this in mind, River Valley counseling Center needed to receive the equipment, infrastructure and IT counsel necessary to support its people in our Holyoke location – both in person and via telehealth." PROPOSAL The cost of outdated technology often is not discussed, but for providers to do their jobs effectively, sound technology infrastructure is a table-stakes requirement, said Stephen Moss, senior vice president and general manager, connected workforce, at Insight, a health IT and infrastructure company. "The last two years have forced health providers to play IT catchup and significantly accelerate digital transformation," he said. "For many like River Valley counseling Center, it calls for starting with the basics. "They are navigating the impact of legacy infrastructure that is sometimes decades old, not to mention extremely outdated devices that magnify the frustration of resources that should make their work easier actually impeding their ability to care for patients," he continued. River Valley's challenges stood out to Insight. "To help, we focused on how to improve productivity and the client experience, particularly to address the lag and frozen sessions during telehealth consultations," Moss explained. "A simple upgrade to 50 new Intel-powered desktops and laptops has made daily multitasking an afterthought rather than a source of frustration for clinic staff. "To be able to hold a telehealth session without hang-ups not only allows River Valley's medical providers to more effectively address their clients' needs, by eliminating disruptions, they're gaining credibility and the ability to treat more people on a daily basis," he added. The Insight and Intel teams took a hands-on approach to provide and implement the right technology, at the right price, said Jason Kimrey, vice president, U.S. channel and partner programs, at Intel. "The strategy was informed by the mindset that having the best technology was the most effective way to maximize productivity for River Valley and its counselors," he said. "To help guide the process, we collaborated and leveraged our partner ecosystem to understand the unique challenges and pain points for the organization." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE With River Valley's considerations in mind, Intel prioritized implementing more modernized devices and hardware that provided an opportunity to update core infrastructures, Kimrey said. Intel upgraded network switches, physical hard drives, chips and more to accommodate for the increased bandwidth necessary for telehealth usage, he added. "As a team, Insight's counsel helped combine and implement all of this," Moss explained. "Going from barely conducting any services remotely before the pandemic to now doing most of their work via telehealth is a monumental culture change. Coping with new technology shouldn't be a burden on caregivers; it needs to be an intuitive, simplified experience. "When we work with organizations like River Valley, we start with understanding what their unique challenges are, who is impacted and what they need to accomplish in their daily work," he continued. "Then we figure out the right technology based on individual caregiver personas and their needs to optimize their user experience, productivity and ability to help their clients." Insight handles rapid provisioning, configuration and deployment for virtual desktop environments so new devices are ready to go out of the box with minimal setup and networking connection required by the organization's IT team or employees, he added. "Insight also has the ability to provide virtual IT support for day-to-day management of the health of the devices, which frees up organizations with limited internal IT resources, such as River Valley counseling Center, to focus on more meaningful transformative projects," Moss said. "For River Valley, they've gained the ability to quickly provide new devices to their staff that are ready to go with the applications they need," he added. "Their care providers now can work just as effectively from home or at the clinic." RESULTS Technology is critical to making peoples' lives better, and River Valley has really felt that, Crowell-Miller stated. Thus far, highlights for River Valley, she reported, have included: Improved client and clinician experience. There have been tangible benefits for the client experience – both internally and externally. The provider organization has increased its telehealth services from 5% pre-pandemic to 95% during the height of the pandemic, while removing common barriers like lag time and income lost from prior no-show rates. Now, because of the ability to adapt, adjust and shift to telehealth, when necessary, clinicians can meet the patients where they're at. Increased productivity. The technology addressed a loss of productivity and slowness for River Valley counseling Center, which impacted the quality of services it was able to provide. Even just logging onto computers is much faster and happens within seconds. Specifically, the organization has dramatically improved productivity by up to an estimated 25% for clinicians with minimal access to technology at home, making it easier to use the office for virtual or in-person visits when necessary. Providing community resources. River Valley counseling Center now is able to get a better foothold to help and serve the community. This technology isn't just transactional from a healthcare provider standpoint; having this infrastructure in place is mutually beneficial for the clinicians and the patients in ways beyond traditional appointments and hosting telehealth sessions. This technology has helped River Valley counseling Center put the resources in the hands of clients. River Valley works on these computers while seeing a patient in person, and staff are able to help provide resources like databases, printed materials and more for the patients. ADVICE FOR OTHERS "Because every organization is different, it's really important to ensure you're working with a technology partner that understands not only the healthcare sector and how technology plays a vital role in patient care, but also the unique challenges and needs of your operations, clinicians, patients and the community you serve," said Crowell-Miller. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/river-valley-counseling-center-boosts-productivity-and-experience-telehealth < Previous News Next News >

2022 Proposed Physician Fee Schedule Center for Connected Health Policy July 2021 ...I want my MTV (Mental Telehealth Visits)! On July 13, 2021, the Center for Medicare and Medicaid Services (CMS) released their proposed CY 2022 Physician Fee Schedule (PFS). The PFS is historically where CMS will make administrative changes to telehealth policy in the Medicare program. As the pandemic begins to stabilize and restrictions begin to lift, there has been great concern as to what will happen with the temporary telehealth changes on the federal level. The CY 2022 proposed PFS is one step towards addressing those questions. Telehealth Services & Communications Technology Based Services (CTBS) The PFS is traditionally where CMS will add additional telehealth services to the eligible telehealth services list for Medicare. No new services were added in the CY 2022 proposal. Instead, CMS made permanent adoption of G2252, virtual check-in service of 11-20 minutes, which was introduced in last year’s PFS and noted that the temporary services they had placed in Category 3, also in last year’s PFS, will remain active until the end of CY 2023 and not the end of the year that the public health emergency (PHE) is declared over. Mental Health & Audio-Only The most significant proposals involve the provision of mental health services via telehealth and utilization of audio-only to deliver those services. In December 2020, Congress passed the Consolidated Appropriations Act (CAA) which included a change to federal telehealth policy. That change allowed for the provision of mental health services in the home and without the geographic limitation, if the patient had an in-person visit with the telehealth provider within six months prior to the telehealth service taking place. CMS is implementing that policy and outlined details in the PFS noting that the in-person visit would need to have taken place before each telehealth encounter. Therefore, if you had an in-person visit with your telehealth provider a month before you received services via telehealth, that visit would qualify. But if you wanted a follow-up visit eight months later via telehealth, you would need to have another in-person visit with that provider. Additionally, CMS stated that because of the likelihood that mental health services provided via technology will continue post-pandemic, the concern about cutting off people who receive such services, and the efficacy of utilizing audio-only to provide mental health services, the agency is revisiting its stance on how it defines “interactive telecommunications system.” In federal statute, telehealth is provided through a “telecommunications system.” There is no federal definition for “telecommunications system.” In regulations, CMS added the word “interactive” before “telecommunications system.” CCHP has always maintained and provided comments to CMS over the years that given the lack of a federal statutory definition for “telecommunication system,” it is within CMS’ power to change the definition to be more expansive. In comments to last year’s PFS and at the end of the year when the public was solicited for comments regarding the temporary waivers, CCHP reiterated this position. In their response to comments in last year’s PFS, CMS noted that they “continue to believe that our longstanding regulatory definition of “telecommunications system” reflected the intent of statute and that the term should continue to be defined as including two way, real-time, audio/video communications technology.” In the proposed CY 2022 PFS, CMS has reassessed their position. Based on data from COVID-19 and other factors, CMS is proposing to allow the use of audio-only to provide mental health services in the Medicare program if: It is for an established patient; The originating site is the patient’s home; The provider has the technical capability to use live video but, The patient cannot or does not want to use live video and There must be an in-person visit within six months of the telehealth service. Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs) CCHP has maintained that additional flexibilities may be given to FQHCs and RHCs without Congressional action by redefining what constitutes as a “visit” for these entities. CMS is proposing to expand the definition of a “mental health visit” for FQHCs and RHCs by including that definition mental health services provided through “interactive, real-time telecommunications technology” including audio-only. For the latter, the patient must not be capable or not consent to the use of live video. Additionally, the rate paid to FQHCs and RHCs will be their prospective payment system (PPS) rate or all-inclusive rate (AIR). It should be noted that FQHCs and RHCs will still be not be considered distant providers providing telehealth services. This is a definition change to what constitutes a “mental health visit” for these entities. Therefore, that would also mean that the statutory limitations on the use of telehealth, such as geographic limits, would presumably not apply if CMS is not viewing this as “telehealth” but simply as a visit for these entities. Other items were proposed in the CY 2022 PFS. To read about those proposals and a more in-depth look at the aforementioned ones, download CCHP’s fact sheet (below). Public comments on the PFS are due September 13, 2021. CCHP’s fact sheet - https://www.cchpca.org/2021/07/Proposed-CY-2022-Physician-Fee-Schedulefinal.pdf < Previous News Next News >

Telehealth regulations don't go far enough for some Georgina Gonzalez April 21, 2022 Telehealth protections are fading as pandemic era waivers, which allowed providers to treat patients across state lines, are expiring. Many lobbyists are worried about the future of the industry and believe that the current proposals don't do enough to help secure its future, Politico reported April 20. More than 30 states have signed onto the American Medical Association favored Interstate Medical Licensure Compact, which creates a common application for providers, allowing them to more easily apply for licenses to practice in other states. However, some lobbying groups don't think the compact is enough. "[The compact] streamlines the application process, but it doesn't do a lot to reduce the burdens and costs of maintaining a multistate licensure footprint. That is a source of a lot of frustration for physicians in telemedicine," Nate Lacktman, partner at Foley & Lardner's law firm told Politico. The American Telehealth Association believes states should recognize each other's licenses, but acknowledges that due to the federal nature of the country, more compacts will have to be created to get around the problem. Another advocacy group, the Alliance for Connected Care, has proposed a voluntary national system that would recognize licenses from other states. However, the ATA thinks the federal government could tie federal funding to the proposal to encourage states to sign on. For Full Posting: https://www.beckershospitalreview.com/telehealth/telehealth-regulations-don-t-go-far-enough-for-some.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >

Updated Version of CONNECT for Health Act Introduced in Congress Center for Connected Health Policy May 4, 2021 Last week an updated version of the CONNECT for Health Act was introduced in Congress. Last week an updated version of the CONNECT for Health Act was introduced in Congress. The bill, which was first introduced in 2016 but has been repurposed in this newest version to remove restrictions on telehealth for mental health, stroke care and home dialysis in certain circumstances. It also addresses several of the restrictions in Medicare, including geographic limitations, expanding originating sites to include the home, restrictions on federally qualified health centers (FQHCs) and rural health clinics (RHCs) reimbursement and gives the Secretary of Health and Human Services the ability to waive other telehealth restrictions permanently. For more information, see the press release, or read the bill’s summary published by Senator Schatz office. Stay tuned for a deeper dive and further analysis from CCHP next week. Press Release: https://www.schatz.senate.gov/press-releases/schatz-wicker-lead-bipartisan-group-of-50-senators-in-reintroducing-legislation-to-expand-telehealth-access-make-permanent-telehealth-flexibilities-available-during-covid-19-pandemic Summary: https://www.schatz.senate.gov/imo/media/doc/CONNECT%20for%20Health%20Act%20of%202021_Summary.pdf < Previous News Next News >

Telehealth Industry Expected to Grow from $26.4 Billion in 2020 to $70.19 Billion by 2026, at a CAGR of 17.7% DUBLIN--(BUSINESS WIRE) August 5, 2020 The present situation of COVID-19 has a great impact on the Telehealth market, where home care services are increasing through the modes of telehealth services. Information is passed through telecommunication where a patient can access the treatment from the clinician and can take advice without approaching to the doctor and without going out for the hospital. This situation gives immense opportunity for the telehealth market players. Market Highlights The Telehealth Market is estimated to reach USD 70.19 billion by 2026, from USD 26.4 billion in 2020 and registering a CAGR of ~17.7% during the forecast period. The growing technologies in the telecommunications sector to reach the patients in time play a major role in the telehealth services, which raise the growth in the Telehealth market. Based on the application of Telehealth - Telehealth services market is segmented into three segments, including Teleradiology, Tele-consultation, Tele-ICU, Tele-stroke, Tele-psychiatry, and Tele-dermatology. Teleradiology had achieved a major share in the telehealth market in the last year due to increasing mental health issues among people. The insufficient health services providers give the scope of opportunities in the telehealth industry to fulfill the demand of the end-users. The market components cover the segments of Software & Services and Hardware. The segment of software & services accounted for the larger share of the global telehealth market in 2019. Telehealth market based on the end-user segment classified into Providers, Payers, and Patients. The end-users, such as providers segment accounted for the largest share in 2019. Telehealth segmentation is based on geography includes North America, Europe, APAC, and RoW. North America accounts for the largest share in the telehealth market in the entire world. The Telehealth market is growing enormously in the region of North American countries, which is very advanced in the technological perspective and in the advanced medical facilities. The increase of chronic diseases like cancer, asthma, and other diseases driving the adoption of the home healthcare services to avoid the expensive costs charged by hospitals, these are some aspects which increased the growth in the telehealth market in this region. In the last recent years, Europe is also another region in the telehealth market region where market players experienced tremendous growth due to knowing the awareness of remote monitoring and healthcare from home. The telehealth market is expanding globally during the forecasting period. The factors which give opportunities for this market are lack of physicians, increasing chronic diseases that need immediate attention from the physicians. However, the reimbursement or coverage of the fee, illiteracy of some people who cannot adopt the current advanced telecommunication are the challenges faced by the telehealth market. Key Players in the Telehealth Market The key players in the market are Teladoc, Doctor on Demand, GE Healthcare, SnapMD, Encounter Telehealth, GlobalMed, HelloMD, MDLIVE Inc, InTouch Technologies, Dictum Health, Inc., LLC, and American Well. Globally, advancements in the technologies and growing awareness of remote services increased the demand for telehealth services. In the coming future, emerging countries/regions play an important role in the telehealth services market. This study will help the market players to understand the key market trends, market dynamics, and end-users pain-points. The qualitative and quantitative analysis of the study will enhance the user experience of the study. The competitive analysis of the major players enables users to understand the dynamic strategies such as technology innovation, partnerships, merger & acquisitions and joint ventures of the key players This report also provides the portfolio analysis and capability analysis of the leading players. Quantitative analysis of the market enables users to understand the actual facts of the market across four major regions. Companies Mentioned AMC Health American Well Asahi Kasei Corporation Cerner Corporation Chiron Health Cisco Systems E Healthcare Imediplus Iron Bow Technologies Koninklijke Philips Medtronic Medvivo Group Medweb Siemens Healthineers AG Teladoc Health Telespecialists Vsee Zipnosis For more information about this report visit https://www.researchandmarkets.com/r/kyppo0 Contacts ResearchAndMarkets.com Laura Wood, Senior Press Manager press@researchandmarkets.com For E.S.T Office Hours Call 1-917-300-0470 For U.S./CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900 < Previous News Next News >

Are Amazon, Walmart, CVS & Dollar Store Taking Over Healthcare? Dr. Maheu, Telehealth.org August 2021 ​ Amazon, Walmart, CVS, and Dollar General are making notable strides toward increasing their healthcare footprints, positioning themselves to create a seismic shift in healthcare. Telehealth.org has been reporting such efforts for the last several years, and this week offers you an update on the latest developments on amazon care, Walmart care clinic, CVS health, and Dollar General. Amazon Care Introduced in 2019, Amazon Care launched a pilot study for employees in Seattle, quickly followed by an expansion into Washington State. Amazon Care is now expanding nationwide. In addition to developing connections with other companies, the service appears most focused on expanding into underserved rural areas. The pivotal issue to consider as Amazon grows its healthcare footprint is that Amazon currently dominates two digital areas lacking in the industry: optimizing the delivery of digital customer experiences and excelling at the automation of services. Walmart Care Clinic In 2019, Walmart announced the first of its many health centers, called Walmart Care Clinic, with these offerings: primary care, labs, X-ray and EKG, counseling, dental, optical, hearing, community health (nutritional services, fitness), and health insurance education as well as enrollment, in a growing number of their facilities. Walmart has since been keeping itself involved in telehealth developments through mergers and acquisitions. Walmart, the largest in-person retail company in the United States, recently purchased MeMD, described as an “on-demand, multispecialty telehealth provider.” As a complementary addition to the already existing Walmart health centers, MeMD will enable Walmart to provide digital behavioral, primary, and urgent care services. Walmart has also begun a collaboration with Ro, a pharmacy services telehealth app. The relationship will also Ro to sell its health and wellness products in Walmart locations while further increasing Walmart’s digital service offerings. CVS Health Although CVS and Walmart had previously worked together to deliver care through Walmart’s pharmacies, CVS Health announced in January 2019 that Walmart opted to leave the CVS Caremark pharmacy benefit management commercial and Managed Medicaid retail pharmacy networks. That same year, CVS purchased Aetna for $69 billion in cash and stock. The merger brought one of the largest providers of pharmacy services together with the third-largest US-based health insurer. The successful merger formed a healthcare giant with more than $245 billion in annual revenue. Since then, CVS Health has steadily grown its healthcare footprint and, just last week launched a new health care benefit called Aetna Virtual Primary Care. The announcement reads: Offered through the CVS Health Aetna medical insurance subsidiary, Aetna Virtual Primary Care offers members access to a diverse panel of board-certified physicians and coordinated care from a consistent team of specialists based on their health needs. Members will have a continuous relationship with a virtual care physician, beginning from their first 30-45 minute comprehensive primary care visit and extending to every visit thereafter. Existing Aetna virtual care offerings include mental health counseling, dermatology services, and 24/7 urgent care. Dan Finke, executive VP, CVS Health, and President, Aetna, explained, “The future of digital health solutions is rapidly unfolding.” He added, “Aetna Virtual Primary Care is a first-of-its-kind health care solution that provides a simple, affordable, convenient way for eligible members to receive quality primary care from a physician-led care team that knows them and is accessible from virtually anywhere.” As described in his profile, Mr. Finke “is passionate about addressing mental health stigma. He is also deeply committed to attaining health equity for all Americans by engaging public and private stakeholders to address social determinants of health through analytics-based approaches that offer new insight and opportunities into health care disparities.” Dollar General Dollar General is a smaller company, but it has an enviable foothold in rural America. Their stores are well known and trusted. Therefore, they can offer care to patients who live in areas where primary care, behavioral and other specialists are difficult to access. While analysts doubt that Dollar General would follow Walmart’s lead and build primary-care clinics, telehealth solutions are easily within their reach. Dollar General differs from Amazon due to limited floor space, small parking lots, leased rather than owned retail space, and a lack of infrastructure for filling prescriptions. However, these limited abilities did not prevent Dollar General from serving as a site for COVID-19 testing in some states. Dollar General has already partnered with Higi, a blood-pressure machine company that can be seen in some Dollar general stores. Babylon Health is a telehealth provider that has invested in Higi. Given its rural presence, Dollar General may be positioning itself for acquisition by one of the larger publicly traded telehealth companies. In July 2021, the company issued a press released stating: With 75% of the U.S. population living within approximately five miles of one of Dollar General’s 17,000+ stores, the Company recognizes the unique access it provides to rural communities often underserved by other retailers as well as the existing healthcare ecosystem. The Company’s commitment to expanding its health offerings is underpinned by its existing infrastructure, robust supply chain, and current complementary health and nutrition assortment. < Previous News Next News >

Expanded Medicare Telehealth Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs Sunny J. Levine Hannah E. Zaitlin Nathaniel M. Lacktman November 09, 2022 Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” This new reimbursement is intended to further the Centers for Medicare and Medicaid Services’ (CMS) objectives in its 2022 Behavioral Health Strategy, with a particular focus on improving access to substance use disorder (SUD) prevention, treatment, and recovery services. To this end, CMS added several expansion opportunities for OTPs, including telehealth coverage. However, these flexibilities do not extend to SUD treatment provided outside an OTP, such as office-based opioid treatment (OBOT) services. Details of the new coverage rules are contained in the 2023 Physician Fee Schedule (PFS) Final Rule (Final Rule), and summarized below. Background and History of Medicare Telehealth Coverage of SUD Treatment Prior to the federal COVID-19 Public Health Emergency (PHE), to initiate treatment with buprenorphine at an OTP, a practitioner needed to perform a complete in-person physical evaluation. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administrating (SAMHSA) waived this requirement for the duration of the PHE, allowing medication-assisted treatment (MAT) practitioners to initiate treatment with buprenorphine via audio-video telehealth and/or audio-only telephone communications without an initial in-person evaluation (subject to state law restrictions). This temporary exemption only applies to OTP patients treated with buprenorphine; it does not apply to new patients treated with methadone. CMS also extended coverage for SUD treatment services provided via telehealth. While Medicare telehealth services fall under Section 1834(m) of the Social Security Act, which generally limits payment for telehealth services to patients located in specific types of medical settings (originating sites) in mostly rural areas, the SUPPORT Act amended Section 1834(m), by removing the originating site and geographic limitation for telehealth services provided to individuals with a diagnosed or co-occurring mental health disorder (including a SUD) delivered on or after July 1, 2019. In 2020, CMS established a new Part B benefit category for opioid use disorder (OUD) treatment provided by OTPs. The covered benefit includes MAT for patients with OUD, a leading treatment modality that combines prescribing FDA-approved medication (e.g., methadone and buprenorphine) with counseling and other behavioral therapy, to provide a whole person approach. Subsequently, the Consolidated Appropriations Act of 2021 (CAA) permanently removed the geographic restrictions and added the patient’s home as a qualifying originating site for telehealth services provided for the diagnosis, evaluation, or treatment of a mental health disorder. Under the CY 2022 PFS final rule, CMS revised the definition of “interactive telecommunication system” to allow the use of audio-only communications technology for telemental health services under certain conditions when the beneficiary is located at their home. New Changes to Medicare OTP Telehealth Services Under the Final Rule, CMS made the following changes relating to OTP telehealth services: 1. OTPs can use the OTP intake add-on code to bill for the initiation of buprenorphine treatment through two-way interactive audio-video communication technology, as clinically appropriate, and in compliance with all applicable requirements (provided such flexibilities are authorized by DEA and SAMHSA at the time service is furnished). 2. Audio-only telephone calls can be used to initiate buprenorphine treatment at OTPs when two-way audio-video communications technology is not available to the beneficiary, and all other requirements are met. 1. CMS interprets “not available to the beneficiary” to include “circumstances in which the beneficiary is not capable of or has not consented to the use of devices that permit a two-way, audio/video interaction because in each of these instances audio/video communication technology is not able to be used in furnishing services to the beneficiary.” 3. After the initiation of buprenorphine treatment, OTPs can continue to use audio-only telephone calls to perform periodic patient assessments when two-way audio-video is not available (provided such flexibilities are authorized by DEA and SAMHSA at the time service is furnished). This flexibility will be in place until the end of CY 2023. CMS Recognized Broad Stakeholder Support for Telehealth SUD Treatment In comments to the new rules, stakeholders lauded the benefits of two-way audio-video communications technology used to initiate treatment with buprenorphine. CMS concurred, noting it is “of critical importance to individuals who have limited ability to attend in-person appointments or who are disincentivized to do so due to perceived stigma and fear.” CMS also acknowledged that audio-only flexibilities “further promote equity for individuals who are economically disadvantaged, live in rural areas, are racial and ethnic minorities, lack access to reliable broadband or internet access, or do not possess devices with video functions.” CMS declined to address comments relating to issues outside the scope of the final rule, including: 1) comments related to allowing prescribers to initiate buprenorphine treatment for SUDs without an in-person evaluation in other settings (outside of OTPs); 2) coordinating with DEA to create a special registration for telehealth providers under the Ryan Haight Act; and 3) developing an add-on code for Contingency Management. While the final rule does not extend coverage to OBOT treatment – which has proven a successful treatment option during the COVID-19 PHE – it evidences CMS’s view of technology as a viable way to provide life-saving SUD treatment to vulnerable beneficiaries. © 2022 Foley & Lardner LLP National Law Review, Volume XII, Number 313 See original article: https://www.natlawreview.com/article/expanded-medicare-telehealth-coverage-opioid-use-disorder-treatment-services < Previous News Next News >

Permanent Pay, Originating Site Policies Boost Access to Virtual Addiction Services Victoria Bailey Dec. 29, 2021 By making temporary reimbursement and site-originating policies permanent, legislators could help increase access to virtual opioid use disorder treatment, according to a new report. December 20, 2021 - Lawmakers have the power to solidify access to virtual opioid use disorder treatment by introducing policies that ensure reimbursement parity, solidify audio-only telehealth coverage, and expand the list of eligible originating sites, according to an issue brief from the Pew Charitable Trusts. During the COVID-19 pandemic, telehealth proved to be a successful care modality for delivering opioid use disorder treatment to individuals across the country. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services (SAMHSA) lifted their restrictions and allowed buprenorphine prescribers to initiate medication treatment via telehealth without requiring an in-person visit first. However, these regulations are temporary and are set to expire once the public health emergency ends. In order to ensure access to virtual opioid use disorder treatment, state Medicaid agencies and policymakers should make these and other telehealth regulations permanent, Pew said. Legislatures should require public and private payers to reimburse providers for all opioid use disorder treatment services delivered via telehealth, including clinical assessments, prescriptions, medication management, and counseling sessions. Additionally, ensuring reimbursement for a variety of providers — including physicians, nurse practitioners, physician assistants, and mental health professionals — could help solidify the virtual treatment process. According to Pew, states that offered coverage for buprenorphine prescribing via telehealth saw positive patient outcomes that were similar to in-person services. Policymakers should also establish payment parity between telehealth and in-person opioid use disorder treatment services under public and private payers alike. “Without assurances of sufficient reimbursement rates, providers may be unwilling to invest in telehealth infrastructure for their practices, or they may find it infeasible to increase the use of telehealth for OUD treatment,” researchers wrote in the brief. Medicaid programs can ensure reimbursement parity for telehealth services without submitting a plan amendment to the Centers for Medicare and Medicaid Services (CMS). Thirty-eight states and Washington D.C. have established payment parity for certain telehealth services, but not all programs include opioid use disorder services in their provisions. Originating-site restrictions must also be addressed, Pew researchers said. Some states allow patients to use telehealth but only from certain clinics that can serve as an originating site. By expanding the list of eligible originating sites to include the patient’s home, policymakers could make accessing virtual care more convenient for individuals. Medicare currently allows individuals to receive telehealth-based opioid use disorder treatment from their homes, according to the brief. Past studies have shown that patients can initiate buprenorphine safely and successfully while remaining in their homes. In addition, patients seemed to prefer receiving treatment from home. Further, Medicaid programs should make audio-only telehealth policies permanent to facilitate access to virtual care, Pew researchers recommended. Audio-only coverage is set to expire when the public health emergency ends. Ensuring that providers receive reimbursement for audio-only opioid use disorder services may help address care disparities and benefit underserved communities that tend to use the care modality most often, including Black and Hispanic populations, individuals with limited English proficiency, and communities with inadequate broadband access. At least 15 Medicaid programs offer reimbursement for audio-only telehealth as of February, but some states only provide coverage for certain services, the brief noted. Finally, Pew researchers recommended that policymakers allow correctional settings to offer telehealth-based opioid treatment. Jails and prisons typically allow incarcerated individuals to receive healthcare via telehealth but the option to receive virtual opioid use disorder treatment is far less common, the brief stated. If states allocated funding to these institutions, they could invest in the necessary telehealth resources to establish virtual opioid treatment services. A few correctional facilities, including one in Minnesota and one in Massachusetts, currently offer buprenorphine treatment, counseling sessions, and clinical assessments through telehealth. Even with these policy changes, states may face additional barriers to offering virtual opioid treatment services including a lack of funding for infrastructure and poor broadband access. Pew researchers suggested that states consider partnering with the National Consortium of Telehealth Resource Centers to receive assistance with launching a telehealth program. Additionally, state and local governments can leverage funding from the American Rescue Plan Act to invest in expanding internet access to communities that need it. https://mhealthintelligence.com/news/permanent-pay-originating-site-policies-boost-access-to-virtual-addiction-services < Previous News Next News >

US Reps Push for Extension of Telehealth Flexibilities for HDHP Members Mark Melchionna December 15, 2022 Three US Representatives led a bipartisan group of lawmakers in submitting a request to Congress to extend telehealth flexibilities for some high-deductible health plan members. In anticipation of critical telehealth flexibilities expiring on Dec. 31, US Representatives Michelle Steel (CA-48), Brad Schneider (IL-10), and Susie Lee (NV-3), along with a bipartisan group of 30 Congress members, sent a letter requesting that House leadership include two pieces of legislation that extend some flexibilities in a year-end package. When the COVID-19 pandemic began, patients and providers turned to telehealth in droves to maintain care. According to the Centers for Disease Control and Prevention (CDC), there was a 154 percent increase in telehealth visits when comparing data from the last week of March 2020 with that of March 2019. This uptake of telehealth was likely associated with the withdrawal of regulatory restrictions in response to the limitations placed on in-person care during the public health emergency. As part of the CARES Act of 2020, Congress passed reforms that expanded access to telehealth services. For instance, prior to the CARES Act, Americans with high-deductible health plans (HDHPs) coupled with health savings accounts (HSAs) had to reach the minimum deductible before they qualified for telehealth coverage. However, Section 3701 of the CARES Act eliminated this requirement initially through Dec. 31, 2021. The provision was later extended through the Consolidated Appropriations Act, 2022. This led to wider coverage of telehealth services as health plans and employers were able to expand access to virtual care services for individuals with HDHP-HSAs pre-deductible. According to the representatives, increased access has led to many benefits for patients, particularly those without access to transportation services and those who reside far away from clinical locations. “Access to telehealth has also provided a significant portion of the U.S. workforce relief at a time when household costs are rising. Telehealth has allowed families to avoid taking time off from work to travel to and from appointments, and timely care has helped prevent costly visits to urgent care or the emergency room. Unfortunately, those with a high deductible may decide to skip critical preventative services – including primary care and behavioral health services – if the deductible is not waived, often leading to poor health outcomes and more costly care down the line,” the letter states. Due to the increasingly apparent benefits of telehealth, the US representatives are requesting that House leadership include the Primary and Virtual Care Affordability Act and the Telehealth Expansion Act in the end-of-the-year package. The Telehealth Expansion Act would make the telehealth flexibility permanent for people with HDHP-HSAs. The Primary and Virtual Care Affordability Act would both extend the flexibility and allow insurance providers to cover primary care services pre-deductible. This letter is part of a larger effort among healthcare stakeholders to ensure that expanded access to telehealth is solidified. Another letter written by the Connected Health Initiative (CHI) requested that Congress extend the safe harbor for telehealth coverage by HDHPs. In the letter, CHI noted its support for removing restrictions impeding telehealth access among Medicare beneficiaries. It also emphasized the upcoming telehealth deadline Americans with HDHPs will face at the end of 2022. Due to this, CHI requested that Congress extend the safe harbor for HDHPs to cover telehealth with first-dollar coverage. This would also allow them to maintain HDHP status. See original article: https://mhealthintelligence.com/news/us-reps-push-for-extension-of-telehealth-flexibilities-for-hdhp-members < Previous News Next News >

Finding Our Way Out of the Pandemic Haze: What Telehealth Tools Are Medicare Providers Allowed to Keep, and Which Must They Leave Behind? Amy J. Dilcher, Kara Du November 30, 2022 During the COVID-19 pandemic, Medicare coverage expanded to include a vast arsenal of tools that help patients access medical services while keeping patients and practitioners safe. Many of these tools involve telehealth services and were made possible by the COVID-19 emergency blanket waivers, which went into effect when the U.S. Department of Health & Human Services (“HHS”) declared a Public Health Emergency (the “PHE”). Some of these tools: Permitted providers to furnish distant site telehealth services; Expanded the use of audio-only telehealth to behavioral health counseling services; and Facilitated the conducting of telehealth appointments by practitioners from their homes while billing from their currently enrolled locations. As a result of these efforts, the use of telehealth and telemedicine exploded in 2020 according to an HHS Study. This growth was no surprise given the unparalleled advantages of conducting a variety of medical appointments from remote locations in a time where limiting one’s exposure to the COVID-19 virus was paramount. Despite the current trend towards relaxing previously stringent regulations on exposure and contact, many providers and patients prefer telehealth services as the primary method of treatment. This post provides an overview of recent developments in the adoption of telehealth tools by providers, the status of Medicare coverage for telemedicine services, the regulatory vision for the ascent out of the PHE, and fraud, waste and abuse considerations as we begin to make our way out of the pandemic haze. When does the PHE current expire? The blanket waivers that expand Medicare coverage of certain telehealth technology are in effect so long as the Secretary of HHS has declared a COVID-19 public health emergency. The first PHE was declared in 2020 and has been renewed every 90 days since then. The latest HHS extension for the PHE is effective through January 11, 2023. The PHE status is very likely to continue to be extended beyond next January given a possible surge in COVID-19 infections in the United States this winter, according to two Biden administration officials. Moreover, in a letter to the state governors, HHS has indicated that they will provide at least a 60-day notice before the current PHE ends (i.e., on or before November 11, 2022) in the event that it does not intend to issue an extension. To date, the agency has not provided that notice. Updates on the status of HHS declarations of public health emergencies are available via the federal government’s PHE tracker. Adoption of Telehealth Tools by Providers Looking towards the future, many providers anticipate keeping some COVID era telehealth tools in their arsenal after the PHE has ended. According to a recent study by the American Medical Association, tele-visit tools ranked highest in provider enthusiasm, provider adoption and improved patient outcomes in comparison to other digital health tools. The vast majority of physicians who have not yet incorporated these tools are seeking to utilize them in the next three years. The Regulatory Vision For the Ascent Out of the PHE CMS has outlined their strategy for assessing which blanket waivers should stay in effect after the last PHE extension expires. The strategy consists of three concurrent phases: Phase1: Evaluating blanket waivers based on the current stage of the PHE as compared to when the waivers were first issued. Phase 2: Keeping tools in place which would be the most helpful in future PHEs, to ensure a rapid response both locally and nationally. Phase 3: Continuing coverage of flexibilities that are aimed at producing high-quality care and health equity. CMS is working with the healthcare industry to holistically prepare our health care system for future PHEs. Medicare Coverage in Advance of Expiration of the PHE Effective as of January 1, 2022, CMS finalized a rule as part of the FY22 Medicare Physician Fee Schedule that expanded Medicare coverage of telehealth for behavioral health services to facilitate greater access and equitable services for those who may not have access to mental health services providers. Most recently, on November 1, 2022, CMS issued the Medicare Physician Fee Schedule (MPFS) 2023 Final Rule (the “2023 Final Rule”), which includes policy revisions and guidance regarding Medicare telehealth services. For example, several services that are temporarily available as telehealth services for the PHE were made available through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List. CMS also confirmed its intention to implement provisions such as allowing telehealth services to be furnished in any geographic area and in any originating site setting via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. Proposed Legislation to Continue and Expand Medicare Coverage of Telehealth Services The American Hospital Association is one of many groups that urged Congress to expand and make permanent the regulatory flexibilities granted to Medicare telehealth services during the PHE. This strong support in favor of extending and expanding Medicare coverage of telehealth flexibilities was repeated again in a letter sent by 375 organizations to Senate leaders on September 13, 2022. The letter indicates several specific telehealth tools, such as lifting in-person requirements for tele-mental health and waiver of location limitations, that have been among the most integral to bringing needed care to patients in the age of technology. To that end, there are currently several bills in the Senate and House, which would codify much of the progress in telehealth service coverage that providers and industry organizations are seeking. In the Senate, the Telehealth Extension and Evaluation Act was introduced in February of 2022. The bill proposes an extension of and modification to Medicare coverage of four specific telehealth tools. This expansion would continue for two years after the PHE expires. Representatives in the House introduced the Ensuring Telehealth Expansion Act of 2021 in January of 2021. This bill would make Medicare coverage of telehealth flexibilities permanent outside of the PHE. Recently, the Advancing Telehealth Beyond COVID-19 Act of 2022 was passed by the House and is now being reviewed by the Senate. This bill modifies the extension of certain Medicare telehealth flexibilities and provides that some of them continue to apply until December 31, 2024, in the event that the PHE ends before that date. For example, the bill allows beneficiaries to continue to receive telehealth services at any site, regardless of type or location (e.g., the beneficiary’s home), occupational therapists, physical therapists, speech-language pathologists, and audiologists to continue to furnish telehealth services, and federally qualified health centers and rural health clinics to continue to serve as the distant site (i.e., the location of the health care practitioner) for telehealth services. Fraud, Waste and Abuse of Telehealth Services The COVID-19 emergency blanket waivers have been a useful tool for healthcare providers, but the expansion of Medicare coverage of telehealth during the PHE has also presented the opportunity for fraud, waste and abuse. In a recent report (the “Report”) the HHS Office of the Inspector General (“OIG”), identified 1,714 out of 742,000 providers as “high risk” for fraud, waste, or abuse with respect to their billing practices for telehealth services. OIG identified several billing practices that may be indicative of providers it considers to be “high risk” of engaging in Medicare fraud, waste or abuse: Facility fees and telehealth fees are billed for the same visit; The highest, most expensive level of telehealth services is billed every time; Telehealth services are billed for a high number of days in any given year; Medicare fee-for-service and a Medicare Advantage plan are billed for the same service for a high proportion of services; A high average number of hours of telehealth services are billed per visit; Telehealth services are billed for a high number of beneficiaries; and Telehealth services and ordering medical equipment are billed for a high proportion of beneficiaries. Although the “high risk” providers submitted only a small percentage of the total number of claims for telehealth services, the amount of claims associated with these providers represented $127.7 million in Medicare fee-for-service payments. The Report also found that over half of the “high risk” providers were connected with at least one other “high risk” provider. The OIG provided several recommendations to CMS: Strengthen monitoring and targeted oversight of telehealth services; Conduct additional education outreach to providers including training sessions, educational materials, and webinars on appropriate telehealth billing practices; Establish billing modifiers to help providers identify circumstances in which non-physician clinical staff primarily render telehealth services under the supervision of a physician; Identify telehealth companies that bill Medicare by updating the Medicare provider enrollment application or working with the National Uniform Claim Committee to add a taxonomy code that identifies telehealth companies; and Conduct targeted reviews of the “high risk” providers identified in the Report. Final Thoughts The importance of telehealth services cannot be understated. Under the current PHE, providers have had the opportunity to deploy these tools in the emergency context, and at the same time have been able to demonstrate their efficacy and reliability in providing quality medical care to patients who would not otherwise have access to either because of coverage or geographic limitations. Nevertheless, given the rapid growth of the industry in recent years and the amount of Medicare dollars spent on telehealth services, it is prudent for healthcare providers to proactively review their telehealth billing practices and supporting documentation. Doing so will reduce the potential for billing errors and minimize compliance risks while improving quality control and financially protecting their organizations. See original article: https://www.natlawreview.com/article/finding-our-way-out-pandemic-haze-what-telehealth-tools-are-medicare-providers < Previous News Next News >

Telehealth Mini-Grants NM BHSD March 16, 2021 BHSD would like to announce the release of funding in the form of telehealth mini-grants. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us To CYFD and BHSD Non-Medicaid Providers: Dear New Mexico Providers: BHSD would like to announce the release of funding in the form of telehealth mini-grants. When the COVID-19 public health emergency ends, BHSD will no longer be able to support behavioral health providers who are delivering behavioral health services through telehealth systems that are not HIPAA compliant. We are now offering funding to help providers come into compliance so that critical behavioral health services will not be disrupted. If your agency is currently delivering services using the telephone and/or another non-HIPAA compliant system, this grant could help you make the transition. BHSD is seeking letters of interest that respond to this question: what is your current telehealth system, and what do you need to become HIPAA compliant? Funding is available in amounts of up to $50,000 per agency, and all work must be completed by the end of 2021, which is when the PHE is currently set to expire. Letters of interest should include: • Specific hardware and/or software and costs • Training for staff and administrators and costs • Anticipated changes to practice model • How many practitioners/staff members do you expect to train • How many clients do you anticipate serving with your new system • Timeframe for making changes BHSD will expect any agency that receives funding to report back on progress made on each of these points. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us < Previous News Next News >

Teladoc Reports $133M Net Loss in Second Quarter, but Visit Numbers Are Up Kat Jercich, Healthcare IT News July 2021 Meanwhile, Amwell announces its acquisition of SilverCloud Health and Conversa Health. The virtual care giant Teladoc released its earnings report this week, showing a net loss of $133.8 million for the second quarter of 2021. Total net loss for the first half of 2021 was $333.5 million, compared to $55.3 million for the same time period last year. At the same time, the vendor said its $503 million second-quarter revenue earnings had more than doubled compared with 2020. This change led Teladoc to forecast its total yearly revenue to be in the range of $2 billion to $2.025 billion, with a predicted net loss between $3.35 and $3.60 per share. Its visit numbers were also up, at 3.5 million: 28% higher than the second quarter of 2020, during the first wave of the pandemic. The company expected 13.5 million and 14 million total visits this year. After the earnings report, Teladoc's shares fell more than 7% in the extended session Tuesday, as reported by MarketWatch. Still, execs voiced optimism, driven in part by the launch of myStrengthComplete and what the company described as a "significant new agreement" with the Health Care Service Corporation. "Teladoc Health delivered a strong second quarter, marked by exciting new client wins, product launches, and tremendous progress on our quest to be the category-defining provider of whole person virtual care," said CEO Jason Gorevic in a statement. "We have solid momentum heading into the second half as the market embraces the unified care experience that only Teladoc Health has the breadth and scale to achieve," he added. New Amwell acquisitions Teladoc competitor Amwell was also in the news this week for its $320 million acquisition of SilverCloud Health and Conversa Health. SilverCloud Health delivers a range of digital cognitive behavioral health programs, which the company says are evidence-based and clinically validated. According to SilverCloud, the programs are used by more than 300 organizations, including Kaiser-Permanente, Optum and Providence Health. Amwell will use the platform to enrich its own behavioral health offerings and develop new programs. Conversa Health, meanwhile, uses automated patient interactions to ensure patients stay on track before and after live or virtual visits. It is used, the company says, by organizations including Northwell Health, UCSF Health, UNC Health, University Hospitals and Prisma Health. Amwell says it will use Conversa's technology to advance initiatives aimed at longitudinal care, clinical quality and population health. The acquisitions will also enable Amwell to create new digital workflows and programs and expand its client base to include those of Conversa and SilverCloud – especially in the U.K. "We believe that future care delivery will inevitably blend in-person, virtual and digital care experiences; and as such, we are uniquely building a global platform to support such advanced, coordinated care," said Ido Schoenberg, chairman and co-CEO at Amwell. "By integrating SilverCloud Health and Conversa Health into our platform, we are demonstrating Amwell’s fundamental and repeatable design to continually scale digital healthcare services across the different sites of care," he added. "These acquisitions will amplify the presence and reach of care teams and reaffirm that as the needs of the healthcare marketplace evolve so too will the Amwell platform." < Previous News Next News >

New Wave of Federal Bipartisan Bills to Expand Telehealth Center for Connected Health Policy June 2021 A good majority of the recently introduced bills focus on increasing telehealth reimbursement, however a few look to increase funding for telehealth services and infrastructure. At present, CCHP is tracking over 100 pieces of telehealth legislation in the current federal legislative session. This month we have seen a number of bipartisan bills introduced, continuing the federal push to expand telehealth availability and codify flexibilities allowed during the COVID-19 public health emergency (PHE). A good majority of the recently introduced bills focus on increasing telehealth reimbursement, however a few look to increase funding for telehealth services and infrastructure. It is notable the significant amount of support from both sides of the aisle for telehealth. For instance, representatives Dan Newhouse (R-WA) and Tom O’Halleran (D-AZ) introduced the Rural Remote Monitoring Patient Act (HR 4008) that would establish a pilot grant program to support the use of remote patient monitoring in rural areas. Senator John Kennedy (R-LA) introduced as part of a package of telehealth bills a reintroduction of a bill similar to legislation from 2020 titled the Telehealth Health Savings Account (HSA) Act (S 2097). The Telehealth HSA Act would allow employers to offer high-deductible health plans that include telehealth services without limiting employees’ ability to use health savings accounts. According to Kennedy’s press release, “a current IRS regulation stops employees from making or receiving contributions to HSAs if they hold a high-deductible health plan that waives the deductible for telehealth services, meaning employees holding high-deductible health plans often need to pay out of pocket for telehealth services. The Coronavirus Aid, Relief and Economic Security (CARES) Act (HR 748) temporarily waived this regulation, but S 2110 would make the waiver permanent.” We have also seen a few of the recent bills look at audio-only and codifying pandemic telehealth flexibilities. The Protecting Rural Telehealth Access Act (S 1988) by Senator Joni Ernst (R-Iowa) and also sponsored by Senators Jerry Moran (R-Kan.), Joe Manchin (D-W.Va.), and Jeanne Shaheen (D-N.H.), would: *Allow payment parity for audio-only telehealth services *Make permanent the ability for patients to be treated at home *Let rural health clinics (RHCs) and federally qualified health centers (FQHCs) serve as distant sites for telehealth services The Advancing Telehealth Beyond COVID-19 Act of 2021 by Representative Liz Cheney (R-Wyo.), introduced with Representative Debbie Dingell (D-MI), makes the following permanent changes: *Removes originating site and geographical limitations *Maintains telehealth flexibilities for RHCs/FQHCs *Expands coverage for audio-only services *Removes restrictions that limit clinicians’ ability to remotely monitor and track patient health and provide them access to innovative digital devices Additionally, we have seen bipartisan support around broadband legislation, such as from Senators Michael Bennet (D-Colo.), Angus King (I-Maine), and Rob Portman (R-Ohio), who recently introduced legislation which seeks to address the digital divide. Their Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act of 2021 would allow states to deploy “future-proof” networks able to meet communities’ broadband needs, including supporting local initiatives on affordability, adoption, and inclusion. According to Bennet’s press release, The BRIDGE Act would: *Provide $40 billion to States, Tribal Governments, and U.S. Territories for affordable, high- speed broadband *Prioritize unserved, underserved, and high-cost areas with investments in “future proof” networks *Encourage gigabit-level internet wherever possible while raising the minimum speeds for new broadband networks to at least 100/100 Mbps, with flexibility for areas where this is technologically or financially impracticable *Emphasize affordability and inclusion by requiring at least one affordable option *Increase choice and competition by empowering local and state decision-making, lifting bans against municipal broadband networks, and allowing more entities to compete for funding Lastly, additional information was just released regarding Cures 2.0 – another bipartisan bill, which creates the Advanced Research Projects Agency for Health (ARPA-H), a President Biden budget request proposal. According to a discussion draft and section-by-section summary, Cures 2.0 will address a variety of areas, including telehealth access, while incorporating and building upon several additional bipartisan bills, such as the Telehealth Improvement for Kids’ Essential Services (TIKES) Act (H.R. 1397 / S. 1798) and Telehealth Modernization Act (H.R. 1332 / S. 368). The telehealth provisions proposed in Cures 2.0 include: *Review the impact of telehealth on patient health and encourage better collaboration *Provide guidance and strategies to states on effectively integrating telehealth into their Medicaid program and Children’s Health Insurance Program (CHIP) *Make many of the COVID-19 PHE flexibilities post-pandemic permanent, such as: -Removing the geographic and originating site restrictions -Expanding the range of health care providers that can be reimbursed by Medicare for furnishing telehealth services to any health care professional eligible to bill Medicare -Enhancing telehealth services for use by FQHCs, RHCs, hospices, and for home dialysis The authors anticipate that the Cures 2.0 bill will be introduced in the coming weeks and hope to see it signed in the fall. While the fate of these telehealth bills is yet to be seen, it does seem to highlight strong federal support for expanding access to telehealth post PHE with such a large amount of bipartisanship support behind them. Given Medicare’s historically conservative approach in regard to telehealth pre-PHE, any additional shift would be significant. CCHP will continue to update its tracking tools and monitor the ever evolving telehealth landscape as we continue to move through the current federal legislative session. < Previous News Next News >

CMS Warns Providers to Bill Correctly Center for Connected Health Policy May 2021 OIG is currently conducting several audits on telehealth In mid-April, CMS sent out a Medicare Learning Network (MLN) Connects Newsletter with a reminder to providers to bill correctly for telehealth services. In the short section in their newsletter, CMS cites a 2018 Office of Inspector General (OIG) report that found that there was a significant amount of telehealth claims that were improperly paid, and thus not billed correctly. As the OIG is currently conducting several audits on telehealth, it is possible that they may come to a similar conclusion again. The section also refers providers to several resources to ensure they are billing correctly, including the: Telehealth Services MLN booklet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Telehealth Payment Eligibility Analyzer https://data.hrsa.gov/tools/medicare/telehealth List of Covered Telehealth Services https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes For policies specific to the public health emergency (PHE), CCHP also recommends providers review the CMS resources listed in the Federal COVID-19 section in CCHP’s Policy Finder, as there are several telehealth flexibilities currently in place as a result of the PHE. CCHP's Policy Finder: https://www.cchpca.org/federal/?category=covid-19&topic=originating-site < Previous News Next News >