Audio-Only Telemedicine Services Special Announcement NMTHA's communication with the New Mexico Office of the Superintendent of Insurance about billing for AUDIO-ONLY telemedicine services February 2022 Update: New Mexico Audio-Only Telemedicine Services The New Mexico Telehealth Alliance (NMTHA) works hard to ensure telehealth is sustainable and meets healthcare needs in our State. The NMTHA has been instrumental in ensuring New Mexico has one of the leading telehealth laws in the country. Looking at the NM Telehealth Act, last amended in 2019, the New Mexico Office of Superintendent of Insurance (OSI) has put out the following information around the continued ability to bill for telephonic services. What you need to know: The telemedicine definition allows the use of audio-only telemedicine services. The NM Telehealth Act: The New Mexico Telehealth Act, which was last amended in 2007, defines telehealth as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education.” § 24-25-3(C) NMSA. This definition clearly incorporates audio-only services, particularly as “the purpose of the New Mexico Telehealth Act is to provide a framework for health care providers to follow in providing telehealth services to New Mexico citizens in a manner that provides efficient and effective access to quality health services.” § 24-25-2(B) NMSA. What insurance this affects: This is only for fully-insured health plans regulated by the NM OSI, and for NM State employee, public school, and retiree health plans. It does not apply to Medicaid, Medicare, other federal health plans, or self-insured health plans. Access the final text of S.B.354 (2019) and chaptered statutes HERE . See the email communication from the NM OSI HERE . Sincerely, New Mexico Telehealth Alliance

The challenges of telemental health, and how they can be overcome Bill Siwicki June 14, 2022 Mental healthcare may be among the more intuitive specialties to deliver via telemedicine – but privacy demands, technology difficulties and the need for safe places deter some from taking advantage. Of all the medical specialties impacted by telemedicine during the course of the pandemic, perhaps the one with the most wholesale and lasting effects is behavioral and mental health. Mental health appointments do not typically involve any collection of vitals or specimens, nor do they absolutely require a face-to-face meeting, although therapists can observe physical cues from the whole body in person. Just talking via video, or even just audio, is enough. We talked with Dr. Janice Johnston, chief medical officer and cofounder of Redirect Health, a telehealth technology and services company, to get her expert observations regarding: The biggest ways telehealth is changing America's treatment of mental health. What impact increased telehealth accessibility has had on mental health treatment. The challenges telehealth presents in treating mental health. The improvements that can be made to telehealth for the treatment of mental health. Q. What are the biggest ways telehealth is changing the U.S.'s treatment of mental health issues? A. Before COVID-19 and historically in the U.S., there has been a negative stigma around receiving mental healthcare. While there have been a lot of movements and campaigns attempting to try and stamp out the stigma, many people have been deterred from seeking professional help due to a lack of coverage in healthcare plans, high copays and fear. As telehealth widens, the availability of mental health services continues to grow and is more accessible than ever. Gone are the days of driving to appointments and sitting in a waiting room, with the feeling that all eyes are on you. Social networks also have created a platform for mental health activists and we are seeing, in real time, an increase in people looking for treatment or routine mental care. COVID-19 accelerated the need for more access and new ways of treating mental health, such as telehealth. As a result of the COVID-19 pandemic, we also have seen many major insurance companies offer permanent or temporary plan benefits that include mental health services. Telehealth has made it easier for insurers to include these benefits in their plans with less out-of-pocket costs for patients. In many cases, insurance providers even waived the entire cost for visits when using telehealth. While most people don't want to be thought of or treated differently because they choose to seek mental health treatment, the stigma around it can make them feel judged, and they avoid choosing care. Telehealth has made it possible for people to now access care from the privacy of their homes, making the decision to seek care much easier and more comfortable. Being able to speak with a mental health professional from home has provided patients the ability to choose a setting that provides the most comfort, making the process of opening up and sharing concerns with a new person much easier. Q. What impact has increased telehealth accessibility had on mental health treatment in the U.S.? A. The COVID-19 pandemic forced changes for Americans across the country that have affected mental wellbeing, such as working from home, quarantine enforcements, lack of spending time with friends and family, and feeling isolated. This led to a surge in mental health issues with most non-emergency medical treatments shut down due to safety concerns and quarantine enforcements. Telehealth was a necessity we didn't see coming, and the pandemic accelerated this service due to the timely needs that were arising. With the higher demand for mental healthcare, telehealth has been the answer for many. People living in rural communities or underserved areas, specifically, experience limited access to specialty healthcare services, especially mental health. One of the key impacts of increased telehealth accessibility is that these communities have been able to turn to telehealth as an option when they may not have had an alternative. Different from rural or underserved communities, many urban populations see that finding in-person care isn't the difficult part, but affording it and getting to their appointment can be. Another key impact of increased accessibility is that telehealth tends to be a much more cost-effective option, as in-person care can regularly be more than double the cost. Think of all the money and time wasted having to take off work, which can result in lost wages, needing to hire a babysitter, or paying for gas when commuting to and from appointments. With telehealth, patients are able to afford their scheduled appointment at a time that is convenient and works for them. Additionally, while most offices provide services in standard office hours, many telemental health services provide care before and after work hours as well, so patients have more scheduling flexibility. There also are a lot of cultural barriers and health inequities that many minority communities experience that may deter them from seeking mental healthcare. During the pandemic, these communities experienced a rise in telemental health usage. While there are several reasons why this rise has occurred, we have seen that telehealth has been able to combat some of the barriers these groups have had to overcome. For one, telehealth affordability has made services much more accessible to minority groups or lower income individuals, enabling them to include mental healthcare into their budgets. Additionally, minority groups have experienced higher rates of depression and anxiety, only exacerbated by the pandemic, so the demand from these communities, along with the decrease in negative stigma around mental care through telehealth, has driven them to these options. Lastly, telehealth allows those with language barriers in the U.S. to have access to a broader group of mental health professionals who can provide a better understanding of their cultural backgrounds, partnered with the ability to speak in their preferred language. Q. What are some of the challenges telehealth presents in treating mental health issues, and instances when in-person care must be sought? A. While telehealth has expanded access to mental healthcare for so many across the country, there are still limitations that may lead some to favor in-person care. First, privacy. While many patients prefer telehealth so they can have their appointment in the privacy of their homes, there are situations where people may not have that same privacy in their home. Some people may live in multi-generational homes where others are home and in earshot, or they could share a room with others with privacy not immediately available. This may leave patients taking their calls from their car, which is not always comfortable or preferred. As a result, people in these settings may prefer care in person. Second, safe places. While some people prefer their care virtual for a variety of reasons, others feel that virtual mental healthcare is cold and distant, and favor in-person care in order to feel more engaged with their mental health provider. Sometimes being removed from their normal home setting can help create a safe place for the patient to discuss their mental health concerns. This is especially a factor with live support groups, which can be more engaging and easier in person than virtually. Many times, live support groups are used for people looking to overcoming addictions, and being able to separate them from their traditional setting can be helpful for pulling them out of their environment, even momentarily. And third, technology. Some individuals may not understand the technology behind apps or websites that provide mental health services. They may not know how to access video links or use their phone to connect to a provider, which could result in a sub-par session, where they do not feel comfortable or at ease. Patients also do not want to see time consumed or wasted during their appointment because of technical struggles and may prefer to see their providers in person to avoid the hassle of these situations. Q. What improvements can be made to telehealth specifically for the treatment of mental health issues? A. We can look to the current challenges of the telehealth space to find where to start with improving the telehealth experience for everyone. For starters, creating wider access to the internet allows telehealth to reach more people who may not have any options available to them today. In fact, the Biden administration recently secured commitments from 20 leading internet service providers to either reduce prices or increase speeds to serve low-income households. This is a great step in the right direction. Better cellular and internet speeds allow for more telemental health experiences to be held over video, and not telephonically, where mental health professionals can better assess their patient through both verbal and nonverbal cues. With all the advancements and changes we have seen in technology in just the last few decades, there is a lot for patients and providers to keep up with. Education is key to making sure telehealth sticks around and continues to rise in its availability. Many providers are willing to learn new technology, but need to be trained by the people that thoroughly understand the ins and outs of these systems. As new standards of care are set by technological advancements, providers and patients alike need to be provided the education to keep up with these evolving standards. It is important for those implementing new systems to deliver the proper education providers need to learn the technology, as well as assist their patients. Another thing to consider is how to assist patients with disabilities through telehealth. There are laws in place in the U.S. to ensure equality in care for those with and without disabilities, and therefore considerations need to be made in telehealth situations as well, such as providing additional instructions or scheduling longer appointment times. Sometimes added support or modifications need to be made to technology systems in order to support these patients as well. Telehealth systems should meet accessibility requirements and should provide resources that are available in multiple formats, like audio recordings or large text sizes. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. For more information: https://www.healthcareitnews.com/news/challenges-telemental-health-and-how-they-can-be-improved < Previous News Next News >

Healthcare Connect Fund The FCC's newest component of the Rural Health Care (RHC) program: Funding may significantly improve access for patients and service providers. Participants may receive a subsidy of up to 65%. Funding recipients must provide 35% cash match. The New Mexico Telehealth Alliance (NMTHA) manages the Southwest Telehealth Access Grid (SWTAG), a Federal Communications Commission (FCC) approved consortium for funding through the Healthcare Connect Fund (HCF). If you manage one or more healthcare provider sites serving clients in New Mexico, contact NMTHA to discuss joining SWTAG. Advantages to applying to SWTAG via NMTHA include: Lower application and administrative costs .* Access to expert funding advice for a mix of rural and urban sites. Professional assistance with proven track record of funding success . ELIGIBILITY Eligible healthcare sites must meet all three following criteria: Non-profit or public entity In a rural area (as defined by the FCC: Eligible Rural Areas Search Tool Designated type of facility: Post-secondary educational institution offering health care instruction (e.g., teaching hospital, medical school) Community health center or health center providing services to migrants Dedicated emergency department of a rural for-profit hospital Local health department or agency Community mental health center Not-for-profit hospital Skilled nursing facility Rural health clinic Part-time eligible entity located in an ineligible facility *NMTHA contracts with Prairie Health Ventures to manage the application process and other bureaucratic aspects of the HCF. SWTAG members span over 200 sites in several States including many rural and urban facilities in New Mexico. SWTAG members have secured millions of HCF funding dollars to date. Current funding requests are under development. Universal Service Administrative Company ( USAC) Funding "Lingo" Form 460: Confirms Eligibility Step 1: Determine Eligibility of Your Site Form 461: Request for Services Step 2: Develop Bid Evaluation Criteria & Select Services Form 462: Funding Request Step 4: Submit Funding Requests Form 463: Invoice USAC for Release of Funds Step 6: Invoice USAC Evergreen Contract: Evergreen Contracts Funding Request Number (FRN) Funding Commitment Letter (FCL) Health Care Provider (HCP) Network Cost Worksheet (NCW) F or additional information about the Healthcare Connect Fund, please consult the following resources: HCF web page Related FAQs FCC orders

CCHP Releases Updated Telehealth Billing Guide Center for Connected Health Policy March 16, 2021 The Center for Connected Health Policy (CCHP) has released a new updated telehealth billing guide as a follow up to its 2020 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services. The Center for Connected Health Policy (CCHP) has released a new updated telehealth billing guide as a follow up to its 2020 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services. Policy changes during the COVID-19 Public Health Emergency (PHE) have only made telehealth billing rules more nuanced. The updated billing guide addresses whether or not there is reimbursement for telehealth both generally and/or during the PHE, as well as how to correctly bill for a telehealth encounter, which is one of the most common policy questions CCHP receives as the National Telehealth Policy Resource Center (NTRC – P). Further complicating the billing process is the need to understand whether current rules are only applicable during the pandemic as well as the fact that payer policies continue to vary from payer to payer. For example, policies that apply to a Medicare beneficiary remain different than those that apply to a state Medicaid enrollee or to patients that have private insurance. DOwnload the guide here: https://www.cchpca.org/sites/default/files/2021-03/2021BillingGuideFINAL.pdf Please note, this resource is only provided as a guide and should not be considered legal advice. < Previous News Next News >

Controversy about Eliminating Telephone Telehealth Coverage By Dr. Maheu April 7, 2021 Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. A study published in the Journal of the American Medical Association focused on telehealth use among the low-income population in California. The study included data from outpatient primary care and behavioral health visits from February 2019 to August 2020 at forty-one federally qualified health centers representing 534 locations in California. The study showed that, with regards to primary care visits, 48.5% of visits occurred via telephone, 48.3% occurred in person, and 3.4% occurred via video. For behavioral health visits, 63.3% via telephone, 22.8% in person, and 13.9% via video. The study’s key finding was that most telehealth appointments during the pandemic period were conducted over the phone. “Eliminating telehealth coverage for audio-only telemedicine visits would disproportionately impact underserved communities,” according to Lori Uscher-Pines, the study’s lead author. “Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth,” she said. “These are important considerations for policymakers if telehealth continues to be widely embraced in the future.” Since the use of telehealth expanded due to COVID, few studies have examined differences in the use of telehealth modalities. However, one federal agency estimated that 30% of telehealth visits had involved phone therapy sessions alone during the pandemic. According to the study, telehealth visits delivered via over-the-phone therapy peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits. Before the pandemic, many definitions of telehealth excluded phone therapy visits, and private insurers or the government rarely reimbursed them, the study authors noted. Some payers, including the Centers for Medicare and Medicaid Services, have indicated they may stop telehealth coverage reimbursement for phone therapy sessions when the pandemic ends. Read more about previous rulings for COVID-19 Telephone Telehealth Reimbursement. “There are some concerns that telephone visits could result in fraud, abuse, and unnecessary and lower-quality care. Although these concerns are important to assess, eliminating telehealth coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of the clinics to meet patient needs” stated Dr. Uscher-Pines. The Reality of Professionalism and Telephone Therapy It seems a bit dramatic to point out that telephone therapy can be more subject to fraud and abuse when it actually is often the only lifeline for many people in distress during the pandemic, and beyond. Fraud and abuse can potentially exist everywhere. The real question is whether the professional has bothered to learn how to properly use the telephone for clinical interventions – or if they are making it up on the fly. Unfortunately, although a clear evidence base exists for telephone-based interventions, very few professionals have received adequate training, and more likely, no professional training to use only the telephone to deliver services to a patient or client. They may not have yet realized that a good in-person clinician is not the same as a good telephone therapist, regardless of intention or need. This point can be clarified quite readily by looking at the case of the alcoholic therapist-in-recovery who now decides to offer therapy for alcohol use. Assuming of course that the therapist has excellent therapy skills to start, the therapist’s history with alcohol can actually interfere with their functioning as an addictions therapist, narrowing perspective with unchallenged assumptions related to etiology, treatment options, and/or prognosis. This is why the professional standard for qualifying alcohol therapists is not one’s prior experience with alcohol, but rather, a course completion certificate or certification in alcohol interventions. Even a good (or great) in-person therapist approaching telephone telehealth without training is likely to overestimate the quality and/or effectiveness of their communications. If one does read the literature about telehealth in general and telephone therapy in particular, it is very clear that professional training in order. In fact, most published studies directly call for clinicians to get such training for telehealth and telephone therapy as well. The Telephone Telehealth Evidence-Base The research in telehealth, in general, has also been quite clear that therapists who have received training are more likely to use the medium correctly to deliver outcomes that are not only comparable to in-person care but also to minimize frustration in both themselves and their clients/patients and feel more confident about how to protect the privacy of the exchange. In 2018, after conducting a systematic search for articles published over a 25-year period (January 1991–May 2016), Coughtrey & Pistrang published a study of 14 studies that concluded that “telephone-delivered interventions show promise in reducing symptoms of depression and anxiety.” This conclusion is warranted, given that much of the Similarly, in 2020, Castro and colleagues published a meta-analysis looking at 10 studies looking at treatment adherence to telephone therapy for depression. In general, they showed beneficial effects on depression severity when compared to control conditions. However, in these and other published reports showing the effectiveness or adherence rates related to telephone telehealth, treatment models are typically highly manualized. That is, they do not consist of free-form, open discussion common to many psychotherapeutic approaches. Therapists in such studies tend to follow very strict procedural dictates, and often, the recipient of care is given written materials and assignments that coincide with specified topics for each meeting. Conducting a mid-pandemic online qualitative survey of mental health care professionals in Netherlands, Feijt and colleagues (2020) reported, “Regarding the mediated nature of communication, the most frequently reported challenge concerns the lack of nonverbal signals that practitioners normally use in face-to-face communication, such as posture and hand movements, but also general demeanor, including smell. Practitioners find it more difficult to connect with their client or clearly communicate their intended message. This is even stronger when sessions are conducted by telephone when there is only audio to rely on.” Such a conclusion seems warranted, given that in-person training often teaches practitioners to rely on visual stimuli to render a diagnosis, develop and deliver a treatment plan. In evidence-based telehealth professional training, and especially in competency-based certificate programs of professional training, many of these issues can be addressed using protocols that are tailored to the clinician’s specific client for one’s patient population, setting, state, and professional requirements. On the other hand, clinicians who use communication technology without professional training are likely to be as confused by the online delivery of healthcare as someone accustomed to using a handset telephone who now is handed a smartphone to make a simple call. Therapist Vulnerability in Telephone Telehealth? Assessing a client or patient’s emotional state from voice alone can be problematic, particularly if the professional’s prior telephone habits involve multitasking. As discuss by Hilty, Randhawa, Maheu, McKean, Pantera & Mishkin (2020), distractions are the #1 problem with digital interventions. Don’t we all multitask when on the phone? Where then does distractibility leave the busy professional who typically multi-tasks during telephone therapy? Professionals who allow their workspace to be impinged by devices that regularly emit incoming messages, beeps, flashing lights, and other forms of alerts will likely find it difficult to stay focused on the voice input they now are attempting to use to deliver the same standard of care as in-person. Some therapists even so boldly encourage their clients and patients to “take a walk” while they themselves stroll about their neighborhoods or other local public areas while offering telephone therapy. All the while, these professionals profess to be delivering the same standard of care as when the client is seated in front of them, in a closed room. Could these realities be used to discredit an earnest professional who is attempting to deliver quality care via telephone therapy to people in need? Telehealth Service Delivery is Not Intuitive Telehealth service delivery is not intuitive, regardless of one’s experience in person or the need of the client. Faulty assumptions, lack of knowledge, undeveloped skillsets, and naive attitudes can lead to preventable error and potential harm. Pierce, Perrin, & McDonald (2020) stated, “Organizations interested in encouraging telepsychology use should adopt policies supporting the use of telepsychology and provide adequate training to do so.” Such calls for training are common to published reports and mimic those of telehealth in general for more than two decades. In 2000, Maheu and Gordon reported the results of an extensive survey assessing psychologist’s assumptions regarding the legal and ethical requirements for telehealth. Fourteen years later, a similar article was published by Maheu and a larger team of researchers who assessed roughly the same variables. In the 2020 study, two-thirds of clinicians endorsed items suggesting that standard legal and ethical mandates don’t apply to telehealth delivery of psychotherapy (Maheu & Gordon, 2000). In a more extensive survey, Glueckauf, Maheu, Drude, Wells, Wang, Gustafson & Nelson (2018) showed that the number had decreased to one-third. The disturbing fact is, however, that while two-thirds of clinicians endorsed items suggesting an awareness of legal and ethical mandates, it cannot be assumed that those clinicians understood how those mandates apply to their everyday telehealth practices. Where does this leave the average clinician who has no or minimal telehealth training, yet is confident that they are delivering quality care because they “feel good about it” and because it is “needed?” Therapists too are vulnerable to emotional reasoning… Courtroom Realities of Telephone Therapy Knowing how litigating attorneys work, it is quite conceivable that opposing counsel in a lawsuit against a therapist would wield several such recently published telehealth articles in the direction of an unwitting therapist who blithely offers telephone therapy without the proper documentation to prove that they indeed were actually trained in evidence-based telephone telehealth. Perhaps the CIVID emergency would tempter such accusations, depending on the circumstance. Hopefully so. However, the worrisome issue at hand is that most clinicians have never been taught the reality of what actually happens in courtrooms. Such training can be a difficult awakening. To help our readers better understand the issues involved with delivering clinical care in an area where there is a lack of professional training, we will make you privy to a training video that we regularly show in our 2-day certificate training programs. It features Attorney Joe McMenamin demonstrating his litigation skills as a prosecuting attorney for the defense in a “mock deposition.” In this video, he demonstrates exactly how a prosecuting attorney would “prepare” their case against a witness’s testimony for a trial wherein the therapist is being sued by an angry client. The video is painful to watch. Our only solace at TBHI is that Mr. McMenamin has not only worked for decades as a prosecuting attorney for the defense, but he is also a physician. he understands and shares the ethos of many healthcare professionals, and has worked these many years to defend us in court. That’s his motivation for working with TBHI for decades to develop training materials and peer-reviewed books and articles – to help professionals who are poorly informed of what can happen when one is led by the unbridled desire to help rather than a firm grounding in telehealth theory and practice. Caveat While this type of cross-examination wouldn’t happen to professionals who deliver telephone therapy during the pandemic because we are currently in a state of national emergency, but if telephone therapy were to be approved long-term, this is precisely the type of rigor that would be expected of professionals delivering professional services to people in need. As all licensed professionals know, there is a high bar for the delivery of professional services. Practicing licensed healthcare professional in the United States or Canada as well as in many other countries isn’t something one does in the same manner as they would if they were talking to a family member on the phone, multitasking, opening email, glancing at texts, perhaps outside strolling about the park — while the other party probably is also multi-tasking and/or strolling about as well. When we share the video below, please use this information to extrapolate how a skilled professional needs to be able to defend the amount of training they have obtained in any new area of practice including phone therapy sessions alone when a litigating attorney has them on the witness stand. Please note, we at TBHI are not saying this process is fair or right. It simply is reality. Courtroom Realities of Telehealth Malpractice Before watching, please let us explain what is happening in the video. First, this is one of the many training videos that we typically share with our training audiences. You will see how the attorney discredits the psychologist who is named “Dr. Joanne Johnson,” acted by Dr. Marlene Maheu for purposes of this role-play. The cross-examining attorney is Mr. Joe McMenamin, who is indeed a litigating attorney and physician in real life. He, however, defends practitioners in court rather than a prosecuting attorney, which he depicts in this audio lesson. However, having litigated against attorneys who prosecute, he is in a unique position to show you exactly what happens in court, should you ever have the misfortune of experiencing it firsthand. The interactions portrayed in the audio recording are abbreviated because Dr. Johnson provided additional information rather than doing as witnesses are instructed, and that is to give yes/no answers when possible, and offer as little as possible unless directly asked. You will see that Dr. Johnson actually offers a fair amount of information to get to the point of the demonstration. Upon experiencing the agony of witnessing such an exhaustive exchange, but in real life, it would behoove you to obtain the advice of a defense attorney about offering as much information as is depicted. The purpose of the demonstration, in this case, was to show you what a skilled litigator can do to disarm a well-intentioned professional during a deposition. The attorney goes on to explain his rationales, strategies, and how opposing counsel (which he is role-playing) would generally use the information gathered to discredit the plaintiff in court. This first training video is 37 minutes in length. TBHI Position on Telephone Therapy Just to be clear, TBHI is in complete support of phone therapy sessions alone for all clients and patients who need or are interested in such healthcare. However, having been the Chair of the CTiBS Committee on Telebehavioral Health Competencies, the Founder of TBHI is acutely aware of the lack of competence in psychotherapists who deliver such care. Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. All untrained professionals then are encouraged to consider serious telehealth training if they wish to be competence and legally and ethically compliant with the evidence base. References Castro, A., Gili, M., Ricci-Cabello, I., Roca, M., Gilbody, S., Perez-Ara, M.A., Seguí, A. & McMillan, D. (2020) Effectiveness and adherence of telephone-administered psychotherapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 514-526, ISSN 0165-0327,https://doi.org/10.1016/j.jad.2019.09.023. Coughtrey, A. E., & Pistrang, N. (2018). The effectiveness of telephone-delivered psychological therapies for depression and anxiety: a systematic review. Journal of telemedicine and telecare, 24(2), 65-74. Feijt, M., de Kort, Y., Bongers, I., Bierbooms, J., Westerink, J., & IJsselsteijn, W. (2020). Mental health care goes online: Practitioners’ experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychology, Behavior, and Social Networking, 23(12), 860-864. Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205. Hilty, D. M., Randhawa, K., Maheu, M. M., McKean, A. J., Pantera, R., & Mishkind, M. C. (2020). A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care. Journal of Technology in Behavioral Science, 1-28. https://doi.org/10.1007/s41347-020-00126-x Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484. Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Demographic, organizational, and clinical practice predictors of US psychologists’ use of telepsychology. Professional Psychology: Research and Practice, 51(2), 184. Link: https://telehealth.org/telephone-telehealth/?utm_source=ActiveCampaign&utm_medium=email&utm_content=New+COVID-19+FCC+Telehealth+Grant+%7C+TBHI+Telehealth+News+4%2F14%2F21&utm_campaign=April+13th+Newsletter&vgo_ee=L60XUD6gIFzXzaAzbkkf6r35hO7C%2FF3J%2FgQB9Uu3XAY%3D Previous rulings for COVID-19 Telephone Telehealth Reimbursement: https://telehealth.org/reimbursement-covid-19-telephone/ < 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 >

CCHP Releases Factsheet Based on Policies in New FQHC Category of Policy Finder CCHP October 25, 2022 Last week’s latest update to CCHP’s Telehealth Policy Finder included a brand-new feature: a category specifically for federally qualified health centers' (FQHC) Medicaid fee-for-service policies. Funded by the National Association of Community Health Centers (NACHC) through funding from the Health Resources and Services Administration (HRSA), the new section includes the many unique rules that apply to FQHCs that sometimes effect their ability to utilize telehealth. CCHP is now making a factsheet available summarizing the findings from our new FQHC section. CCHP searched statute, state Medicaid manuals, administrative code and fee for service polices between July and early September 2022, for relevant policies. In some categories, the factsheet reports a certain number of states that are reimbursing for a specific modality or the prospective payment system (PPS) rate. Note that CCHP only counts states as providing reimbursement if official and explicit Medicaid documentation was found confirming they are reimbursing FQHCs specifically for a certain modality. A broad statement that all providers are reimbursed or any originating site is eligible without an explicit reference to FQHCs was insufficient. Additionally, a state Medicaid program was counted as reimbursing FQHCs even if they do so in a very limited way, such as only for mental health. KEY FINDINGS INCLUDE: Definition of Encounter/Visit: The majority of Medicaid programs do provide a definition for a FQHC ‘encounter’ or ‘visit’ that stipulates that it is a face-to-face interaction. This does not necessarily preclude use of telehealth as live video can also be considered ‘face-to-face’. Same-Day Visits: CCHP examined each state Medicaid program’s policy on ‘same day encounters/visits’. Many states have limitations around FQHCs claiming more than one encounter in a single day for a single patient. This is thought to be a limitation applicable to telehealth because it is common for a patient to visit a FQHC for a primary care visit, and upon examination require a specialty service (such as mental health). CCHP observed that most state Medicaid programs do indeed have limitations around same day encounters, particularly if the services occur at the same location and are both considered the same type of encounter (for example, a medical encounter). However, there are often allowances for multiple encounters if the service is considered a different type of encounter, for example a mental health encounter. FQHCs as Originating Sites: 36 states and DC explicitly allow FQHCs to serve as originating sites for telehealth-delivered services. If a state does reimburse a facility fee, it is common for FQHCs to be eligible to collect the fee, however not every state Medicaid program reimburses the facility fee. FQHCs as Distant Site: 34 states and DC explicitly allow FQHCs to be distant site providers. This was often stated in Medicaid manuals or regulations as a clarification so that there could be no confusion about their eligibility for reimbursement. FQHCs Collecting the Prospective Payment System (PPS) Rate: In some cases, policy addressed whether or not FQHCs would be eligible for the prospective payment system (PPS) rate. Twenty state Medicaid programs and DC explicitly clarify that FQHCs are eligible for the PPS rate when serving as distant site providers. Store and Forward Reimbursement: The vast majority of states did not specify or excluded store-and-forward from an eligible service FQHCs could be reimbursed for. Only 4 state Medicaid programs explicitly reimburse FQHCs for store-and-forward. Audio-Only Reimbursement: 9 state Medicaid programs explicitly allow reimbursement for audio-only services to FQHCs. In some cases, services are only reimbursed through communication technology-based services (CTBS) codes, or have other restrictions (such as limitations around the service type) limiting its use. Remote Patient Monitoring Reimbursement: While most states did not address whether or not FQHCs would be eligible for remote patient monitoring, in a few instances CCHP noted states that allowed them to be reimbursed through CTBS codes, although separate from their ‘core services’ or encounter rate. Services Outside the Four Walls: FQHCs have sometimes had to adhere to rules restricting services from being rendered outside of the four walls of their facility. This can pose a problem for telehealth encounters when the patient may be at home and connecting to a FQHC provider. CCHP found that Medicaid policies did not always address this situation explicitly, and the policies that were found often did not address a telehealth situation explicitly leaving it ambiguous whether this model of care is allowed. FQHC Limitations on Establishing a Patient Provider Relationship: This was examined as a topic area for each state, but only California was found to have such requirements. For more detailed explanations, examples of each topic area above, and a chart reporting whether each state reimburses FQHCs for the specific modalities or PPS rate, see the Telehealth Policies and FQHCs Factsheet. For each state’s specific FQHC policies, along with links to source materials, see the new FQHC section of CCHP’s Policy Finder. See original article: https://mailchi.mp/cchpca/cchp-releases-factsheet-based-on-policies-in-new-fqhc-category-of-policy-finder < Previous News Next News >

The Future of Telehealth: Informatics, Scalability and Interoperability Bill Siwicki, Healthcare IT News July 2021 A Philips executive describes what's happening now with virtual care – and what needs to happen to ensure a solid future for telemedicine and remote patient monitoring. The COVID-19 pandemic pushed telehealth into the spotlight with exponential adoption, helping to prove its value. The healthcare industry learned that, with the right solutions, care can extend outside hospital walls and be conducted anywhere. Further, CIOs and other health IT leaders reinvented systems and processes, and clinicians gained an improved understanding of the invaluable impact of integrated informatics on digital transformations and the quality and efficiency of care. Even while the pandemic continues, healthcare provider organizations have begun to stabilize these infrastructures and revisit the technologies and workflows deployed earlier in the crisis and turn them into standard practices. On this note, Karsten Russell-Wood, portfolio leader for post-acute and home at Philips, shares his viewpoints with Healthcare IT News on the biggest priorities to ensure telehealth is sustained long term. Q. How can telehealth and remote patient monitoring technologies help support chronic and acute care anywhere? A. With the right tools, extending care outside the hospital is not only feasible, but in many cases preferred. The Philips Future Health Index 2021 Report, which surveyed nearly 3,000 healthcare leaders across 14 countries, found that healthcare leaders expect an average of 23% of routine care to take place outside of the hospital walls within three years. This new frontier will undoubtedly include extending real-time care to those with both acute needs and chronic conditions who benefit from consistent communication with doctors. For these patient populations in particular, COVID-19 spurred an interest in becoming a more active participant in care plans, bringing them new levels of convenience and personalization. To meet these needs, providers must continuously work to tailor care toward the consumer, just as we're seeing happen in the banking and retail industries, and [to] advance care models from brick and mortar to "clicks and mortar." Even if the home can't be the hospital, community spaces and retail locations can fill in as connected care stations for underserved communities or patients [who] don't have an ideal setup at home. This is only possible through the use of data-driven, connected care solutions that feed into cloud-based software and allow clinicians to maintain visibility into their patients' conditions from afar. Beyond wellness checks, remote patient monitoring enables doctors to view critical patient data on a consistent basis, helping them cater care to a patient's unique needs, as well as activate timely interventions before health deteriorates. Traditionally, acute patients need an inpatient admission to the hospital and require continuous rounding by a physician. Approaching this patient population with a 360-degree model – monitoring them at home from pre-admission through post-discharge – could help track the different phases of acute care from outside the hospital. The benefits here include freeing clinicians from the bedside, helping them better allocate hospital resources according to risk, and, above all, keeping patients in a more convenient, lower-cost setting. Hospital-grade wearables equipped with secure data integration, for example, can help guide relevant, timely decisions from care teams regarding whether a patient needs to be hospitalized immediately, or can receive treatment elsewhere and remain outside the hospital for the time being. Care teams can view daily and weekly trends via continuous biometric devices, showing everything from skin temperature, respiratory rate at rest and coughing frequency, and be notified if symptoms are worsening. There are similar advantages of using connected devices when managing patients with chronic conditions. In the comfort of their own home, patients can remain connected to their providers in a convenient, passive manner, which can motivate them to adhere to their treatments. Until recently, patients have traveled to their doctors to receive care. However, that doesn't mean hospitals have always been the most accessible means of delivering that care, people just didn't have a choice. The industry now has the means to deliver that same level of care in a much more accessible way, bringing it to patients wherever they may be. For example, those with diabetes or congestive heart failure who may wish to avoid in-person visits can potentially avoid an unnecessary hospitalization if their doctors detect a change in their condition in time. Patients with cardiac arrhythmias can remain home while being continuously monitored. Doctors can detect arrhythmias such as atrial fibrillation as they occur and intervene if necessary. Telehealth solutions can also help clinicians monitor whether a chronic condition is becoming acute. Q. With telehealth and remote patient monitoring comes the need for interoperability and security. How does a healthcare provider organization ensure data can be accessed and shared seamlessly across settings, and that solutions are interoperable? A. As hospitals evolve to extend care beyond their walls, telehealth and remote patient monitoring enable a hybrid continuum of care that brings an increased amount of health data. This requires secure, robust data-sharing infrastructures and a standard for technologies to work together across platforms and locations. The Future Health Index 2021 report found that two of the biggest barriers to the adoption of digital health technologies were difficulties with data management (44%) and lack of interoperability and data standards across technology platforms (37%). Providers need to rely on a longitudinal health record to activate the right care anytime and anywhere. For example, for remote care for patients in ICU settings, known as tele-ICUs, where integrated systems are particularly important: Without a strong backbone for smooth data integration, intensivists can only see what is happening in front of them, instead of making informed decisions based on a holistic view of a patient's health. To ensure data can be accessed and that solutions are interoperable, secure flows of data must be activated. Solutions that are designed to work in tandem are better organized and more secure from malicious attacks. By safeguarding technologies to make sure they're interoperable across platforms and geographic locations, health systems can better protect the data that flows throughout their system and provide increased security. Using a cloud-based platform approach will help achieve this, as well as standardize the current disparate IT landscape and allow data to be accessed anywhere. Leveraging open APIs and approved standards like IHE-HL7 can help facilitate data exchange across multiple sources and vendors across the continuum of care with minimal friction. With the rise in cloud-based applications, software-as-a-service and virtual care solutions enabling data sharing, organizations must work to ensure systems and processes mature at the rate they are evolving. Providers should assess their current infrastructure and their performance metrics such as ROI, quality, scalability and satisfaction, which will help them develop IT models accordingly that support these emerging care pathways. New types of executive roles will also grow in necessity to support building beyond hospital walls, such as chief digital officer and virtual health leadership supporting the informatics department. Further, to ensure confidentiality, integrity and availability of critical data and the systems that house that data, security plans should span across organizations and industries. While updating IT systems all at once may not be realistic, health systems can start by rigorously assessing third-party vendor capabilities, only using 510k cleared medical devices and implementing policies for data protection. Hospitals should prioritize partnerships with organizations that take a proactive approach to protecting health information across devices, systems and settings, so administrators, healthcare providers and patients have confidence about how care is delivered. By connecting devices, unlocking data and fostering collaboration, we will empower new forms of engagement, actionable insights and better health outcomes. Q. You have said that virtual care strategies cannot be a bandage on top of existing or new piecemeal solutions that work in silos, that a much-needed technology infrastructure must be established that not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. Please elaborate. A. Implementing telehealth solutions during the pandemic to supplement in-person care was like building a plane while flying it. Now healthcare organizations can be strategic, stabilize these infrastructures and revisit the technologies deployed in times of crisis and transform them into standard practices. Our world moving forward is one that embraces the best solutions available, leveraging both traditional care models as well as virtualization to provide quality care. This change isn't one that any one organization can do alone, and relies on partnerships with technology companies that enable and foster clinical creativity through co-creation and embrace the subscription economy. Healthcare organizations are increasingly partnering with those with proven track records in implementing foundational technology infrastructures and who can serve as consultants to drive their digital transformation. The ability to co-create has never been more important in driving outcomes. Working side by side with partners in the technology sector will help hospitals and health systems develop solutions from the ground up. There is value in disintermediated partners in this case, as they allow providers, vendors and patients to take collaboration to the next level. And health systems should be given flexibility when it comes to implementing and exploring virtual tools that are right for them. Rather than making a big capital investment upfront, they should be able to adopt solutions in a stepwise fashion, and scale up or down in real time. Today's healthcare organizations care more about access than they do about ownership. They want customized experiences and flexible payment options. That's why healthcare organizations are increasingly turning to subscription services, with a shift from buying a physical product to leveraging a holistic solution that provides ongoing value and engagement. By adopting these new business models, it not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. We've seen success with software-as-a-service models as a predictive, usage-based model that allows for faster innovation, but also reduces the demand for IT maintenance, standardizes service levels and usage, and helps providers quickly scale according to need. < Previous News Next News >

New FAIR Health White Papers Shows Large Telehealth Utilization Increases Before COVID-19 Center for Connected Health Policy April 2021 Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. In its fourth edition of the Healthcare Indicators and Medical Price Index White Paper, FAIR Health found that the fastest area of healthcare utilization growth from 2018 to 2019 occurred for telehealth services. FAIR Health conducted the annual analysis using its data repository of 32 billion claims for patients in commercial insurance plans. Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. FAIR Health also noted that the most common claim type for telehealth was for mental health services, bolstering other recent evidence that telehealth utilization continues to grow for behavioral and mental health services. The findings are an important contribution to ongoing policy discussions about where telehealth is going after the pandemic. While most telehealth experts have been paying close attention to telehealth utilization during the pandemic, these findings suggest that the story of telehealth’s rapid growth likely begins in 2019, one year prior to the public health emergency. FAIR Health is a national nonprofit organization that maintains a large database of privately insured healthcare claims data. The organization performs healthcare utilization and cost analyses on market trends for use by researchers, consumers, and industry stakeholders. For more information about FAIR Health's data, view their website. FAIR Health Consumer: https://www.fairhealthconsumer.org/#about FH Healthcare Indicators and FH Medical Price Index 2021: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/FH%20Healthcare%20Indicators%20and%20FH%20Medical%20Price%20Index%202021--A%20FAIR%20Health%20White%20Paper--FINAL.pdf < Previous News Next News >

Congress' last-minute $1.7 trillion omnibus package: 8 healthcare takeaways Molly Gamble December 20, 2022 Lawmakers rolled out a roughly $1.7 trillion year-end spending bill Dec. 20 to fund the U.S. government through most of 2023, tacking on proposals to extend telehealth and hospital-at-home flexibilities while leaving out other healthcare asks. Lawmakers have until the end of Dec. 23 to clear the 2023 Omnibus Appropriations bill or federal funds are set to run out, bringing key agencies and programs to a halt. The package consists of all 12 annual appropriations bills Congress must pass and would fund the government through the remainder of fiscal 2023, which runs through September. Eight healthcare- and hospital-specific notes out of the 4,155-page bill: 1. The legislation curbs a scheduled cut of nearly 4.5 percent to the Medicare physician fee schedule that was set to take effect in 2023, narrowing the cut to 2 percentage points in the year ahead with a scheduled cut of 3.25 percentage points in 2024. The American Medical Association, which lobbied against the cuts, said it is "extremely disappointed and dismayed" with the cuts that made it to the bill. 2. While physicians did not get the relief they sought with complete aversion of fee schedule payment cuts, the spending bill would avert the 4 percent Statutory Pay-As-You-Go reduction, which would have amounted to cuts of approximately $36 billion, from taking effect in 2023. 3. The legislation extends incentives under the alternative payment model, which were set to expire this year, but reduces the amount from 5 percent to 3.5 percent. The incentive is designed to offset losses in revenue physicians may incur as they move from fee-for-service to participation in value-based care models. 4. The package extends Medicare telehealth flexibilities through 2024. The deadline for these flexibilities has been tied to 151 days after the end of the COVID-19 public health emergency, meaning the precise date was unclear as HHS has continued to renew the PHE in 90-day increments. Under the legislation, providers would be able to lean on flexibilities guaranteed throughout 2024. 5. The package extends acute hospital care at home waivers and flexibilities for two years through 2024. Similar to telehealth flexibilities, the deadline for hospital care at home waivers was tied to the status of the PHE. CMS has approved more than 250 hospitals to participate in the acute hospital care at home program. 6. The legislation extends the low-volume hospital payment adjustment and Medicare-dependent hospital programs through fiscal year 2024, or Sept. 30, 2024. 7. The legislation includes $118.7 billion — a 22 percent increase — for VA medical care. Other healthcare end medical allotments include $47.5 billion for the National Institutes of Health (a 5.6 percent increase); $9.2 billion for the CDC; $1.5 billion for NIH's second-year Advanced Research Projects Agency for Health and $950 million for the Biomedical Advanced Research and Development Authority, according to Senate Appropriations Committee Chairman Patrick Leahy. 8. The American Hospital Association expressed satisfaction with a number of measures in the legislation, including the extension of telehealth, hospital-at-home and programs to help rural hospitals, but signaled toward the work that remains to garner funding for hospitals. "In the new year, we will continue to advocate for Congress and the administration to take action to address patient discharge backlogs, support our current workforce and increase the pipeline into the future, hold commercial health insurers accountable for policies that compromise patient safety and add burden to care providers, and strengthen hospitals that care for a disproportionate number of patients covered by government programs or are uninsured, to name a few of our priorities," association President and CEO Rick Pollack said in a statement shared with Becker's. See original article: https://www.beckershospitalreview.com/finance/congress-last-minute-1-7-trillion-omnibus-package-8-healthcare-takeaways.html < Previous News Next News >

AMA survey shows widespread enthusiasm for telehealth American Medical Association March 23, 2022 CHICAGO — An American Medical Association (AMA) survey released today shows physicians have enthusiastically embraced telehealth and expect to use it even more in the future. Nearly 85% of physician respondents indicated they are currently using telehealth to care for patients, and nearly 70% report their organization is motivated to continue using telehealth in their practice. Many physicians foresee providing telehealth services for chronic disease management and ongoing medical management, care coordination, mental/behavioral health, and specialty care. The survey comes as Congress recently extended the availability of telehealth for Medicare patients beyond the current COVID-19 public health emergency. Additional action by Congress will be needed to permanently provide access to Medicare telehealth services. As physicians and practices plan to expand telehealth services, they say widespread adoption hinges on preventing a return to the previous lack of insurance coverage and little to no payer reimbursement. Payers, both public and private, should continue to evaluate and improve policies, coverage, and payment rates for services provided via telehealth. “Physicians view telehealth as providing quality care to their patients, and policymakers and payers have come to the same conclusion. Patients will benefit immensely from this new era of improved access to care,” said AMA President Gerald E. Harmon, M.D. “This survey shows adoption of the technology is widespread as is the demand for continued access. It is critical that Congress takes action and makes permanent telehealth access for Medicare patients.” Physicians strongly support that telehealth via audio-only/telephone remains covered in the future to ensure equitable access. That coverage has been permitted during the public health emergency and extended for several months afterward. According to the survey, 95% of physicians report patients are primarily located at their home at the time of the virtual visit. Allowing patients to be in their home is a key component of making telehealth more accessible. Before the pandemic, Medicare patients needed to be physically located in a rural area to access telehealth services, shutting out urban and suburban patients from receiving the same benefits of virtual care. Before the pandemic, rural patients needed to travel to an “originating site,” essentially another health care facility, outside of their home to access telehealth services. The temporary extension in the omnibus will allow patients with Medicare to receive telehealth services anywhere they are located, including in their home. The AMA will continue to urge Congress to make permanent this and other policies that have offered coverage and convenience to patients. Fewer than half of respondents report being able to access all of their telehealth platforms via their electronic health records, and more than 75% report that their support technology does not automatically collect and deliver patient-reported data. Improving interoperability between platforms and support technology would improve and streamline telehealth services. Physicians perceive technology, digital literacy, and broadband internet access to be the top three patient barriers to using telehealth. In addition, only 8% of physician respondents said they were using remote patient monitoring at this time. The AMA will advocate for patient populations and communities with limited access to telehealth service, including but not limited to, supporting increased funding and planning for telehealth infrastructure such as broadband and internet-connected devices. Read the survey here. To learn more about the results, register for an AMA Telehealth Immersion Program webinar at 10 a.m. ET March 31. Media Contact: Jack Deutsch ph: (202) 789-7442 jack.deutsch@ama-assn.org About the American Medical Association The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care. < Previous News Next News >

How Does a Telemedicine Pain Program Work in Rural American with Multi-Vulnerable Patient Populations? Dax Trujillo, MD July 20, 2022 In April 2017 Summit Healthcare started a multi-disciplinary program to treat patients with chronic and acute pain in the White Mountains of Arizona. Our patient service area is HRSA-designated as having a shortage of providers and medically underserved. The area is the size of Rhode Island and includes Native American reservations and other vulnerable populations. Many of our patients live in a high poverty area which makes access to care challenging. In order to provide multi-disciplinary services that include interventional procedures, monitored medication management and cognitive behavior therapy, we needed to create a hybrid program. Our program incorporates in-person, video/audio and telephone visits. By using three different modes of care delivery we were able to reach and follow more patients with better outcomes. Since April 1, 2017 we have had over 900 patients participate in our telemedicine pain program. The visits include virtual appointments for medical management, behavioral therapy, and general wellness checks after an in-person visit; virtual check-ins for procedure or testing follow-ups and eVisits via email communication to answer questions and/or review prescription issues or re-ordering. Due to the rurality of the service area we estimate that patients were saved from having to travel 66,144 miles to a physician’s office. This was a significant relief to patients with limited means to transportation, knowing that their weekly, monthly in-patient visits were reduced to quarterly in-patient visits. Patient satisfaction has been high due to the reduction of travel time and costs. Simultaneously, the patient perceived they were being more closely monitored and their pain issues addressed in a timely manner. Another benefit is that more than one professional can join a telemedicine visit with the patient which allows a more holistic and comprehensive visit for better value based care of the patient. By providing virtual visits as part of the entire treatment program, we have saved thousands of dollars in chronic pain treatment costs. Through evidence-based research we know that patients are achieving better healthcare outcomes in this hybrid program by incorporating telemedicine technology. Our program has had overall success with addressing pain but there are some risks involved that must be addressed within your institution to provide a platform that is HIPPA compliant and protects critical sensitive health information. Providing a secure platform must be a top priority when delivering pain treatment virtually due to the sensitive nature of the disease/treatments with this patient population. While most patients do well with the hybrid program we do have patients for whom it is not appropriate. Due to our location, a subset of patients do not have access to broadband internet service so we cannot perform visits via video or sometimes audio. Other patients have expressed a preference for in-person visits while another group prefers all visits to be virtual. Patients needing neuraxial interventions or surgeries will need to be seen in-person. Each patient has their own unique circumstances so having a hybrid pain treatment program with various care delivery options allows us to reach more patients previously not being treated for their chronic pain issues. In the future we will purchase a remote patient monitoring platform/equipment that can be used with our chronic pain patients to better track their vitals, physical and mental health. This will also allow us to manage medications and behavioral issues related to pain and opioid addiction, both of which are prevalent in our service area. Our hospital system is also developing a hospital at home program which will incorporate the telemedicine pain program for patients with co-morbidities. The future of healthcare access is using hybrid delivery of care systems that include telemedicine, to improve accessibility and outcomes for chronic pain patients. For original article: https://southwesttrc.org/blog/2022/how-does-telemedicine-pain-program-work-rural-american-multi-vulnerable-patient < Previous News Next News >

Frequently Asked Questions Regarding Licensure & Telehealth Mei Wa Kwong, JD September 12, 2022 This video addresses the most frequently asked questions CCHP receives regarding licensure and telehealth for example: (1) What does the law says if your patient is going on vacation to another state, but still needs your services? (2) Do you really need a license in another state if you’re just consulting with a provider who is already licensed in that state? (3) ….and many more! View the PPT for this video here. See original video: https://www.cchpca.org/resources/frequently-asked-questions-regarding-licensure-telehealth/ < Previous News Next News >

State Telehealth Laws and Reimbursement Policies Report, Fall 2021 Center for Connected Health Policy October 2021 Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2021. Our semi-annual report has gone digital Historically, our twice-yearly updates to the “State Telehealth Laws and Reimbursement Policies” report have been published as a PDF document, and included the telehealth policies for all 50 states and the District of Columbia. Earlier this year, we transitioned exclusively to our new and improved online Policy Finder. This online database allows the CCHP team to easily update each state’s information whenever there is a change, instead of waiting for the spring and fall to roll out the report. Now, you can look up (or download a PDF) of the most up-to-date information on each state from that state’s page. We hope this transition will result in more timely policy information that is easier for you to navigate and understand. Read the Executive Summary We will continue to produce bi-annual summary reports of the status of telehealth policies across the United States to provide a snapshot of the progress made in the past six months. The information for this summary report covers updates in state telehealth policy made between June and September 2021. DOWNLOAD SUMMARY This report is for informational purposes only, and is not intended as a comprehensive statement of the law on this topic, nor to be relied upon as authoritative. Always consult with counsel or appropriate program administrators. Introduction The Center for Connected Health Policy’s (CCHP) Fall 2021 analysis and summary of telehealth policies is based on its online Policy Finder database tool. It highlights the changes that have taken place in state telehealth policy between the initial release of CCHP’s Policy Finder in Spring 2021, and Fall 2021. The research for this Fall 2021 executive summary was conducted between June and September 2021. This summary offers policymakers, health advocates, and other interested health care professionals an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder tool which breaks down policy for all 50 states and the District of Columbia. Please note that many states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in this executive summary, although they are listed under each state in the online Policy Finder under the COVID-19 category. In instances where the state has made policies permanent, or extended policies for multiple years, CCHP has incorporated those policies into this report. DOWNLOAD INFOGRAPH WITH KEY FINDINGS Methodology CCHP examined state law, state administrative codes, and Medicaid provider manuals as the primary resources for the online telehealth policy database tool, from which the findings in this summary are taken. Additionally, other potential sources such as releases from a state’s executive office, Medicaid notices, transmittals or Agency newsletters were also examined for relevant information. In some cases, CCHP directly contacted state Medicaid personnel in order to clarify specific policy issues. Most of the information contained in the database tool specifically focuses on fee-for-service; however, information on managed care plans has also been included if available from the utilized sources. Every effort was made to capture the most recent policy language in each state at the time it was reviewed between the months of June and September 2021. In some cases, after a state was reviewed, they passed a significant piece of legislation. In order to incorporate those significant changes, CCHP conducted a scan for these instances in late September and incorporated language from those enacted bills where appropriate. It should be noted that even if a state has enacted telehealth policies in statute, these policies may not have been incorporated into its Medicaid program. For purposes of this summary, CCHP only counts states as reimbursing for a specific modality or removing a restriction if there is documentation to show that the Medicaid program has implemented a statutory requirement for that policy. Requirements in newly passed legislation will be incorporated into the findings section of future editions of CCHP’s summary report once they are implemented in the Medicaid program, and CCHP has located official documentation confirming this. This survey focused on three primary areas for telehealth policy including Medicaid reimbursement, private payer laws and professional requirements. Within each category, information is organized into various topic and subtopic areas. These topic areas include: Medicaid Reimbursement Definition of the term telemedicine/telehealth Reimbursement for live video Reimbursement for store-and-forward Reimbursement for remote patient monitoring (RPM) Reimbursement for email/phone/fax Consent issues Out-of-state providers Private Payer Laws Definitions Requirements Parity (service and payment) Professional Regulation Definitions Consent Online Prescribing Cross-State Licensing Licensure Compacts Professional Boards Standards Key Findings No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. The main areas where changes were made over the past six months fall in the three buckets that CCHP uses to categorize information within its policy finder: Medicaid policy, private payer policy, and regulation of health professionals. Changes were also highly influenced by temporary expansions made during the COVID-19 pandemic. Some states took approaches to extend their pandemic policies multiple years into the future, while others made policies (or portions of their COVID policies) permanent. Still others have not adopted their more lenient COVID policies at all. Connecticut, for example, passed a new temporary law (active until June 30, 2023) which not only requires Medicaid to reimburse for synchronous, asynchronous store-and-forward transfers, remote patient monitoring and audio-only modalities if the provider is in-network, but also places similar requirements on private payers as well. In Medicaid, it was common for states to make slight adjustments to their telehealth policies to add or clarify the services that can be delivered via telehealth, types of professionals that can deliver care through telehealth or the types of settings a patient could be in during a telehealth interaction. For example, Iowa clarified that an intern psychologist can provide telehealth services to Medicaid members. Mississippi clarified federally qualified health centers (FQHC) and rural health clinics (RHC) could be distant site providers, and added the home as an originating site. And, Arkansas now specifies that both the home is an eligible patient site and that group meetings may be performed via telemedicine. Although reimbursement for audio-only telephone has become pretty standard during the COVID-19 public health emergency (PHE), less than half of state Medicaid programs explicitly are reimbursing for the modality permanently, and many that are have placed restrictive parameters around its reimbursement. It was also common for states to make modifications to their telehealth private payer reimbursement law language to alter the definition of telehealth/ telemedicine. This typically included an expansion of the definition to be broader in scope so that it entails more than just live video, although often with some caveats. For example, Arkansas’ private payer law now stipulates that telemedicine does not include audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan. Iowa revised their law to include ‘real-time interactive electronic media’, but still excludes audio-only telephone from the definition of telehealth. Requirements around payment parity were also a common change, with eight states passing a law requiring the reimbursement amount is the same whether a service is provided via telehealth or in-person since Spring 2021. Illinois, for example, now requires reimbursement parity for in-network or tiered network health care professionals or facilities, including services provided via audio-only. Iowa is another example of a state requiring reimbursement of covered services is made on the same basis and same rate as in-person mental health services. Finally, there is a noticeable shift in telehealth policy towards tightening of professional requirements around the use of telehealth by providers. For example, Michigan passed new consent requirements for social work, athletic trainers, massage therapists, acupuncturists and veterinary medicine. Texas is another state that added practice standards (including a consent requirement and prescribing rules) for teledentistry specifically. West Virginia adopted emergency telehealth practice standard regulations to implement a previous law that passed (W. VA Code 30-1-26(b)) for five professions, including dentistry, nursing, osteopathic medicine, social work and medicine. While many states have had these types of standards for several years, the rate at which new telehealth standards are being adopted has increased significantly within the last six months. Additional findings include: Fifty states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. Twenty-two state Medicaid programs reimburse for store-and-forward. However, three states (NC, OH, VT) solely reimburse store-and-forward as a part of CTBS, which is limited to specific codes and reimbursement amounts. Michigan is the only state to add reimbursement for store-and-forward since Spring 2021. Additionally, three jurisdictions (MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of the creation of this edition, don’t have any official Medicaid policy indicating this is occurring. Twenty-nine state Medicaid programs provide reimbursement for RPM. States that added RPM since Spring 2021 included Washington, Michigan and California. As is the case for store-and-forward, three Medicaid programs (NH, HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this report was written, did not have any official Medicaid policy. Additionally, two of the states (OH and CA) only reimburse the remote physiologic monitoring codes CMS does. Twenty-two states reimburse for audio-only telephone in some capacity (often limitations apply); however, Michigan only reimburses for it when used for provider to- provider electronic consultations. Eleven state Medicaid programs including Arizona, California, Maine, Michigan, Minnesota, North Carolina, Ohio, Oregon, South Carolina, Texas, Washington, reimburse for all four modalities, although certain limitations apply. While this Executive Summary provides an overview of findings, it must be stressed that there are nuances in many of the telehealth policies. To fully understand a specific policy and all its intricacies, the full language of it must be read utilizing CCHP’s telehealth Policy Finder. Below are summarized key findings in each category area contained in the Policy Finder as of September 2021. Read more: https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2021/ < Previous News Next News >

Telemental Health Collaborative Care Medication Management: Implementation and Outcomes Smita Das, Jane Wang, Shih-Yin Chen, and Connie E. Chen Dec. 22, 2021 Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Abstract Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Materials and Methods: CoCM MM was available to adult employees/dependents through their employer benefits, in addition to therapy. Outcomes included Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) collected at baseline and throughout participation. This analysis was not deemed to be human subjects research by the Western Institutional Review Board. Results: Over 17 months, 212 people enrolled and completed >2 assessments; the enrollees were 58.96% female with average age of 32.00 years (standard deviation [SD] = 7.38). In people with moderate to severe depression or anxiety, PHQ-9 and GAD-7 scores reduced by an average of 7.27 (SD = 4.80) and 6.71 (SD = 5.18) points after at least 12 ± 4 weeks in the program. At 24 ± 4 weeks, the PHQ-9 and GAD-7 reductions were on average 7.17 (SD = 5.00) and 6.03 (SD = 5.37), respectively. Approximately 65.88% of participants with either baseline depression or anxiety had a response on either the PHQ-9 or GAD-7 at 12 ± 4 weeks and 44.71% of participants experienced remission; at 24 ± 4 weeks, 56.41% had response and 41.03% experienced remission. Conclusions: An evidence-based CoCM telemedicine service within an employee behavioral health benefit is feasible and effective in reducing anxiety and depression symptoms when using measurement-based care. Widespread implementation of a benefit like this could expand access to evidence-based mental health MM. Read more here: https://www.liebertpub.com/doi/full/10.1089/tmj.2021.0401 < Previous News Next News >

The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Centers for Medicare and Medicaid Services Nov. 10, 2021 CY 2022 Physician Fee Schedule (PFS) policies for Medicare The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Unless otherwise noted, the policies will take effect on January 1, 2022. Much of the proposals published in July 2021 for public commentary remain intact, but CMS did make several modifications and clarifications. https://public-inspection.federalregister.gov/2021-23972.pdf < 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 >

HHS-OIG Reports on Pandemic Medicare Telehealth Trends to Inform Permanent Policies Center for Connected Health Policy Nov. 2, 2021 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. Interestingly, it was found that though pre-pandemic requirements limiting telehealth visits to established patients were waived, 84% of visits still occurred within those parameters. In addition, as policymakers consider making some telehealth pandemic policies permanent, some stakeholders have suggested a need to require an in-person visit within a certain period of time in order to be eligible for a telehealth visit. However, the data collected by HHS-OIG shows such requirements may not be necessary, as Medicare patients were found to already have had an in-person visit on average within four months prior to the telehealth visit without such a requirement. Additional findings included: Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management services via telehealth from providers with whom they had an established relationship Beneficiaries received about 45.5 million office visits delivered via telehealth, which accounted for nearly half of all telehealth services 86% of traditional Medicare beneficiaries received a telehealth service from providers with whom they had an established relationship, compared to 81% of Medicare Advantage Beneficiaries who received home visits via telehealth, which represented only 1% of all services provided via telehealth, were the least likely to have an established relationship with their providers The average amount of time between beneficiaries’ in-person visits and their first telehealth services varied by type of service Beneficiaries who received home visits via telehealth had an in-person visit with their providers at an average of around 9 months prior to first telehealth service Beneficiaries who received nursing home visits and assisted living visits via telehealth had an in-person visit at an average of 2 months prior to their first telehealth service HHS-OIG notes that the provision of this data seeks to inform policymakers looking at long-term telehealth policy and making certain pandemic expansions permanent, especially in light of concerns around telehealth fraud and abuse. For instance, it could help in examining the necessity of one of the most controversial, and confusing, permanent federal changes made thus far as part of the Consolidated Appropriations Act, which post-PHE will require an initial in-person visit within 6-months of a tele-behavioral health visit for purposes of Medicare reimbursement. However, the requirement only applies if the service is not provided in a geographically rural area and at a qualifying medical facility. There is also an exception for treatment of substance use disorder and co-occurring mental health treatment. In addition, CMS is proposing to make the 6-month in-person visit a requirement for subsequent visits in the proposed calendar year 2022 physician fee schedule. For non-behavioral health visits, the 6-month requirement wouldn’t apply, however patients would need to be located in a rural area and eligible facility type to qualify for Medicare reimbursement. Some Medicaid programs are considering limiting telehealth use to established patients, occasionally also applying restrictions to specific modalities and services. However, the HHS-OIG findings may suggest that it is unnecessary to limit telehealth to certain patients and services to prevent fraud and abuse as standard practice may already be providing sufficient guardrails in those respects. In addition, the study findings could indicate that the issue may be more related to general standard of care concerns that apply across all services, not just those delivered via telehealth. The balance may then include looking at how to manage health care fraud generally, which elsewhere HHS-OIG has clarified that most fraud is not telehealth specific. The issue could then boil down to how much autonomy to provide clinicians when making medical determinations, including when a telehealth visit is appropriate. Typically oversight in that respect has been under the purview of clinical licensing boards, not governed by general laws, but as we shift outside of the pandemic it is possible we may see additional shifts in terms of these policy approaches. As policymakers balance these multiple findings, perspectives and concerns, it remains to be seen how such data will be applied or used to justify permanent policies. It will also be important to continue to weigh these factors against general access to care issues so as to not inadvertently limit telehealth as a means of ensuring patients can receive necessary medical services. Additional information on the HHS-OIG study can be found by viewing the brief and complete report. < Previous News Next News >

Citing Medicaid misery, 25 governors push for PHE's end in April Molly Gamble December 21, 2022 In a letter sent to President Joe Biden this week, 25 governors ask for the end of the COVID-19 public health emergency in April. HHS last renewed the federal PHE in October for another increment of 90 days — until January 11 — with the pledge to provide states with 60 days' notice if it decided to terminate the declaration or allow it to expire. Since those 60 days came and went without notice, states are operating under the assumption the PHE will be renewed for another 90 days and expire in April, unless extended again. "We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration," the governors urged Mr. Biden in their Dec. 19 letter. The governors claim the PHE hurts states, largely through the Medicaid flexibilities costing states "hundreds of millions of dollars." Under the continuous coverage requirement of the Families First Coronavirus Response Act, state Medicaid agencies are barred from disenrolling people during the PHE — unless they request it — in exchange for an enhanced federal match. HHS estimates up to 15 million people will be disenrolled from Medicaid and the Children's Health Insurance Program when the PHE ends. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," the governors wrote to Mr. Biden. "Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share." The governors sent their letter a day before Congress released its omnibus spending bill, which contains working language for states to be able to start evaluating Medicaid enrollees' eligibility as of April 1 in a redetermination process that would take place over at least 12 months. The measure also calls for phasing down the enhanced federal Medicaid funding through December 31, 2023, though states would have to meet certain conditions during that period. The American Hospital Association advocated for the latest extension of the PHE in October, noting that the majority of the hospital members it polled said they still depend on the flexibilities provided by the PHE waivers to deliver care. The letter was initiated by Chris Sununu, governor of New Hampshire, and signed by the following: Kay Ivey, Alabama Mike Dunleavy, Alaska Asa Hutchinson, Arkansas Doug Ducey, Arizona Ron DeSantis, Florida Brian Kemp, Georgia Brad Little, Idaho Eric Holcomb, Indiana Kim Reynolds, Iowa Charlie Baker, Massachusetts Tate Reeves, Mississippi Mike Parson, Missouri Greg Gianforte, Montana Pete Ricketts, Nebraska Doug Burgum, North Dakota Mike DeWine, Ohio Kevin Stitt, Oklahoma Henry McMaster, South Carolina Kristi Noem, South Dakota Bill Lee, Tennessee Greg Abbott, Texas Spencer Cox, Utah Glenn Youngkin, Virginia Mark Gordon, Wyoming See original article: https://www.beckershospitalreview.com/finance/citing-medicaid-misery-25-governors-push-for-phes-end-in-april.html?utm_medium=email&utm_content=newsletter < Previous News Next News >

Celebrating 2021 National Rural Health Day Southwest Telehealth Resource Center Dec. 1, 2021 Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. This webinar streamed live to a national audience on November 15th and the recording and presentation slides are available at: https://telemedicine.arizona.edu/webinars/previous for on-demand playback. Each year the National Organization of State Offices of Rural Health selects a Community Star from each of the 50 states. The 2021 Community Star report, https://en.calameo.com/read/0045723395dc12ef8ac48, includes stories of how each Community Star is working to improve life in their rural community. Congratulations to all of the 2021 Community Stars! Matthew Probst, PA-C Chief Quality Officer and Medical Director El Centro Family Health Mathew Probst is the Chief Quality Officer and Medical Director for a Federally Qualified Health Center located Northeast of Albuquerque, New Mexico. Under his leadership, Mr. Probst was able to implement initiatives at the start of the pandemic which resulted in his county having one of the lowest fatality rates and one of the highest vaccination rates in the county. Read more about why Mr. Probst was featured in an award-winning documentary named The Providers: https://en.calameo.com/read/0045723395dc12ef8ac48 < Previous News Next News >