Telehealth and Maternal Mental Health Needs Two recent studies show telehealth can help new and expectant mothers. Psychology Today April 30, 2021 Telehealth measures decreased prenatal distress, pregnancy-related anxiety, and postpartum depression. Telemedicine has skyrocketed since the start of the pandemic. According to The New York Times, just short of May 2020, the Johns Hopkins neurology department was seeing 95 percent of patients virtually. The rise in telemedicine to address maternal mental health has also seen unprecedented growth during the pandemic. Meanwhile, Mental Health America states that the mental health needs of Americans have skyrocketed. Anxiety and depression screenings increased nearly four-fold in 2020, from nearly 2,000 screenings per day to roughly 8,000 per day. Women, and in particular pregnant women, are vulnerable to hormonal fluctuations that make them twice as likely to experience depression during their lifetime compared to men. Research in the past year and a half has shown that telehealth can be substantially as effective as in-person care. (Telehealth, more encompassing than telemedicine but inclusive of it, may include only educational components.) With respect to maternal mental health, there are two studies highlighted herein that demonstrate telehealth's promise when it comes to improving maternal mental health in terms of prenatal distress, pregnancy-related anxiety, and the postpartum period. Of note, one of the studies was conducted prior March 11, 2020, or the official start of the pandemic, which makes it non-COVID-19 related. Maternal mental health, or perinatal mental health, is defined by the Maternal Health Task Force as a woman’s mental health during pregnancy and in the postpartum period. The significance of this period is multifold. It includes increased risk of the following: preterm delivery, low birth weight, impaired postnatal infant growth, insecure infant-mother attachments, and suboptimal breastfeeding practices. The first study published in Midwifery in 2021 supports the use of tele-education in improving prenatal distress and pregnancy-related anxiety. Specifically, the Midwifery study showed that “tele-education offered to the pregnant women on pregnancy and birth planning during COVID-19 decreased their prenatal distress and anxiety levels.” What the pregnant women received were phone calls, text messages, and a digital education pdf file, all of which educated women on a variety of topics, including “general methods of protection from coronavirus, coronavirus prevention methods during pregnancy, coronavirus and delivery process, measures to be taken during the coronavirus pandemic and postpartum process, measures to be taken during the coronavirus pandemic and breastfeeding, and how to manage stress, anxiety, and depression in these processes.” The tele-education included a digital pdf file called the “Booklet for Pregnancy and Birth Planning Education during Coronavirus (COVID-19).” All the of the educational content was developed with suggestions from medical and public health experts. A major takeaway from the above Midwifery study is that tele-education is effective in reducing the fears pregnant women have about giving birth as well as about their babies’ health in the context of a pandemic; in summary, prenatal distress and pregnancy-related anxiety were significantly decreased (p-value <0.05). Significantly lower scores on pregnancy-related anxiety questionnaires developed by van den Bergh (1990) and revised by Huizink et al. (2016) demonstrated the effective role played by tele-education. The second study published in Midwifery in 2021 supports the use of telemedicine interventions in treating postpartum depression symptoms. While the study’s timeframe was not during COVID, the results are helpful in understanding the beneficial role telemedicine has played in the past couple of years. Previous research has shown it can be a challenge for postpartum women to seek care for the “baby blues” or depressive symptoms, either of which could be significant. This may be due to perceived stigma, time, financial constraints, transportation, or childcare concerns. In this study, the telemedicine modalities included: telephone support, mobile applications, social media, and websites. This meta-analysis reviewed at least seven randomized controlled trials that largely used cognitive behavioral therapy (CBT) or psychoeducation to help pregnant women participants. The second Midwifery study concluded that telemedicine interventions “significantly decreased postpartum depression symptoms” and “demonstrated feasibility and acceptability among mothers in the postnatal period.” A major takeaway from the second Midwifery study is that telemedicine appears to be “promising in preventing and improving postpartum depression.” Of note, the study looked at women without a history of mental health conditions. Meanwhile, Hanach et al. highlight the need for larger-scale, future research to figure out the structure, content, and type of providers recommended within future telemedicine interventions. In conclusion, the benefits of telehealth—especially during COVID-19—appear to help women in the prenatal and postpartum phases of pregnancy. While the research is still growing, and quite limited, such positive signs are helpful in understanding the role that technology can play in addressing maternal mental health needs. Future studies that reflect on the benefits of telehealth are vital and will be particularly useful in supporting new and expectant mothers, especially in times of adversity. Source: https://www.psychologytoday.com/ca/blog/healthy-mothers-healthy-families-and-healthier-world/202104/telehealth-and-maternal-mental < 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 >

2021 National Telemedicine Summit World Conference Forum, LLC Sept. 13, 2021 Key Strategies to Revolutionize & Transform Healthcare Delivery, Optimize Quality Patient Care & Outcomes, Increase Accessibility, Enhance Data Analytics, and Reduce Costs! September 13 – 14, 2021 • The Ritz-Carlton, South Beach • Miami, FL Today, telemedicine is one of the fastest growing sectors in healthcare. Specifically, COVID-19 has enhanced and accelerated the role that telemedicine plays within our healthcare system. It is reshaping the landscape of healthcare delivery in the United States, and is being recognized as the future of global healthcare. Telehealth addresses and achieves the basic tenants of Healthcare Reform: providing the population with access to improved and convenient, high quality patient centric care, enhancing outcomes, while reducing per capita expenditures. Today, more than 70 percent of hospitals throughout the United States are engaged in telehealth programs. Studies have shown that the benefits of telehealth include significantly improved outcomes, efficient care delivery as well as reduction in mortality rates, hospitalizations, length of stay, readmissions and healthcare costs. Telehealth has greatly enhanced access to quality care in rural areas and patient satisfaction has increased due to its convenience and patient centric approach. We have created an exciting, high level forum featuring knowledgeable leaders and executives from the nation's leading Hospitals and Health Systems who will share their perspectives, valuable insights and expertise on how to be best equipped for the rapidly evolving and exciting landscape of telehealth. This exclusive event targets senior level executives in order to maximize educational and networking opportunities. By attending the 2021 National Telemedicine Summit, you will learn what highly regarded Hospitals and Health Systems are doing to be prepared for the challenges that lie ahead in 2021 and beyond! We look forward to greeting you in Miami! Link: https://www.wcforum.com/conferences/telemedicine < Previous News Next News >

How Telemedicine Requirements and Policies Will Change Post-Pandemic Jordan Scott, HealthTech July 2021 The public health emergency led to a loosening of telemedicine requirements and an uptick in virtual care use, but are these changes here to stay? Telehealth was instrumental in providing care throughout the COVID-19 pandemic as people avoided in-person interactions. While many people are now comfortable returning to in-person appointments, Americans are more open to using telehealth services than they were prior to the pandemic, and telehealth use is expected to remain above pre-pandemic levels. Some telehealth restrictions were lifted at the beginning of the pandemic out of necessity, a major factor in the rapid expansion of virtual care services. However, many providers are wondering if those changes are here to stay or if a tightening of telemedicine requirements will lead to a “telehealth cliff.” The CARES Act: How the Pandemic Changed Telehealth Policy Former U.S. Secretary of Health and Human Services Alex Azar declared a public health emergency on Jan. 31, 2020, in response to growing concerns over the spread of COVID-19. And on March 13, 2020, by Proclamation 9994, President Donald Trump declared a national emergency. As a result of authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Centers for Medicare & Medicaid Services (CMS) provided flexibility for Medicare telehealth services. It did this by broadening the waiver authority under section 1135 of the Social Security Act. Before the declarations, providers were subject to CMS’ geographic and originating site requirements for telehealth reimbursement under Medicare. According to the requirements, the originating site is the patient’s location at the time telehealth services are received. Under Section 1834(m) of the Social Security Act, the originating site must be a physician’s office, skilled nursing facility or hospital. The patient must also be located within a Health Professional Shortage Area or in a county outside of any Metropolitan Statistical Area as defined by the U.S. Census Bureau. “That meant an extremely small proportion of Medicare reimbursement was going toward telehealth, well under 1 percent,” says Kyle Zebley, vice president of public policy for the American Telemedicine Association (ATA). Dr. Ezequiel Silva III, a radiologist with the South Texas Radiology Imaging Centers and a member of the American Medical Association’s Digital Medicine Payment Advisory Group, explains that the waivers also impacted licensure. Physicians enrolled in the Medicare program licensed in any state can provide telehealth services to people anywhere in the U.S. if the state allows it. Each state has its own telehealth policies. The waivers also allowed physicians to practice from home since many offices were closed at the beginning of the pandemic, says Silva. He adds that CMS’ Interim Final Rule expanded coverage of audio-only health services, which helped those without access to two-way audiovisual technology and those who weren’t comfortable using video telehealth. Telehealth policies were put into place in 1997. While there’s been incremental expansion, the regulations haven’t kept up with changes in technology and what’s now possible in virtual care, says Zebley, who adds that if the pandemic hadn’t happened, the pace of telehealth adoption would have remained slow. However, he explains that the Medicare waivers had an extraordinary impact and led to an uptick in telehealth utilization. “During the first quarter of 2020, the number of telehealth visits increased by 50 percent, compared with the same period in 2019, with a 154 percent increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019,” reads a CDC report released in October 2020. “Laws hadn’t kept up with the way providers wanted to deliver care, so it was a game-changing moment,” says Zebley. “Ninety percent of Medicare beneficiaries are satisfied with their care, and two-thirds are very satisfied.” HIPAA-Compliant Telehealth Requirements Likely to Return The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) enforces HIPAA requirements. It announced on March 17, 2020, that “OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” Telehealth creates a unique challenge for HIPAA because a physician is no longer interfacing with a patient behind a closed clinic door, says Silva. Instead, information is transferred digitally, which requires different security precautions. Silva explains that while security requirements were reduced, OCR loosely defined which communication technologies could be used for telehealth. It also encouraged healthcare organizations to notify patients of privacy risks. AMA found this guidance to be appropriate, says Silva. However, it’s likely that HIPAA requirements will be reinstated once the public health emergency ends. “The reinstatement of HIPAA requirements is inevitable, and healthcare organizations need to prepare accordingly. They need to have their regulatory and legal offices getting ready to follow the spirit and letter of the law,” says Zebley. “It’s very clear what HIPAA requires. If an organization is operating a telehealth platform or technology that’s not HIPAA compliant, I expect that it would need to be compliant perhaps in a few months’ time.” The ATA supports the reinstatement of HIPAA requirements because it’s important to protect patient data, explains Zebley. Will Telehealth Restrictions Return Post-Pandemic? The public health emergency and telehealth waivers are still in place, but if the declaration ends before Congress or CMS acts, healthcare providers could hit a “telehealth cliff.” “If that happens it’s going to be regressive,” says Zebley. “However, I’m extremely optimistic that Congress will act before the emergency ends.” The public health emergency has been renewed approximately every 90 days since it was first declared, with the most recent renewal on July 20, 2021, by U.S. Secretary of Health and Human Services Xavier Becerra. Silva says there’s been speculation that the public health emergency will last through the end of the calendar year. If it doesn’t, the previous Medicare telehealth requirements could go back into effect until CMS rule-making addresses the issue. CMS released its 2022 Medicare Physician Fee Schedule Proposed Rule on July 19, 2021, which would extend the waivers on some telehealth services, especially those that address mental health, through the end of 2023. Comments are due on Sept. 17, 2021 “As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of Dec. 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE,” reads the CMS fact sheet. The CONNECT for Health Act of 2021, introduced in the U.S. Senate on April 29, 2021, aims to expand the use of telehealth by removing geographic requirements for telehealth services and expanding originating sites permanently. It’s one of several bills that could address the long-term expansion of telemedicine. Organizations such as the ATA and AMA have been advocating for a permanent expansion of telehealth services on federal and state levels. AMA published a telehealth implementation playbook for those looking to implement telehealth. Silva says the healthcare industry needs to look at the data around patient experience and the value of telehealth to determine how to proceed with virtual care policy going forward. Zebley encourages those who are concerned about the possible loss of telehealth flexibility to reach out to their elected officials. Source: https://healthtechmagazine.net/article/2021/07/how-telemedicine-requirements-and-policies-will-change-post-pandemic-perfcon < Previous News Next News >

Consumer Survey Data Supports Use of Virtual Visits Center for Connected Health Policy July 2021 The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. The Deloitte Center for Technology, Media & Telecommunications released the second edition of their Connectivity and & Mobile Trends 2021 survey, which gathered information from consumers about their relevant experiences during the pandemic. Using an online methodology of over two thousand consumers surveyed in March 2021, the report looks broadly at how the pandemic has influenced innovation and the “digital home,” including the increase in virtual doctor visits and patient telehealth preferences. In regard to telehealth, they found that over half of Americans had a virtual visit, 80% of those patients were satisfied with their experiences, and 62% were likely to schedule future telehealth visits post-pandemic. Almost 30% of consumers reported assisting someone else in their household with a telehealth visit. The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. While 30% of consumers reported no challenges, others did report they found the lack of human connection challenging, as well as the inability to have their vitals collected which was indicated more frequently among older patients. The report also looked at individual use of “wearables” to advance health and wellness, presuming their ability to support health care providers will continue to grow along with telehealth – although the authors also stated both will likely require the evolution of the regulatory landscape. Interestingly enough, use of wearables was actually found to be mixed during the pandemic and 39% said cost is the primary reason they haven’t bought one. Also, of note for those that had used wearables was that 60% claimed not to be concerned about privacy of their wearable-generated data, which is often raised as one of the main regulatory concerns related to increased innovation in health care. To review additional details about the information gathered, please view the findings in their entirety - https://www2.deloitte.com/content/dam/insights/articles/6978_TMT-Connectivity-and-mobile-trends/DI_TMT-Connectivity-and-mobile-trends.pdf#page=8. < Previous News Next News >

Membership Benefits COMING SOON: NEW MEMBERSHIP BENEFITS Thank you for your interest in joining the New Mexico Telehealth Alliance. The newly formed Membership Co mmittee and the NMTHA Board of Directors are revising the Membership section of this website. If you have any questions please contact us HERE .

Policy & Legislation New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. New Mexico Legislation Federal Resources NEW MEXICO LEGISLATION Telehealth NMSA § 13-7-14 "Healthcare Purchasing Act" NMSA § 59A-22-49.3 "Health Insurance Contracts " NMSA § 59A-23-7.12 "Group and Blanket Health Insurance Contracts " NMSA § 59A-46-50.3 "Health Maintenance Organizations " NMSA § 59A-47-45.3 "Nonprofit Healthcare Plans " (see also S.B.354 (2019) "Coverage for Telemedicine Services" ) Broadband NMSA § 63-9J-1 thru 63-9J-4 "The Broadband Access and Expansion Act" ( see also S.B.93 (2021) "Broadband Access and Expansion Act" ) New Mexico Federal FEDERAL RESOURCES Center for Connected Health Policy (CCHP) Find up-to-date information for Medicare, Medicaid, Federal Employee Plans, and more... CCHP, a nonprofit, nonpartisan organization, has been the federally designated National Telehealth Policy Resource Center since 2012. CCHP provides technical assistance to twelve regional Telehealth Resource Centers (TRCs), state and federal policy makers, national organizations, health systems, providers, and the public. CCHP - Federa l CCHP - New Mexico

AHA Statement Stresses Importance of Telehealth in CVD Care Yael L. Maxwell November 16, 2022 With ongoing challenges related to reimbursement, access, and acceptance, the writing committee offers potential solutions. Stressing the importance of telehealth in cardiovascular care, especially given its increased prevalence during the COVID-19 pandemic, a new scientific statement from the American Heart Association (AHA) outlines the current barriers to this type of care and offers some strategies for continued access. As in-person visits were shut down in the spring of 2020, many clinicians and patients turned to telehealth, with subsequent studies and surveys showing related gains in heart failure and nonemergent cardiovascular care. Other research showed that patients who were more likely to use telehealth tended to be younger and privately insured, have more comorbidities, and be from underrepresented racial/ethnic groups. As the pandemic has waned, however, reimbursement for telephone and video visits has been a larger concern. Earlier this month, the US Centers for Medicare & Medicaid Services (CMS) released its 2023 Physician Fee Schedule, which includes continued coverage for telehealth, but only for 5 months following the end of the public health emergency, which some say is not long enough for clinicians to make long-term plans and invest in necessary infrastructure. “This paper in a way summarizes the importance of telehealth and the benefits of telehealth in patient care,” writing committee chair Edwin A. Takahashi, MD (Mayo Clinic, Rochester, MN), told TCTMD. “Payment parity is so important in sustaining telehealth. So I hope that CMS and insurance companies will see the importance highlighted in this paper and reconsider their reimbursement plans with it.” What Is Telehealth? The statement, published online this week in Circulation, begins by defining the concept of telehealth, breaking it down into clinician-to-patient visits and clinician-to-clinician consults. The former includes real-time virtual visits, either video or audio, as well as digital communication, called eVisits, initiated by either the physician or patient. The latter includes both real-time virtual consults, which may also include the patient, as well as digital exchange of low-complexity medical information between clinicians, called eConsults, or second opinions on more-complex concerns. A final hybrid category includes remote monitoring for patients and predictive analysis for clinicians—both machine initiated. Takahashi and colleagues point out some commonly used telehealth tools for cardiovascular home monitoring, including machines for monitoring risk factors like blood pressure, weight, smoking, and diet; medication tracking apps and smart pillboxes for managing medication adherence; and tools like home EGC, pulse oximeter, and pulmonary artery pressure monitoring devices. While there are an undefined number of ways in which telehealth can be useful within cardiovascular care, Takahashi said it’s most effective in tracking disease progression for heart failure and CAD, improving stroke outcomes by decreasing time to diagnosis, and monitoring PAD progression, as well as preventing ulcers and tracking patients postoperatively. The paper outlines advances in telestroke, teleradiology, and telehealth in PAD management. Challenges and Potential Solutions Many challenges remain in order for telehealth to flourish in a nonpandemic era. In his experience, Takahashi said, the biggest barrier to using telehealth relates to “having patients accept it as a replacement for inpatient visits.” But overall, challenges like infrastructure—including broadband internet and hardware for patients—to complete telehealth visits as well as reimbursement stand in the way of telehealth use more generally, he said. “In order for people to adopt and use telehealth, people need to be able to bill for using it. Otherwise, it just is not sustainable.” The statement also stresses the importance that clinician attitude, biases, and acceptance play in the success of telehealth. Difficult to use technological platforms hindered by HIPAA-compliant encryption can also make it more difficult for clinicians to access telehealth appointments. Beyond increases in reimbursement for telehealth, the authors propose a few strategies for continued success. They advocate for government programs to improve broadband internet access across the country, more research to elucidate the specific benefits telehealth can have across the spectrum of cardiovascular disease care, and increased standardization for methods in assessing telehealth quality. “The COVID-19 pandemic improved the telehealth infrastructure through necessity but also uncovered systemic weakness, limitations, and inequities,” they conclude. “Further research into barriers for telehealth implementation and equitable execution are important to ensure the delivery of high-quality care for patients.” Yael L. Maxwell by Yael L. Maxwell Editor, Fellows Forum Yael L. Maxwell is Senior Medical Journalist for TCTMD and Section Editor of TCTMD's Fellows Forum. She served as the inaugural… Read Full Bio See original article: https://www.tctmd.com/news/aha-statement-stresses-importance-telehealth-cvd-care < Previous News Next News >

New SAMHSA Telehealth Guide: Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders Center for Connected Health Policy June 2021 Telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth The Substance Abuse and Mental Health Services Administration (SAMHSA) and its National Mental Health and Substance Use Policy Laboratory recently released a new evidence-based resource guide titled, Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders, to support implementation of telehealth across diverse mental health and substance use disorder treatment settings. The guide examines the current telehealth landscape, including evidence on effectiveness and examples of programs that have integrated telehealth modalities (live-video, telephone, and web-based applications) for the treatment of serious mental illness (SMI) and substance use disorders (SUDs). Also included is guidance and resources for evaluating and implementing best practices which are presented across a continuum of services, such as screening and assessment, treatment, medication management, care management, recovery support, and crisis services. The report speaks to how telehealth is known to improve access to care during emergencies and in rural and underserved areas, but stresses that implementation should be expanded outside of such situations and integrated into an organization’s standard practices to improve provider and patient communication, satisfaction, timeliness and continuity of care. The authors highlight how this is increasingly important when it comes to mental health issues, which impact millions of Americans that often face unique treatment gaps and barriers. Ultimately, it is suggested that with the right resources and upfront work, the evidence shows telehealth has the capability to address these barriers, improve health outcomes and care coordination, decrease costs and reduce health disparities. Notable findings related to telehealth use and mental health include: *Telehealth use doubled from 14% to 28% between 2016 and 2019 *Telehealth visits for mental health increased 556% between March 11 and April 22, 2020 *SUD treatment via telehealth increased from 13.5% to 17.4% between 2016 and 2019 *Telehealth use increased 425% for mental health appointments among rural Medicare beneficiaries between 2010 and 2017 The guide presents specific strategies to increase patient access and comfort using telehealth, such as providing devices to those that need them and offering trial sessions to address any technological challenges. It is also suggested that providers first screen patients for their willingness and readiness to receive care via telehealth, as it may not be appropriate for some patients. Additionally, telephone should be encouraged when it reduces prior structural and institutional barriers that have made contacting underserved communities difficult. The guide also offers strategies to increase provider comfort using telehealth, such as: *trainings and designating certain staff to support and evaluate its use *how to create a similar environment to that of an in-person visit for patients *addressing organizational infrastructure issues Understanding and knowledge of relevant and ever-evolving regulatory and reimbursement policies is included as an important consideration as well, to which the authors offer a variety of tracking resources, including the policy finder tool on CCHP’s new website. Regardless of where state and federal telehealth policies land, the guide includes a number of telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth. Additional resources can be accessed on the SAMHSA website. For more information read the full SAMHSA resource guide- https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-06-02-001.pdf < Previous News Next News >

Telemedicine Holds Potential to Help Climate Change Center for Connected Health Policy May 4, 2021 MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. The recent article highlights that the United States healthcare industry is a big contributor to carbon emissions, and although telemedicine doesn’t solve the problem, its increased use does lead the industry in the right direction. This has been proven in two research studies conducted on this very subject. The first study, published in the journal, PLoS One explores the carbon footprint of telemedicine and found that replacing in-person visits with telemedicine resulted in 40-70 times decrease in carbon emissions. They note in their conclusion that for telemedicine to make a significant difference, a paradigm shift is necessary where telemedicine is regarded as an ordinary part of health care rather than exclusively for those who lack access due to geography. The second study, conducted by the University of California Davis Health System, examined travel-related and environmental savings as a result of use of telemedicine appointments for outpatient specialty consultations at the university. They found that telemedicine consultations resulted in significant savings of total emissions and that their telemedicine program had a positive impact on environmental pollutants. CCHP also previously published a catalogue of environmental impacts studies, which included several international studies looking at this same issue and coming to the same conclusion regarding telemedicine’s positive impact on carbon emissions in the healthcare sector. As telehealth has become more widespread due to the COVID-19 public health emergency its not hard to imagine that telehealth will cement its place as a mainstream tool in healthcare as the authors in the PLoS study suggest. However, policy barriers have historically interrupted the growth of telehealth, and it is yet to be seen whether the end of COVID-19 will bring telehealth’s progress to a halt. In a study published in the journal Nature Climate Change, researchers found that as a whole, the temporary reduction in daily global CO2 emissions during COVID-19 saw a decrease by as much as -26% on average, but note that the impact of 2020 annual emissions depends on government actions and economic incentives post-pandemic, which will shape the path forward for decades. It will be important as entities such as the Centers for Medicare and Medicaid Services (CMS), the congressional budget office, state governments and others conduct their analyses on cost estimates for telehealth that they factor in savings to travel costs incurred through the use of telehealth and the implications for the environment. To learn more, see the full mobihealth news article featuring this important issue. Mobile Health News: https://www.mobihealthnews.com/news/telemedicine-came-rescue-during-covid-19-could-it-help-climate-change-too < Previous News Next News >

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

States Expand Medicaid Reimbursement of School-Based Telehealth Services Center for Connected Health Policy June 2021 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. The National Academy for State Health Policy released a report last month on how states are increasing Medicaid coverage of school-based telehealth during COVID-19, as well as assessing which services can be effectively delivered via telehealth and how to best support equitable access to services via telehealth for students. The authors found that 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. As far as services, the brief showed that most states cover audiology and speech-language therapy via telehealth, although behavioral health services had the greatest expansion and providing telemental health they found to be a recognized best practice. Half of all states cover individualized education program (IEP) plan services or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as well. The report also suggests that moving forward states should explore federal funding opportunities to expand technology and broadband access for students facing disparities in access to care. < Previous News Next News >

HHS to maintain COVID-19 public health emergency past January Jakob Emerson November 11, 2022 The U.S. will extend the COVID-19 public health emergency past January 11, 2023, CNBC reported Nov. 11. A 12th extension of the PHE since the first in January 2020 is also likely because of a lack of public statement from HHS warning about a termination. The agency last renewed the PHE Oct. 13 for an additional 90 days to Jan. 11, 2023 — it also told states it would provide a notice 60 days before if it did decide to end it, or Nov. 11. The PHE allows the country to continue operating under pandemic-era policies, which led to a complete overhaul of telehealth and who can use it, fast-tracked approvals of COVID-19 vaccines and treatments, and preserved healthcare coverage for millions of Medicaid beneficiaries nationwide. Eleven states also still have coinciding public health emergency orders in place. As of now, Medicare telehealth flexibilities will end 151 days after the PHE expires. In July, the House passed The Advancing Telehealth Beyond COVID-19 Act, but the legislation must still be approved by the Senate for Medicare patients to continue using telehealth through 2024. "It's not that we necessarily want to continue the PHE for a long period of time," Nancy Foster, AHA's vice president of quality and patient safety, told Becker's in October. "What has not yet happened is fully thinking through how to unwind some of the [telehealth] flexibilities we currently have, and how to perhaps make permanent some of the others." In addition, the end of the PHE will trigger a Medicaid redetermination process that will cause a major disenrollment of beneficiaries. Over the course of about a year, HHS estimates up to 15 million people could lose health coverage. Payers are prepping for the redetermination period, as they expect to lose Medicaid members and hope to switch some to ACA coverage. With the Inflation Reduction Act's extension of ACA premium tax credits through the end of 2025, the nation's largest insurers have all recently announced plans to majorly expand exchange offerings in 2023, including UnitedHealthcare, Elevance, Aetna, Cigna and Centene. The extension of the federal emergency past January may have been unexpected for insurers, as UnitedHealth Group executives told investors Oct. 14 they thought the PHE would end in January. "Our tailwinds will be weighed against one known headwind, and that is the membership attrition and related impacts on our Medicaid business as eligibility redeterminations are conducted over the course of the next year," Elevance Health's CFO John Gallina told investors Oct. 19. The extension also comes amid uncertainty around public health as winter looms. New Omicron strains — dubbed "escape variants" for their immune evasiveness — have become the dominant strains in the U.S., accounting for 40 percent of all cases in the week ending Nov. 12. Daily cases in the country are expected to grow 39 percent from Nov. 3-17. Hospital admissions trends are expected to remain stable or be more uncertain, with 1,300 to 7,300 new admissions likely reported on Nov. 25, according to the CDC. As of Nov. 4, the nation's seven-day average of new hospital admissions was 3,273. See original article: https://www.beckerspayer.com/policy-updates/hhs-to-extend-covid-19-public-health-emergency-through-april.html < Previous News Next News >

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 >

Studies Show How Telehealth Can Increase Equitable Access to Care Center for Connected Health Policy May 24, 2022 Focus on the relationship between telehealth and disparities in access to care continues to result in new research examining pandemic era data and the use of telehealth among disadvantaged populations. While policymakers and studies often try to put findings into two groups, whether telehealth increases or decreases inequities, recent research shows that the study framework used and considerations made may impact outcomes more so than telehealth itself. For instance, this month a new study published in Health Affairs found that as a result of emergency federal telemedicine coverage expansions access increased for all Medicare populations, including those in the most disadvantaged areas. The study was framed to examine the impact of expanded telehealth coverage policies on different populations, rather than looking at access generally where inequities have unfortunately always existed. Comparing pre-COVID temporary waiver data with post-waiver implementation data, the authors discovered that the highest odds of utilization were among those in disadvantaged and metropolitan areas. As reported in a Managed Healthcare Executive article on the study, the Johns Hopkins researchers concluded that the results suggest that increased Medicare telemedicine coverage policies improve access to underserved populations without worsening disparities. An additional study just published in Telemedicine Journal and e-Health and covered in a healthleaders article showed that a virtual care program at Penn Medicine is reducing barriers to access specifically for Black patients and eliminating historic disparities. The authors looked at approximately one million appointments per year in both 2019 and 2020 for Philadelphia area patients and found that Black patients used telehealth more than non-Black patients and that appointment completion gaps between Black and non-Black patients closed. Also recently released, the National Committee for Quality Assurance (NCQA) produced a white paper titled The Future of Telehealth Roundtable: The Potential Impact of Emerging Technologies on Health Equity, which focuses on how to ensure telehealth increases equitable access to care. Following up on its previous pandemic telehealth work, in late 2021 NCQA pulled together a multidisciplinary panel of equity and technology experts for a discussion on equitable access and virtual health care delivery. Reviewing hypothetical case studies and responding to various questions, participants highlighted potential challenges and identified three primary ways to ensure equitable access in telehealth delivery: Tailoring Telehealth Use and Access to Individual Preferences and Needs Addressing Regulatory, Policy and Infrastructure Barriers to Fair Telehealth Access Leveraging Telehealth and Digital Technologies to Promote Equitable Care Delivery The white paper suggests the need to prioritize language and cultural humility, address digital literacy, and optimize telehealth for people with disabilities. In addition, in terms of barriers, the authors stress the need to address broadband infrastructure and licensure limitations, while also updating laws and regulations that restrict telehealth use, including payment policies. Another Health Affairs article published this month, Policy Considerations to Ensure Telemedicine Equity, also looked at various factors that must be taken into account to allow telehealth to increase equitable access to care. The author clarifies that equity is a matter beyond telehealth and is related to patient-level barriers that include family, community, and general health care delivery level factors, such as issues related to the digital divide. In addition, the article cautions against policies focusing on increased utilization concerns, stating that increased use may mean that patients are finally attaining the care they need, in addition to the fact that increased access may reduce overall health care costs. Therefore, policies seeking to reduce reimbursement or limit audio-only modalities to address utilization and cost concerns may instead primarily reduce clinicians’ willingness to offer telehealth and modalities that mitigate access barriers for historically excluded groups. The article also highlights how varying payer policies, such as those that allow reimbursement for telehealth visits with new patients versus those that do not, creates inequities, and that differing medical licensing and/or prescribing regulations by state can create inequitable access issues on top of differing coverage policies. These policy considerations are key to ensuring telemedicine mitigates inequities rather than exacerbates them. While the pandemic generally has highlighted and exacerbated existing inequities, it has also provided the information necessary to show telehealth’s ability to address disparities and increase equitable access to care. It is important that policymakers take such findings and opportunities from studies on telehealth equity into account when looking to potentially make pandemic policies permanent in order to properly preserve telehealth’s positive impacts. It is also important that the framework used in the study be placed in context to help explain why some research speaks to telehealth disparities, or health care disparities, versus how telehealth is decreasing health care disparities. As shown in the aforementioned studies and articles, the difference in framing showcases that telehealth in and of itself does not create or exacerbate disparities, rather it is a tool that can be utilized to decrease disparities in access to care. The tool has to be allowed to be effective, however, and that is where the role of public policy comes in. Policies must support broadband and telehealth infrastructure and promote the use of technology to deliver care equal to the delivery of in-person care. For instance, Medicaid policies that limit when telehealth can be used and/or certain allowable modalities can create inequities in comparison to more expansive commercial policies that guarantee better telehealth access to non-Medicaid patients. Therefore, policymakers must recognize that regulatory restrictions around telehealth cannot prevent already existing general access disparities, rather it is often the regulatory restrictions around telehealth that lead to exacerbating disparities. It becomes vital that research be put into context so that subsequent policies are implemented that allow telehealth to reach its full potential to reduce disparities. For full article: https://mailchi.mp/cchpca/the-latest-telehealth-research-studies-show-how-telehealth-can-increase-equitable-access-to-care < Previous News Next News >

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Memorial Hermann to provide school-based pediatric telehealth Naomi Diaz October 18, 2022 Houston-based Children's Memorial Hermann has partnered with telehealth company Hazel Health to provide outpatient pediatric care to K-12 students in Houston. Under the partnership, schools that have agreements with Hazel will be able to offer their students access to health services via virtual telehealth sessions, according to an Oct. 17 press release. Children's Memorial Hermann pediatricians or specialists will connect with the students through the program for follow-up or long-term care management. The aim of the partnership is to increase access to pediatric care in schools across 12 counties in southeast Texas. See original article: https://www.beckershospitalreview.com/telehealth/memorial-hermann-to-provide-school-based-pediatric-telehealth.html < Previous News Next News >

Apply Now: $250 M in Telehealth Grants National Council for Behavioral Health April 30, 2021 Telehealth Grants - Apply Now Yesterday, the Federal Communications Commission (FCC) opened its second phase of the COVID-19 Telehealth Program with an additional $250 million available to eligible providers, including community mental health and substance use organizations. Organizations are strongly encouraged to apply for the grants that may be used to fund technology and equipment to bolster service delivery via telehealth. The application will close at 12:00pm ET on May 6, 2021. Read more and reach out here with any specific questions on the application process. COVID-19 Telehealth Program Application Resources: https://www.usac.org/about/covid-19-telehealth-program/covid-19-telehealth-program-application-resources/?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjbshy_rZnI19Utm_szbXLRtL_Em1obbBZMPGjL8UcKptxsAQkufy8_qpLAJ8F7YLbidFX_B4uUKtfjz1Xqfb00kuVsv-2qjkBEx3 COVID-19 Telehealth Program (Invoices & Reimbursements): https://www.fcc.gov/covid-19-telehealth-program-invoices-reimbursements?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjeRoIRGRmJOwVOAO8DxtchsnKpit1UbNY_hCbZZVDnK6jxX-VTendryRdaw0BeLxWnFcR90xotZs6ikzMrcjjvHZgcWX3tpv1reh Questions: Round2TelehealthApplicationSupport@usac.org < Previous News Next News >

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

Athena Health Telehealth Adoption Report Center for Connected Health Policy May 2021 How providers are taking advantage of virtual care and their perceived benefits Athena Health began conducting research in 2020 on de-identified data from across their healthcare network (which spans the nation) to understand how providers are feeling about the increased adoption of telehealth. With the onset of COVID-19, the use of telehealth has skyrocketed, and beyond understanding the increased utilization numbers, it’s also important to understand provider adoption rates, their attitudes toward telehealth, which specialties and what services telehealth is being used in the most. An interactive infographic tool on their website can be utilized to identify the amount of care across their system that has gone virtual by specialty (primary care, mental health, cardiology, pediatrics, OB/GYN or all specialties). Users can also view by specialty how providers are taking advantage of virtual care and their perceived benefits (for example, virtual appointments are more convenient), and the reasons why providers are turning to telehealth to keep their practices running. For a complete breakdown of their findings, visit Athena Health’s interactive webpage: https://www.athenahealth.com/knowledge-hub/clinical-trends/the-athenahealth-telehealth-insights-dashboard. < Previous News Next News >