Alliance for Connected Care: Alliance Applauds Inclusion of Major Telehealth Provisions in FY2023 Omnibus Appropriations Bill (12/19) – On December 20, 2022, House and Senate Appropriators released the text of the FY2023 Omnibus Appropriations bill, which includes $1.7 trillion in appropriations for fiscal year 2023 and several key health care extenders and new authorizations.
"The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans. The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both." - Alliance quoted in Health Leaders
The Alliance for Connected was pleased to see the inclusion of several critical telehealth provisions included in this package:
Advancing Telehealth Beyond COVID-19 –This section provides a two-year extension of the following Medicare telehealth flexibilities through December 31, 2024:
Extension of Safe Harbor for Absence of a Deductible for Telehealth– This section provides a two-year extension of the flexibility allowing employers/plans to provide coverage for telehealth services pre-deductible for individuals with a high-deductible health plan coupled with a health savings account (HDHP-HSA) through December 31, 2024. For more information, see the Alliance’s advocacy in this space.
Decentralized clinical studies – No later than one year after enactment, the Secretary shall issue or revise draft guidance that includes recommendations to clarify and advance the use of decentralized clinical studies to support the development of drugs and devices, including recommendations for how to advance the use of flexible and novel clinical trial designs and to help improve trial participant engagement, recruitment, enrollment, and retention of a meaningfully diverse clinical population, including with respect to race, ethnicity, age, sex, and geographic location, when appropriate. The guidance shall be finalized no later than one year after closing the comment period on such draft guidance. This guidance will include considerations to advance the usage of telehealth to ensure the clinical study has a meaningful clinical population.
Modernizing clinical trials – To clarify the use of digital health technologies in clinical trials, the Secretary shall issue or revise draft guidance regarding the appropriate use of digital health technologies in clinical trials to help improve recruitment for, retention in, participation in, and data collection during, clinical trials, and provide for novel clinical trial designs utilizing such technology for purposes of supporting the development of, and review of applications for, drugs and devices.
Extending Acute Hospital Care At Home Waivers and Flexibilities – This section extends the Acute Hospital Care at Home initiative, as currently authorized under CMS waivers and flexibilities, through December 31, 2024. This includes the waiver of telehealth requirements under the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, Strengthening Public Health Act of 2022, such that an originating site shall include the home or temporary residence of the individual.
Special Registration for Telemedicine – The Committee supports efforts by the Drug Enforcement Agency (DEA) to enable health care providers to safely prescribe controlled substances remotely and to provide mechanisms that can be used to prevent illegal online drug sales and drug diversion. The Committee directs the DEA to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued and the procedure for obtaining the registration. For more background, see the Alliance’s advocacy
in this space.
Reports– To fully understand the impact of telehealth, the Committee requests reports from various Departments:
For a full list of telehealth provisions, see our more detailed summary here.
AHRQ: Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication (12/26) - Telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents.
CMS: Medicare Telehealth Trends Report (12/22) – According to a new data analysis from CMS, in the second quarter (Q2) of 2022, about 15 percent of Medicare beneficiaries used telehealth, down from 48 percent in Q2 of 2020. CMS looked at Medicare Fee-for-Service (FFS) Part B claims and Medicare enrollment data from January 1, 2020, to June 30, 2022. Like in Q2 of 2020, women used telehealth more than men in Q2 of 2022. In the latter period, 14 percent of female Medicare beneficiaries used telehealth versus 12 percent of male beneficiaries. Similarly, in Q2 of 2020, 46 percent of female patients, compared with 43 percent of male patients, participated in a telehealth visit. For additional coverage, see mHealth Intelligence.
Health Resources & Services Administration (HRSA): Telehealth for HIV Care (12/21) – HRSA’s Office for the Advancement of Telehealth released a best practice guide for HIV care via telehealth. The Telehealth for HIV Care Best Practice Guide includes information and tools to help providers effectively implement telehealth programs. This guide shares how to use telehealth to prevent, screen for and treat HIV.
Government Accountability Office (GAO): Federal Actions and Selected Non-Federal Practices to Facilitate Diversity of Patients (12/19) – The GAO released a report describing actions taken by federal agencies and non-federal cancer centers to facilitate enrollment of patients from diverse backgrounds in cancer clinical trials. The report found that the Departments of Health and Human Services (HHS), Defense (DOD), and Veterans Affairs (VA) took actions that have the goal of increasing the proportion of patients from diverse backgrounds enrolled in federally funded cancer clinical trials. These efforts are focused on developing research collaborations, modifying research practices, reducing barriers to patient participation, and collecting and sharing data. VA expanded telehealth into clinical trials as a way to enable continued patients’ participation during the COVID-19 pandemic.
(In addition to passage of above law)
Sen. Rosen (D-NV): Data Mapping to Save Moms' Lives Act (S. 198) Signed into Law (12/20) – On December 20, the Data Mapping to Save Moms' Lives Act (S. 198) was signed into law by the President. The bill will require the Federal Communications Commission (FCC) to incorporate data on maternal health outcomes into its broadband health maps. The legislation would require the FCC to identify areas where high rates of poor maternal health outcomes overlap with lack of access to broadband services in order to pinpoint where telehealth services can be most effective.
Telehealth Research, Reports and Surveys
Health Affairs: The Health Plan Environment in California Contributed to Differential Use of Telehealth During the COVID-19 Pandemic (12/23) – Differential patient and provider access to technology and resources has raised concerns that existing health disparities may be extenuated by shifts to virtual care. This study examines the California Public Employees’ Retirement System, to examine potential disparities in the use of telehealth. Researchers found that lower-income, non-White, and non-English-speaking people were more likely to use telehealth. These differences were driven by enrollment in a clinically and financially integrated care delivery system, Kaiser Permanente. The study suggests that access to integrated care may be more important to the adoption of health technology than patient-level differences.
Community Mental Health Journal: Federally Qualified Health Centers Use of Telehealth to Deliver Integrated Behavioral Health Care During COVID-19 (12/22) – Federally qualified health centers (FQHCs) transitioned to deliver care via telehealth during the COVID-19 pandemic. This study reviewed how FQHCs adopted integrated behavioral health (IBH) using telehealth. Nine interviews with FQHC administrators resulted in the four themes: telehealth was essential; core components of IBH were impacted; payment parity and reimbursement were a concern; and telehealth addressed workforce issues. Findings confirm the necessity of telehealth for FQHCs during COVID-19, with additional support.
Kaiser Family Foundation: Access and Coverage for Mental Health Care: Findings from the 2022 KFF Women’s Health Survey (12/20) – A Kaiser Family Foundation brief found that women were more likely than men to report needing mental health services in the past two years, but 40 percent did not seek treatment and 10 percent were unable to get help despite trying. Sixty percent of women had a telemedicine/telehealth visit in the past two years. Mental health care was the third most common reason women cited for accessing telehealth/telemedicine services, with 17 percent saying it was the primary purpose of their most recent telemedicine visit. The majority report that the quality of their telehealth visit was the same as an in-person visit. For additional coverage, see Axios.
The Commonwealth Fund: State Telemedicine Coverage Requirements Continue to Evolve (12/20) – As telemedicine coverage requirements evolve, some states have begun to require coverage of audio-only telephone visits, exempt behavioral health care from limits on telephone visits, and protect patients’ access to their providers. This report from the Commonwealth Fund details state legislation enacted since March 2021, finding that many states have taken more nuanced routes with regard to telehealth regulations, likely influenced by their early pandemic experiences. The report also details the positive impact telehealth has had on access to behavioral health services, as 40 percent of behavioral health visits during the pandemic occurred through telehealth. For additional coverage, see mHealth Intelligence.
Telehealth News and Market Developments
Modern Healthcare: What’s Next for Health Care Policy? (12/19) – As the new year approaches, health care leaders face many challenges including rising costs, persistent labor shortages and changing consumer expectations. There are policies on federal and local levels that could be enacted or amended to ease some of these concerns. In this conversation, Dr. Robert Bessler, founder and CEO of Sound Physicians and Robert Garrett, CEO of Hackensack Meridian Health, discuss policies, including around telehealth, that could improve health outcomes for patients and will move the needle on health equity and value-based care.
State Telehealth Activity
Attorney General of New Jersey: AG Platkin Announces Additional Police Departments Joining ARRIVE Together Mental Health Crisis Response Initiative (12/21) – New Jersey Attorney General Matthew J. Platkin announced an expansion of the ARRIVE Together mental health crisis response initiative to additional municipalities in Cumberland and Union Counties, as well as the initiation of an innovative new version of the program in Atlantic County. In Atlantic City, the pilot will use telehealth tools to aid law enforcement officers in better responding to mental health-related calls for service. Officers will be equipped with electronic tablets that can be used by individuals in distress to obtain real-time virtual telehealth services from mental health professionals at AtlantiCare Regional Medical Center.
American Medical Association: Many State Medical Boards Looking to Update Telemedicine Policy (12/19) – This blog outlines the recent Federation of State Medical Boards (FSMB) policy that facilitates continuity of care via telehealth for patients who are temporarily in a different state. The policy includes recommendations from an AMA Council on Medical Service report that was presented at the 2021 AMA Annual Meeting. While some temporary telemedicine regulations enacted during the pandemic are starting to expire, 21 states have permanent rules governing telemedicine use.
KeyC News Now: Minnesota Launches New COVID-19 Telehealth Treatment Pilot Program (12/19) – The State of Minnesota launched a new telehealth test-to-treat program. The program aims to ensure Minnesotans who have tested positive for COVID-19 have easy access to clinician care and therapeutic treatments that reduce their risk of serious illness or hospitalization. Through the Cue Health app, Minnesotans can have a virtual consultation with a licensed clinician who will evaluate them to determine if therapeutic treatment is a good option. All services, including the consultation, medication and delivery, will come at no cost to the Minnesotans who use this service. This pilot program is available to all Minnesota residents.