June 26, 2023

Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on virtual care. 

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Alliance News

Senate / House of Representatives: Introduction of the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4189/S. 2016) (6/15) - U.S. Senators Brian Schatz (D-Hawai‘i), Roger Wicker (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), Mark Warner (D-Va.) and Cindy Hyde-Smith (R-Miss.) led a bipartisan group of 60 senators in reintroducing the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act.  in the House, Reps. Thompson (D-CA), Matsui (D-CA), Schweikert (R-AZ), and Johnson (R-OH) introduced the legislation, which would expand access to telehealth services. 

The CONNECT for Health Act was first drafted and introduced in 2016 with the support of the Alliance for Connected Care. Since 2016, several provisions of the bill have been enacted into law or adopted by the Centers for Medicare & Medicaid Services (CMS).

Specifically, the legislation would:

• Permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites;
• Permanently allow health centers and rural health clinics to provide telehealth services;
• Allow more eligible health care professionals to utilize telehealth services;
• Remove unnecessary in-person visit requirement for telemental health services;
• Allow for the waiver of telehealth restrictions during public health emergencies; and
• Require more published data to learn more about how telehealth is being used, impacts of quality of care, and how it can be improved to support patients and health care providers.

For additional coverage, see Health Leaders, and Healthcare Dive. The Alliance for Connected Care endorsed the bill. 

Congress

House Energy & Commerce Committee: Health Subcommittee Legislative Hearing: “Responding to America's Overdose Crisis: An Examination of Legislation to Build Upon the SUPPORT Act” (6/21) - On June 21, the House Energy and Commerce Committee Health Subcommittee held a legislative hearing. Several members of Congress requested the Drug Enforcement Administration (DEA) to commit to addressing telemedicine prescribing for controlled substances. DEA Deputy Assistant Administrator, Matthew Strait committed to meeting the November deadline. In his opening remarks, he noted DEA worked with the Department of Health and Human Services (HHS) for a way forward that will give Americans access to needed medications through telemedicine, with appropriate safeguards in place.

Medicare Payment Advisory Commission (MedPAC): June 2023 Report to the Congress: Medicare and the Health Care Delivery System (6/15) - MedPAC released its June 2023 report to Congress, which includes 10 chapters, including the mandated report to Congress on telehealth in Medicare. As mandated by the Consolidated Appropriations Act, 2022, the Commission presents data on the use of telehealth services during the public health emergency and an analysis of the relationship between expanded telehealth coverage and quality, access, and costs.

Key takeaways:

• MedPAC recommends that CMS should resume paying the lower, facility rate for telehealth services as soon as practicable after the PHE.
• MedPAC supports paying FQHCs and RHCs for telehealth services after the PHE at rates that are comparable with PFS rates for telehealth services.
• In 2020 and 2021, E&M services accounted for almost all (98 percent) of PFS telehealth spending. Mental, behavioral, and neurodevelopmental disorders accounted for the highest share of spending for telehealth in 2021 (34.4 percent), which was a higher share than in 2020 (25.4 percent).
• Telehealth visits generally took less time than in-person visits, but the claims data found that the times were about the same for in-person and telehealth visits in 2021. MedPAC notes that “If the time clinicians spend with patients is typically shorter during telehealth services than in-person visits, a smaller share of telehealth visits should be coded at higher levels (more time spent) than in-person visits.”
• Greater telehealth use was associated with little change in measured quality, slightly improved access to care for some beneficiaries, and slightly increased costs to the Medicare program.
• MedPAC recommends to Congress to continue monitoring the impact of telehealth to inform any permanent policy.

For additional coverage, see Healthcare Dive, Politico Pro, Medical Economics, and mHealth Intelligence. 

Administration

Veterans' Affairs: My HealtheVet and Telehealth Reach Veterans Where They Are (6/18) - Central Alabama staff improve Veteran access to mental health care by using telehealth. Video telehealth appointments are also important in supporting Veterans’ mental health. Through My HealtheVet, Veterans can review and manage their VA appointments, refill their VA prescriptions, exchange secure messages with their VA providers and more. Many of the Veterans prefer video visits over in-person appointments. For some, clinic visits are a barrier to care. Many of them put off making appointments or skip them entirely because of travel burdens and environmental stressors or PTSD triggers. And without consistent care, their conditions can worsen.

"Veterans say that before VA telehealth and virtual care technologies, they would avoid appointments because it was too distressing. But these technologies make it possible for them to attend because they do have more comfort at home." Dr. Renato Popovic, primary care mental health integration psychologist

Office of Management and Budget (OMB): 2023 Spring Unified Agenda (6/13) - OMB released its spring regulatory agenda, which lists anticipated rulemaking from federal agencies over the next year or so. There were several anticipated rules on telehealth. Specifically, the DEA announced the release of the Telemedicine Prescribing of Controlled Substances final rule in November 2023.  

Telehealth Research, Reports and Surveys

Kaiser Family Foundation: Rise in Use of Mental Health Apps Raises New Policy Issues (6/20) - During the PHE, many federal and state health care requirements were waived in an attempt to expand access to digital behavioral health services such as mental health apps. This Issue Brief looks at how federal PHE waivers may have expanded use of mental health apps and some of the policy issues concerning the continued use and promotion of mental health apps post-PHE. Topics highlighted include privacy, standards for prescribing of controlled substances via telehealth, among others. 

Circulation: Telehealth: Lessons Learned From the Pandemic and Keys to Effective Research and Policy Design (6/19) - Telehealth and virtual care encompass a complex variety of services and technologies, spanning multiple specialties, disciplines, and populations. This complexity can help in establishing the guiding principles for the use of telehealth, after the resolution of the public health emergency (PHE). In this letter, the authors discuss lessons learned from the pandemic and the keys to effective research for policy. 

JAMA Network: Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022 (6/13) - A JAMA Network Open study by researchers from Harvard and the Rand Corporation found that the number of sites offering telehealth for mental health went from 39.4 percent in the second quarter of 2019 to 88.1 percent in the third quarter of 2022. The number of providers offering telehealth for mental health care increased in states that adopted pandemic policies to expand access to the service. State participation in either of two agreements allowing access to care across state lines were the next biggest drivers of expanded telehealth services at 40 and 21 percent. 

Health Affairs: Telehealth And Network Adequacy: A Recipe To Advance Access? (6/12) - Telehealth’s ability to address mobility, transportation, and geographic barriers has begun to transform the way individuals pursue care. Insured individuals’ access to care has historically been governed by a single tool: network adequacy standards. Authors propose that telehealth can augment network adequacy’s ability to deliver on its promise of ensuring access to care. In this article, authors summarize the advantages, and risks, of incorporating telehealth into network adequacy standards, and next steps for federal, state, and commercial policy makers seeking to eliminate barriers to addressing illness and maintaining health.

Telehealth News and Market Developments

Inside Telehealth: RPM's Post-PHE Future Grounded in Value-Based Care (6/21) - The use of remote patient monitoring technology grew as virtual care ballooned during the COVID-19 pandemic, and the technology’s continued use post-pandemic hinges on providers viewing it not as a cost-saver but as integral to value-based care, panelists said at the mHealth Intelligence RPM Summit said. Providers need to optimize the clinical benefit of remote monitoring services for patients and to encourage innovation in the technology. Clinicians and health care organizations should assess how they can drive value-based outcomes through data technology and the deployment of innovative programs like RPM.

Politico Pro: Solving 'Wicked' Health Problems with Audio-Only Telehealth (6/20) - Leith States is the chief medical officer in HHS’ Office of the Assistant Secretary for Health, where he has a broad portfolio that includes telehealth, long Covid and InnovationX. Ben Leonard, Politico Pro, caught up with States to discuss audio-only telehealth, the future of the Office of Long Covid Research and Practice, InnovationX and more. 

Healthcare IT News: How RPM Can Solve Many Patient and Provider Problems in Rural Areas (6/20) - Rural communities across the U.S. are facing an increasing health care crisis due to shortages in health care providers and facilities, especially as the nursing shortage continues throughout the country. One way people in these rural areas still can receive access to high-quality healthcare in a convenient and cost-effective way is through telemedicine and remote patient monitoring options. Healthcare IT News interviewed Kimberly O’Loughlin, CEO of Health Recovery Solutions, a remote patient monitoring company, to talk about the state of remote patient monitoring in rural America, trends in rural healthcare pushing RPM, drivers that encourage a rural hospital or health system CIO or clinical team to pursue RPM, and what CIOs and other health IT leaders should know about RPM before diving in.

Forbes: How One Telehealth Company Is Combatting The Suicide Epidemic (6/15) - Suicide remains a leading cause of death, with one death occurring every 11 minutes in the U.S. This interview with Brad Kittredge, CEO, and co-founder of Brightside Health, a telemental health care company digs into mental health challenges and how telehealth can bridge many of the treatment gaps. 

Inside Telehealth: RHCs, FQHCs Unable To Contribute To Telehealth Data Talks Due To CMS Rule (6/15) - Rural health clinics (RHCs) and federally qualified health centers (FQHCs) worry they are missing out on conversations about telehealth utilization and cost data because of a special payment rule by CMS that stunts their reporting capabilities. The National Association of Rural Health Clinics supports permanent telehealth legislation, which would fix telehealth for RHCs and FQHCs by changing the definition of an encounter and correcting payment issues. Though FQHCs and RHCs have been performing telehealth visits for the last three years, they have been at a disadvantage. Not only are telehealth visits not paid at parity with in-person visits, but CMS’ special payment rule gave RHCs only one code to use for telehealth, which amputates the ability for RHCs to glean specific telehealth use data.

Vanderbilt University Medical Center (VUMC): Telehealth Maintains Effectiveness of Home Health Program (6/15) - Vanderbilt Home Care Services' chronic disease management program treats patients with heart failure, COPD, diabetes and pneumonia and after coronary artery bypass surgery or heart attacks. The telehealth visits complement traditional home health services. Recent hospital readmission rates for patients served by the CDM program have been lower than the rate for the Medical Center’s entire home care population. In January 2023, the readmission rate was 6%, and in February it was 8%. While the telehealth service is not currently a reimbursable expense, beginning in July home health agencies have been asked to report these types of telehealth calls made to Medicare enrollees to CMS. For additional coverage, see Becker's Hospital Review. 

Healthcare IT News: Why Telehealth Is So Critical For Marginalized Patient Populations (6/12) - Dr. Holly Yang, board president of the American Academy of Hospice and Palliative Medicine, discusses social determinants of health, equity issues and virtual care, a game changer for underserved patients. 

State Telehealth News

Hartford Business: Connecticut's Telehealth (6/19) - In March 2020, Gov. Lamont signed an emergency waiver relaxing state telehealth regulations to enable more people to get medical care without leaving their homes. During the 2021 session, the legislature passed a bill extending most pandemic telehealth policies through June 30 of this year. Last year, the legislature again passed a law extending them through June 30, 2024. However, a spokesperson for the Department of Public Health said the state doesn’t currently have any plans to extend either of those provisions beyond June of next year.

Inside Telehealth: Virtual Counselors To Wait Another Year Before Interstate Compact Takes Off (6/12) - The Council of State Governments (CSG) and the American Counseling Association (ACA) hope Congress will step in to fund interstate compacts and follow through on legislation that directs the FBI to complete background checks for compact clinicians. Twenty-six states are part of the Counseling Compact, and ACA and CSG expect bills to be signed by the governors of Missouri and Iowa by the end of the summer. Despite over half the country being poised to allow interstate licensure for mental health professionals, counselors and patients may wait up to a year before expedited and low-cost interstate privileges can be granted.

Upcoming Events & Hearings

July 12 - Telehealth Centers of Excellence, "Telehealth Implementation of Trauma Focused Treatment." 

July 25 - Arizona Telemedicine Program, "Digital Health and Quality Improvement." 

July 27 - TeleLa Telehealth Resource Center, "Telehealth At The Crossroads Conference: Telehealth In 2023 And Beyond." 

September 27-30 - American Medical Association (AMA), "CPT® Editorial Panel & RUC Meetings." 

October 3 - mHealth Intelligence, "4th Annual Connected Health Virtual Summit." 

April 28-30, 2024 - The Rural Broadband Association, "Legislative + Policy Conference." 

Previous Events, Videos, & Podcasts

Cancer Network, "Telehealth and Treatment Selection: Highlights From an Expert Panel on Multiple Myeloma." CancerNetwork recently hosted a Satellite Sessions program at the University of Texas MD Anderson Cancer Center. The program brought together experts from both the main campus and a satellite clinic to highlight the diversity of views and practices in the multiple myeloma space, and to investigate the treatment standards bridging these different locations. The panel discussion broached a variety of topics, including the challenges and advantages of virtual patient visits. 

Please subscribe to this newsletter and send any news or events to rikki.lam@connectwithcare.org for inclusion.