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Connected Care Update

December 7, 2020

Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.

CY 2021 Physician Fee Schedule

Centers for Medicare & Medicaid Services (CMS) CY 2021 Physician Fee Schedule: (12/1) – CMS has released the final CY 2021 Physician Fee Schedule. CMS has added 144 telehealth services during the COVID-19 PHE. The final rule makes permanent nine services, and adds nearly 60 more “Category 3 codes” which will remain on the Medicare telehealth services list through the calendar year in which the PHE expires. The Alliance was pleased to see the inclusion of many more “Category 3 codes” for 2021. We argued in our letter that the Category 3 code approach is much more reasonable for healthcare organizations to operationalize than temporary PHE-only codes because they create a smoother calendar year-aligned certainty for health care organizations – rather than having an abrupt and unpredictable ending with the close of the public health emergency.

A Modern Healthcare article highlights that CMS Administrator Verma said that CMS will commission a study of telehealth flexibilities promulgated during the COVID-19 emergency to determine the safety, quality and cost of remote patient monitoring and virtual physician supervision. The article notes that "Groups like the Alliance for Connected Care also have been urging providers to share data on telehealth use during COVID-19."

The rule also revises certain Medicare Diabetes Prevention Program (MDPP) policies during the remainder of the COVID-19 Public Health Emergency (PHE) and any future applicable 1135 waiver event. CMS did not permit virtual-only MDPP suppliers to furnish MDPP services. CMS is allowing self-reported MDPP beneficiary weight measurements via a date stamped photograph or video recording of the beneficiary’s weight with the beneficiary visible on the scale.

View the press release, fact sheet MDPP Fact Sheet and Final rule.

    Federal Updates

    Bipartisan, Bicameral Letter Calling for Permanent Expansion of Telehealth Coverage In end of Year Legislation: (12/4) – Sen. Schatz led 49 members of Congress in a letter to Senate and House leadership calling for permanent expansion of telehealth coverage in end of year legislation. “Specifically, immediate action to permanently waive geographic restrictions for originating sites, authorize health centers in rural and underserved areas to provide telehealth, and allow beneficiaries to use telehealth in their homes would be key steps to ensure much-needed certainty about Medicare telehealth coverage for health care providers and to improve access to care for patients,” the letter states.

    Department of Health and Human Services (HHS) PREP Act: (12/3) – HHS issued an amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) to increase access to critical countermeasures against COVID-19. Among other things, the amendment:

    • Authorizes healthcare personnel using telehealth to order or administer Covered Countermeasures, such as a diagnostic test that has received an Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA), for patients in a state other than the state where the healthcare personnel are already permitted to practice. (While many states have decided to permit healthcare personnel in other states to provide telehealth services to patients within their borders, not all states have done so.)

      Legislative Activity

      PREVENT DIABETES Act: (12/3) – On December 3, Reps. Rice (R-SC), DeGette (D-CO), Reed (R-NY), and Butterfield (D-NC) introduced the Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-Based Strategies (PREVENT DIABETES) Act (H.R. 8861), companion legislation to the Senate version (S. 4709) introduced by Sens. Scott (R-SC), Warner (D-VA), Cramer (R-ND), Sinema (D-AZ), Cotton (R-AR) and Smith (D-MN), which would permit the CDC-recognized virtual diabetes prevention program suppliers to be included in the Medicare Diabetes Prevention Program Expanded Model conducted by the Center for Medicare and Medicaid Innovation (CMMI) under section 1115A of the Social Security Act. View the press release.

        State Telehealth News

        EHR Intelligence: (12/3) – Idaho’s statewide health information exchange, the Idaho Health Data Exchange (IHDE), will integrate a remote patient monitoring platform to boost telehealth services and remote patient care to rural areas in the state. This integration will help facilitate public health mitigation strategies and expand access to care for patients who live far away from their providers.

        Boston Business Journal: (12/2) – The Massachusetts Association of Health Plans announced it would sponsor a $200,000 research study to look at racial disparities within telehealth use in the state. The study would seek to understand how COVID-19 has changed telehealth utilization and how health plans and demographic data (such as race and ethnicity) have shaped its use.

        mHealth Intelligence: (12/1) – Texas State Representative Julie Johnson introduced a bill that would ensure permanent payment parity for telehealth services in the state. If enacted, the bill would go into effect September 1, 2021.

        Healthcare IT News: (12/1) – A new National Governors Association report examined state policies around telehealth and outlined key considerations for governors to assess the potential impact such policies could have in the future. The report also notes that 23 states have extended telehealth flexibilities implemented during COVID-19 to extend beyond the public health emergency.

        Wyoming News: (11/30) – Wyoming Governor Mark Gordon made $5 million in funds available through the CARES Act to support behavioral health providers in the state. The funds will help behavioral health providers provide to enhance or offer services to patients via telehealth and other remote services.

        Papers, Surveys, and Studies

        Check out the Alliance for Connected Care studies and polling website for more resources.  

        Charter Communications: (12/3) – Spectrum Enterprise, a part of Charter Communications, Inc., announced the findings of a year-long study revealing that while two-thirds (65%) of the country’s healthcare organizations feel that their telehealth services were very successful in meeting the needs of unprecedented patient demand, they also encountered challenges that they’ll need to prioritize as they look to their long-term strategies. The study, Telehealth in Overdrive: Intelligence on a Year in Adaptation, found that nine out of ten healthcare organizations (e.g. hospitals, healthcare systems, ambulatory facilities) plan to continue to increase or diversify their telehealth services over the coming months. The top two challenges to overcome they say will be patients’ lack of connective devices (e.g. smartphone, computer) and their lack of robust and reliable access to the internet or mobile phone service.

        Meridian Behavioral Healthcare: (12/2) – A new report from Meridian Behavioral Healthcare details how treatment via telehealth massively increased in popularity during the first half of 2020. Meridian provides services to North Central Florida and has a strong presence in Alachua County. Telehealth visits increased by over 500%, with 9,608 patients participating in over 31,000 remote visits, according to its annual report, which covers the fiscal year that ran from July 1, 2019, to June 3, 2020.

        National Governors Association: (11/30) – The NGA released a white paper examining the types of policy flexibilities provided by states and the federal government during the COVID-19 pandemic and longer-term considerations for Governors regarding the impact of such policies on care delivery and payment. Key considerations include: licensure, coverage, pairing payment policies and incentives, establishing policies that narrow the digital divide, encouraging interoperability of telehealth platforms, ensuring policies account for appropriate privacy protections and engaging stakeholders.

        The University of Texas at Dallas: (11/25) – In a new study, Dr. Shujing Sun, a researcher from The University of Texas at Dallas investigated whether telemedicine could enhance ER care delivery. Using a large data set covering all emergency visits in New York state from 2010 to 2014, the researchers found that the adoption of telemedicine in the ER significantly shortened average length of stay and wait time.

        Telehealth News and Market Developments

        Healthcare IT News: (11/30) – Using FCC funding, View Point Health, a community behavioral health agency serving individuals with Medicaid and uninsured and under-insured individuals, has transformed its telemedicine offering – and has since seen decreases in no-show rates for individual counseling and evaluation and management appointments.

        Notable Telehealth Commentary –

        Expanding Medicare coverage for a broader range of telehealth services is the main area in which CMS has jurisdiction, but CMS Administrator Seema Verma on a call with reporters stressed that Congress needs to change federal law to permanently allow a broader swath of the Medicare population to receive such telehealth services at home.

        Access to broadband is essential to boost telehealth, which has skyrocketed during the coronavirus pandemic, Federal Communications Commission (FCC) commissioner Geoffrey Starks said on Thursday at an Axios virtual event on the future of broadband connectivity. "Access to telemedicine and telehealth via affordable, reliable broadband is going to be extremely important to making sure that folks can safely manage their health from home," Starks said.

        Ongoing Alliance Efforts

        PLEASE SIGN-ON to Consensus Principles on Telehealth Across State Lines

        The Alliance for Connected Care seeks your support on an open letter to U.S. State and Federal Policymakers calling for care across state lines to support patients and empower healthcare professionals.

        This high-level statement is intended to call attention to the need for telehealth care across state lines, through solutions that allow for mutual recognition of health professional licensure. Please sign here. Please also feel free to share this opportunity with others.

        Read more about this statement featured in mHealthIntelligence.

          Upcoming Events

          December 7, Milken Institute, “Realizing the Promise of Telehealth During the Pandemic and Beyond.”

          December 7, National Consortium of Telehealth Resource Centers, “NCTRC Telehealth Hack - Building Lasting Telehealth Programs on College Campuses.

          December 8, CDC, The Impact of Telehealth on Health Equity from the Perspective of Large Healthcare Systems during the COVID-19 Pandemic.

          December 8, National Consortium of Telehealth Resources Centers, “Telehealth Roundup – Remote Patient Monitoring Billing Panel Discussion.

          December 10, SR Health, “Telehealth 2021: Reimbursement Updates and Predictions.”

          December 11, AHIP, “Digital Engagement through Digital Communications.”

          Past Events

          Brookings, TechTank Podcast Episode 9: Will telehealth continue under the Biden administration?” In this episode, host Nicol Turner Lee discusses the rise of telehealth and its implications with Ross Friedberg and Niam Yaraghi.

          Axios, The future of broadband connectivity.” Axios' Erica Pandey, Dan Primack, and Ashley Gold hosted a conversation on the future of broadband connectivity, featuring FCC Commissioner Geoffrey Starks, Per Scholas CEO Plinio Ayala and DreamBox CEO Jessie Woolley-Wilson. Access to broadband is essential to boost telehealth, which has skyrocketed during the coronavirus pandemic, Federal Communications commissioner Geoffrey Starks said on Thursday at an Axios virtual event on the future of broadband connectivity.

          HIMMS, “The Role of Telehealth in Primary Care.” Kat Jercich, Senior Editor at Healthcare IT News, spoke with experts in the field about the advantages and pitfalls of relying on telemedicine for primary care.

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