Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on the use of virtual care.
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Alliance News
Patients and Practitioners Agree – Telehealth Is Important for Patient Access, Health Care Workforce
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The Alliance for Connected Care released a major survey of both health care patients and practitioners, conducted by Morning Consult. The poll asked patients and practitioners about their telehealth usage, telehealth experiences, their use of care across state lines, and the workforce implications of these developments. The survey found that 84 percent of recent telehealth patients say they have personally benefited from the option to receive care though telehealth and more than 8 in 10 patients support access to health care practitioners across state lines. “This is the first time we have polled both patients and providers, and they are aligned on the merits of telehealth,” said Krista Drobac, Executive Director of the Alliance for Connected Care. “I am particularly excited to see practitioners reporting that telehealth is a tool to fight clinical burnout and to see such strong support from patients for access to care across state lines.” For additional coverage on this release, please see coverage in Politico Pulse and Inside Telehealth.
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Alliance for Connected Care: Alliance submits comments in response to the White House Office of Science and Technology Policy on Strengthening Community Health Through Technology RFI (3/31) – The Alliance for Connected Care submitted comments
in response to the request for information from the White House Office of Science and Technology Policy (OSTP) on strengthening community health through technology. Comments focused on recommendations around interstate licensure and clinical trial recruitment and diversity. Specifically, the Alliance specifically commented on the burdensome licensure requirements which create a barrier in access to virtual health care and recommended that the federal government: 1) develop and implement a national framework for interstate licensure using a policy of mutual recognition; and 2) address state licensing limitations that impact clinical trial recruitment and diversity.
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Administration
Inside Telehealth: Secretary Becerra and Senate Finance Seek Each Other’s Help to Preserve Telehealth (4/6) – Senators and HHS Secretary Xavier Becerra reiterated their support for making telehealth a permanent fixture in Medicare following the conclusion of the public health emergency during a Senate Finance Committee hearing Tuesday (April 5), but Becerra said HHS will need Congress’ support to permanently and successfully cover such services. Becerra called on legislators to extend waivers that lifted telehealth originating site restrictions in Medicare, continue to allow federal health centers and rural health clinics the ability to provide services remotely, commit to meeting federal mental health parity standards, particularly for substance abuse disorder treatment via telehealth, and expand audio-only options for appointments.
Office of the Inspector General: OIG Launches a New Page on Telehealth (4/5) – The HHS Office of the Inspector General (OIG) launched a new webpage on telehealth, which will be updated with oversight work assessing telehealth services, including the impact of the public health emergency telehealth flexibilities. These reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering changes to telehealth policies. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs.
Inside Telehealth: HRSA Seeks Funding For Pediatric Telepsychiatry Program (4/5) – The Health Resources and Services Administration (HRSA) seeks funding in the FY 2023 Budget Request to continue efforts to expand access to pediatric telemental health care through its Pediatric Mental Health Care Access (PMHCA) Program. Anna Ratzliff, co-director of the Advancing Integrated Mental Health Solutions (AIMS) Center, told Senate Finance Committee members on March 30 that telehealth is essential for parents looking to access pediatric mental health services during the pandemic. Having an expert create a treatment plan and having a primary care provider execute the plan is a way to leverage the scarce resource of pediatric psychiatrists, according to Ratzliff, which is similar to what HRSA’s Pediatric Mental Health Care Access (PMHCA) Program seeks to accomplish.
Drug Enforcement Administration: DEA’s Commitment to Expanding Access to Medication-Assisted Treatment (3/23) – Drug Enforcement Administration (DEA) Administrator Anne Milgram announced the DEA’s continued commitment to expanding access to medication-assisted treatment to help those suffering from substance use disorder. During the COVID-19 pandemic, the DEA implemented temporary regulations allowing medication-assisted treatment to be prescribed by telemedicine. Notably, DEA announced that it will soon make permanent regulations to this effect (following many years of Alliance advocacy).
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Congress
The Alliance maintains a tracker of major federal telehealth legislation.
Medicaid Ensuring Necessary Telehealth is Available Long-term (MENTAL) Health for Kids and Underserved Act (4/7) – On April 7, Senators John Thune (R-S.D.), Sherrod Brown (D-Ohio), and Ben Cardin (D-Md.), members of the Senate Finance Committee, which has jurisdiction over Medicaid and the Children’s Health Insurance Program (CHIP), introduced the Medicaid Ensuring Necessary Telehealth is Available Long-term (MENTAL) Health for Kids and Underserved Act. This bipartisan legislation would direct the Centers for Medicare and Medicaid Services (CMS) to issue guidance to states on options to increase access to behavioral health services and treatment via telehealth for children and underserved Americans.
Data Mapping to Save Moms’ Lives Act (4/4) – On April 4, the House passed by a vote of 310-110 the Data Mapping to Save Moms’ Lives Act (S. 198), which directs the Federal Communications Commission to include data on certain maternal health outcomes in its broadband health mapping tool. The purpose of this tool is 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.
Senators Portman and Whitehouse Urge DEA and HHS to Extend Americans’ Access to Telehealth Once the COVID-19 Public Health Emergency is Terminated (4/1) – U.S. Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) sent a letter
to DEA Administrator Anne Milgram and HHS Secretary Xavier Becerra, urging the agencies to use their authority under the Ryan Haight Act to ensure Americans can continue to access important medication, such as Medication-Assisted Therapies (MAT) for substance use disorder and other necessary drugs, via telehealth once the COVID-19 public health emergency ends. Under the Ryan Haight Act, an in-person examination is required in order to prescribe controlled substances such as buprenorphine, which is commonly used in MAT. In March 2020, that requirement was suspended due to the COVID-19 pandemic, allowing providers to prescribe MAT and other necessary drugs via telehealth.
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Telehealth Research, Reports and Surveys
Modern Healthcare: Rural Veterans Have Fewer ED Visits, More Psychotherapy with VA Tablets (4/6) – According to a study
published in the Journal of American Medical Association, rural veterans who received tablets from the Department of Veterans Affairs had more telehealth psychotherapy appointments and fewer suicide-related emergency department visits. Researchers tracked more than 13,000 veterans with a mental health history over the first year of the pandemic, after receiving a broadband- and video-enabled tablet from the VA. The tablets enabled veterans to receive more mental health care than they normally would have, and they had a lower likelihood of having an emergency department visit for any reason, according to the study. Researchers concluded that other health systems could undertake similar projects for their rural patients to increase access to mental health care and prevent suicides.
PR Newswire: For Third Straight Month, Telehealth Utilization Increased Nationally in January 2022 (4/6) – According to FAIR Health’s Monthly Regional Tracker, national telehealth utilization grew in January 2022. Telehealth utilization also increased in every US census region, with the greatest increase (17.5 percent) in the West. In January 2022, social work was the leading telehealth specialty nationally and, in every region, but the West, where primary care was the leading telehealth specialty, 0.1 percent ahead of social work.
News Wise: Pandemic Drives Use of Telehealth for Mental Health Care (4/5) – A recent Health Affairs study
found that the COVID-19 pandemic is likely permanently increased the delivery of mental health counseling through telehealth. The study suggests that telehealth services for mental health counseling expanded significantly and is likely to stay. Future applications of tele-mental health should really be focused on understanding the population, context and disease conditions most conducive to this method. Researchers concluded that there needs to be future research to understand how telehealth modalities can best improve equitable access to mental health care in the face of increased overall demand.
The Hill: Telehealth for Mental Health Care Likely Here to Stay (4/4) – A recent Health Affairs study
notes that the rise in mental health care delivered online and over the phone due to the COVID-19 pandemic are likely permanent changes. Researchers found that while in-person mental health visits dropped by nearly 22 percent in the early months of the pandemic, visits bounced back by December, with almost 48 percent of patients electing to use a telehealth service. Researchers noted patients with lower incomes, people living alone, and Black and Hispanic populations appeared to be less likely to use mental health services via telehealth. Reducing regulatory and payment barriers may improve access to care for these populations.
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State Telehealth News and Activity
Florida Politics: Governor signs bill allowing providers to use telehealth to prescribe some controlled substances (4/7) – Florida Governor Ron DeSantis signed a bill into law that would allow telehealth to be used to prescribe Schedule III, IV, and V substances starting July 1. Senate Bill 312 narrows the current prohibition on ordering and allows telehealth to be used to prescribe these substances. Under current law, providers are allowed to use telehealth to prescribe controlled substances if the treatment is for psychiatric disorder, or if the patient is hospitalized, receiving hospice services, or is a resident of a nursing home facility.
Health Leaders Media: States Consider Cutting Back on Telehealth Freedoms (4/6) – To address the COVID-19 pandemic, every state eased the rules on telehealth access and coverage to give providers and consumers more opportunities to connect via virtual care. Some legislators are now looking to curb those telehealth freedoms, while others have highlighted the value virtual care has had throughout the pandemic and that should be made permanent. In Alabama, Senate Bill 272 and House Bill 423, which passed the House this week and now goes to the governor for signature, would mandate in-person visits for certain virtual care services. Supporters of this bill argue that a visit to the doctor’s office is needed to maintain the physician-patient relationship and to ensure quality of care, despite growing evidence that this is not the case.
Axios Philadelphia: Telehealth truck to connect doctors with homeless patients in Philly (4/6) – Broad Street Ministry is partnering with local hospital network Trinity Health Mid-Atlantic to expand health care access to Philadelphia’s homeless residents. The nonprofit upgraded its community hygiene truck to allow homeless individuals to access free primary medical care from the health system via telehealth services, which will help to reach more individuals unable to seek assistance at a health center using an iPad.
mHealth Intelligence: 4 States Advance Telehealth Bills (4/5) – Alabama, Kentucky, New Hampshire, and Pennsylvania are considering or have passed bills governing telehealth services in recent weeks. Kentucky Governor Beshear signed into law legislation that would bar professional licensure boards from prohibiting health care providers credentialed in Kentucky from delivering telehealth to Kentucky residents who are temporarily located outside the state. Meanwhile, in Pennsylvania, the House is considering a bill that would remove the state’s statutory requirement that 50 percent of psychiatric care time be provided on-site and instead allow the required on-site psychiatric services to be provided via telehealth.
North Platte Bulletin: State provides $1.5 million for telehealth, applications open (4/4) – Nebraska’s health care providers have until June 23 to apply to receive support from the state Public Service Commission’s telehealth program. The Public Service Commission recently approved an order to open the application window and allocate $1.5 million per fiscal year from the Nebraska Universal Service Fund for the Nebraska Telehealth program.
NC Health News: Providers worry as Medicaid winds down coverage for OT and PT done via telehealth (4/4) – Starting July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services conducted via telehealth. This change was initially supposed to take place March 31, but was extended by the state for 90 more days. Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with. North Carolina does not currently have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services, and the rollback may impact patients across the state, particularly in rural areas.
Sentinel Source: NH bill would allow out-of-state therapists, launch new phase of telehealth (4/4) – A bill in the New Hampshire Statehouse aims to make virtual counseling more accessible by giving patients in the state access to licensed counselors across the country. Senate Bill 397 would allow New Hampshire to join the Counseling Compact, which creates unified licensing guidelines that allow mental health counselors to easily practice across state lines. The compact will go into effect once 10 states join.
State of Reform: Lawmakers debate whether patients receiving telehealth services should require an initial in-person visit (4/1) – Alaska lawmakers debated whether health care patients should be required to have an in-person visit with a provider prior to receiving telehealth services this week. The Senate Health and Social Services Committee discussed a proposed amendment to Senate Bill 175, which would address medical assistance coverage for telehealth services. The bill does not require a patient to attend an in-person visit prior to receiving a telehealth service, but some Senators stated they would support this.
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Telehealth News and Market Developments
mHealth Intelligence: Telehealth Snapshot: Use Cases, Policies & Hybrid Care (4/7) – Speakers Xtelligent Healthcare Media’s Telehealth22 Virtual Summit discussed a wide range of issues related to telehealth, including how telehealth can help improve chronic disease patient outcomes, the barriers standing in the way to patient access and provider adoption, the hybrid care model that is being developed, and the current regulatory landscape governing telehealth use.
The Conversation: COVID-19: Mental Health Telemedicine Was Off to A Slow Start – Then The Pandemic Happened (4/7) – Psychiatry calls for physical examination much less often than most other medical specialties, making it ideal for telemedicine. Telepsychiatry has also opened a window into the home environments of patients. Seeing where and how they live gives therapists and psychiatrists important insights into a patient’s mental health needs. Even as COVID-19 restrictions lift and more clinics offer face-to-face visits again, telehealth is going to take a permanent place for psychiatry.
Law 360: Group Plan Questions After Telehealth Coverage Extension (4/6) – The 2022 Consolidated Appropriations Act allowed group health plans to provide telehealth services to participants in high deductible health plans (HDHPs) before the participants have satisfied the minimum deductible under the HDHP without jeopardizing the participants' eligibility to participate in a health savings account (HAS). The CARES Act also had HAS provisions and telehealth until December 31, 2021. Congress was unable to extend this provision. Group health plans, plan participants, and telehealth service providers hope Congress will provide a permanent safe harbor under the HSA rules permit participants in HDHPs to receive first-dollar coverage for telehealth services.
McKnights Senior Living: Telemedicine Partnership Helps Treat Residents in Place and Reduce Staff Burnout (4/6) – Primrose Retirement Communities has integrated telemedicine services in more than two-thirds of its assisted living and memory care communities. The telehealth partnership with Primrose and Avel allows more focus on supporting our staff, decreasing unnecessary transfers, and keep a laser focus on quality outcomes. The partnership also benefits Primrose staff members by offering them the ability to take time off. Telehealth provides an opportunity to address staff burnout and have a creative staffing structure.
AMA: Nine Key Steps to Advance Equity in Emerging Telehealth Landscape (4/4) – Telehealth has the potential to become an important tool to address longstanding health inequities in the historically marginalized racial and ethnic groups that have been disproportionately affected by the COVID-19 pandemic. In this article, the American Medical Association (AMA) outlines nine steps that should be taken to help ensure an equitable telehealth landscape emerges, a task that will take forethought and intentional actions. In general, telehealth should be designed with patients and providers use in mind.
Boston Globe: The Pandemic-Era Telemedicine Booms Has Peaked (4/4) – Early in the pandemic, there was an 8,000 percent increased use of telehealth between 2019 and 2020, however virtual visits dropped by two-thirds last year. Doctors, Medicare, and private insurers need to reevaluate how much of a role virtual care will be after the public health emergency subsides. Five important things to focus on include what the right amount of telemedicine is, Medicare and private insurance reimbursement, cross-state licensures, ensuring there is equitable access to telehealth, and the potential for telemedicine fraud, overuse, and security breaches.
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