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
Healthcare Dive: As cross-state telemedicine waivers expire, virtual care advocates focus on long-term policy changes (6/21) – Telehealth advocates are hoping to shape a friendlier physician licensing landscape as states increasingly reformulate policies mediating cross-state care. According to a COVID-19 emergency declaration tracker
by the Alliance for Connected Care, 15 states still had licensure flexibilities in place as of mid-April, down from 24 in early March. As of mid-June, this number fell to just 13 states. While the Interstate Medical Licensure Compact (IMLC) provides one avenue for addressing cross-state care, Alliance board member Amwell highlights that it is time-consuming and expensive to utilize the IMLC. Amwell sees an average licensing cost of $1,000 per state per physician, which comes out to roughly $50,000 per provider for nationwide practice.
NBC News: State by state, some patients are losing telehealth access to doctors (6/19) –
Patients are beginning to lose telehealth access to their out-of-state doctors. Cross-state practice of medicine was allowed when there were localized spikes of COVID-19 in states such as New York. “They thought that there’d be a serious COVID rise in cases in one state and the state next door, for example, could have professionals who could help,” said Krista Drobac, the executive director of the Alliance for Connected Care. However, as states roll back pandemic-era emergency health orders, licensing barriers are preventing patients from accessing their providers in a different state. Alliance board member Johns Hopkins Medicine noted “it’s been really difficult to try to explain that providers can see patients only in specific areas.” For more coverage, see Becker’s Hospital Review.
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Congress
Bipartisan Safer Communities Act (6/25) – Senators Murphy (D-CT), Cornyn (R-TX), Sinema (D-AZ), and Tillis (R-NC) released the text of the Bipartisan Safer Communities Act (S. 2938), which would address and reduce gun violence across the nation. The bill includes a provision which requires the Secretary of HHS to provide technical assistance and issue guidance to states on improving access to telehealth for services covered under Medicaid and CHIP. The bill passed the Senate on June 23 and passed the House on June 24, and was signed into law by President Biden on June 25. The enrolled bill text can be found here.
H.R. 8229 (6/24) – On June 24, Reps. Manning (D-NC), Matsui (D-CA), and Fitzpatrick (R-PA) introduced legislation (H.R. 8229) that would clarify the application of certain parity provisions to mental health and substance use disorder telehealth benefits (details forthcoming).
Representative Gonzales: Congressman Tony Gonzales Introduces UNITED Act to Invest in Mental Health Treatment, Education, and Crisis De-Escalation Programs (6/23) – Rep. Gonzales introduced the Undertaking Needed Investments in Therapy, Education and De-escalation (UNITED) Act (H.R. 8180), which would provide for increased authorization of funding to secure schools and improve access to mental health and crisis care. The bill would deliver funding to nine key areas, including extending emergency telehealth services.
House Appropriations Committee: Release of Fiscal Year 2023 Labor, Health and Human Services, Education, and Related Agencies Funding Bill (6/22) – The House Appropriations Committee released the draft fiscal year 2023 Labor, Health and Human Services, Education, and Related Agencies funding bill. The bill includes nearly $935 million for HRSA-wide activities and program support, including more than $37 million for expenses necessary for the Office for the Advancement of Telehealth to advance telehealth activities. The bill was approved by the Subcommittee on June 23 and goes to the full Committee for markup. The House Appropriations Committee also released the FY2023 Agriculture-Rural Development-FDA Funding Bill, which includes $560 million to support rural broadband expansion, including a $450 million addition to the USDA’s ReConnect program. The broadband expansion will help rural residents access telehealth services. This bill was approved by the Committee on June 23.
Rural Telehealth Access Task Force Act (6/22) – Reps. Pence (R-IN) and Craig (D-MN) introduced the Rural Telehealth Access Task Force Act (H.R. 8169), which would establish a Rural Telehealth Access Task Force to determine how to address barriers to the adoption of telehealth technology and access to broadband internet access service in rural areas. This legislation will be discussed during an Energy and Commerce Committee Hearing on Wednesday.
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Administration
Office of Management and Budget: Spring 2022 Unified Agenda of Regulatory and Deregulatory Actions (6/23) – The Office of Management and Budget (OMB) published its Spring 2022 Unified Agenda of Regulatory and Deregulatory Actions, which reports on the actions administrative agencies plan to issue in the near and long term. This includes proposed rules extending pandemic prescribing flexibilities by both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA). One notable update from this Spring 2022 Unified Agenda includes that SAMHSA will move to make pandemic flexibilities permanent for buprenorphine and methadone. The Veterans Administration (VA) also plans to expand coverage of telehealth services to cover health care professionals who practice via telehealth, implementing authorities in the MISSION Act of 2018. For additional coverage, see Inside Telehealth.
White House Office of National Drug Control Policy: ONDCP Announces Report on Improving Telehealth Services for Substance Use Disorder (6/22) – The White House Office of National Drug Control Policy (ONDCP) released the Telehealth and Substance Use Disorder Services in the Era of Covid-19: Review and Recommendations report. The report by the Legislative Analysis and Public Policy Association (LAPPA) found telehealth services can provide increased access to vulnerable individuals with substance use disorder, decrease costs, and reduce the spread of communicable diseases. The report makes several recommendations, including to expand and make consistent current state and federal telehealth policies, and for federal support of mutual recognition and reciprocity of state licenses. For additional coverage, see Bloomberg Law.
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Telehealth Research, Reports and Surveys
University of Michigan Medicine: Telehealth flexibilities didn’t send Medicare visits soaring, despite worries (6/23) – An analysis
of Medicare data from the University of Michigan Medicine found that older Americans and their health care providers have settled into a steady pattern of using telehealth technology for nearly one in 10 outpatient appointments. The analysis shows that for the second half of 2021, about nine percent of all outpatient appointments by people with traditional Medicare coverage took place over video or audio connections – a decline from telehealth connections made from mid-2020 through mid-2021, but still an increase from 2019. “As telehealth use hits its stride in the Medicare fee-for-service population, the fears that flexible telehealth rules might lead to an increase in the total volume of outpatient visits has not panned out,” said Chad Ellimoottil, M.D., M.S., lead author of the new preprint and leader of IHPI’s Telehealth Research Incubator lab. “With all the evidence we have to date, it appears that telehealth has been used as a substitute for in-person care rather than an expansion of care.”
HR Dive: Mental health, telehealth benefits are post-pandemic priorities (6/22) – An annual benefits survey by the Society for Human Resource Management found that mental health and telemedicine or telehealth services are among the most important benefits employers feel they can offer employees in 2022. Of the survey’s 3,129 responses, 93 percent of respondents said they offered telemedicine or telehealth, a 20 percent jump from 2019 when the category was last recorded. The strong prevalence of these benefits indicates they are likely to be permanent fixtures following the COVID-19 pandemic.
mHealth Intelligence: Enhancing Care for Kids with Genetic Conditions Through Telehealth (6/21) – According to a study published in Pediatrics, telemedicine can be used to effectively care for pediatric patients with genetic conditions. The uses of telehealth in pediatrics are varied, enabling expanded care for various acute and chronic conditions, like type 1 diabetes and behavioral health. One of the significant use cases of the care modality is diagnosing and caring for children with genetic conditions. The study found that patients were recommended to undergo more genetic testing when they were seen by telemedicine.
mHealth Intelligence: Interest in RPM, Personal Health Tech Adoption Lagging Among Clinicians (6/21) – A report
by Alliance board member Walmart, in collaboration with Medscape, found that though most rural and non-rural health care professionals believe remote patient monitoring (RPM) might benefit patients, only about half are interested in using it. Medscape surveyed 10,045 US health care professionals between December 29, 2021 and March 9, 2022. About 70 percent of non-rural health care professionals find RPM beneficial, and 63 percent consider personal health technology helpful for patient care. But only 47 percent said they are interested in adopting RPM, and 46 percent said the same for personal health technology. The report noted the importance of supporting avenues for health care professionals to develop a firm grasp of health technologies' value and functionality as a critical first step.
Medcity News: Telehealth visits for mental health continue to rise despite dropping in every other specialty (6/23) – A report
by Zocdoc found that telehealth accounted for 87 percent of mental health appointments booked last month. That percentage is continuing to climb, despite virtual care visits declining across all other specialties. This is due to the ease of access to care for patients, and the ability for providers to deliver high-quality virtual care.
mHealth Intelligence: Patient Characteristics Strongly Tied to Telehealth Use (6/17) – A study
published in the Journal of the American Board of Family Medicine (JABFM) found that, unlike provider characteristics, patient characteristics play a significant role in determining telehealth usage. The study consisted of 37,428 patients representing a total of 106,567 encounters, along with 42 providers. The study found that, compared to Hispanic patients, non-Hispanic White patients were 61 percent more likely to participate in a telemedicine visit, and non-Hispanic Black patients were 32 percent more likely. Researchers concluded that reviewing patient characteristics is critical when designing telehealth intervention strategies, especially for patients living in medically underserved areas (MUAs) who need alternate care methods.
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State Telehealth News and Activity
United Healthcare: Louisiana – Telehealth changes to COVID-19 temporary measures
(6/24) – The Louisiana Department of Health revised its COVID-19 Informational Bulletin 20-5 last month, including areas impacting telehealth. One notable change includes that the Louisiana Medicaid fee-for-service claim processing system is being updated to allow the appropriate teletherapy place of service code, 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of service in addition to the procedure modifier 95.
Washington State Hospital Association: Audio-Only Telemedicine Law Changes: Hospital Facility Fees Prohibited and Established Relationship Requirement Modified (6/23) – The Washington State Hospital Association released a bulletin to inform hospitals about two changes impacting audio-only telemedicine reimbursement in Washington State that were enacted into law during the 2022 legislative session. First, effective June 9, hospitals licensed under chapter 70.41 RCW that serve as either an originating or distant site for audio-only telemedicine are prohibited from charging a facility fee to uninsured and self-paying patients. Second, beginning January 1, providers seeking reimbursement for audio-only telemedicine services must establish a patient-provider relationship consistent with the newly modified “established relationship” definition.
JD Supra: HHS COVID-19 Public Health Emergency Persists as California COVID-19 Policies Are Set To Expire (6/23) – California is preparing to have various COVID-19 policies expire
on June 30, 2022, meaning providers in California will face a regulatory environment where certain conduct that is excused by federal policy tied to the PHE could be sanctioned under state law. Executive Order N-04-22 will end the suspension of administrative fines, civil penalties, and causes of action under the Confidentiality of Medical Information Act (CMIA) — California’s analog to HIPAA — for “inadvertent, unauthorized access or disclosure of health information during the good faith provision of telehealth services.” Relaxed enforcement of other state data protection laws as applied to providers engaged in the “good faith provision of telehealth service” will also cease on June 30, 2022.
WMAR 2 News Baltimore: Maryland Department of Health receives grant to expand telehealth services (6/22) – The Maryland Department of Health received a one-year, nearly $700,000 grant from HHS to support statewide efforts to improve health equity by expanding telehealth services to be used by 11 local health departments and three nonprofit family planning clinics. The grant will allow Maryland family planning programs to expand and provide benefits to more low-income families. The grant will help provide telehealth capacity-building training and technical assistance to these sites to expand access to family planning and preventive services appointments throughout the state. For additional coverage, see here.
RCPA: PA Department of State Extends Waivers Allowing Tele-Inductions of Buprenorphine
(6/21) – The Pennsylvania Department of State (DOS) has reversed course and extended its waivers allowing for an initial prescription of buprenorphine without an in-person physical exam. DOS had announced previously that the waiver would expire on June 30, 2022; however, DOS’s waiver will now continue until the last day of the federal public health emergency declaration, unless the exemptions are ended sooner by SAMHSA or the US Drug Enforcement Administration (DEA).
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Telehealth News and Market Developments
Health Affairs: COVID-19 Inspired Creativity in Health Care: Lessons for Management and Policy (6/23) – The COVID-19 pandemic spurred creativity in health care virtually overnight, with creative innovations and implementation strategies emerging related to care delivery, operations and supply chain management, vaccine distribution, and other areas. This article highlights four key lessons learned during the pandemic as the industry moves forward, including how creativity benefits from collaborations with diverse stakeholders. One such example is how such partnerships facilitated home health services through mobile vans, sometimes with novel features such as rapid responders such as EMTs or paramedics to assist older adults with telehealth visits at home. The authors recommend updating state and local regulations to ensure they do not stifle creativity, such as with telehealth expansion and the positive impact is has had throughout the pandemic.
Health Leaders: Health plans are mapping out a technology strategy for home care (6/22) – Health plans are expanding their platforms to include home-based health care services, and sometimes acting as the primary care provider of record. Telehealth allows for more services in the home and connections to providers in other locations. This new service is part of the evolution to risk-based care.
Health Leaders: Building a business case for asynchronous telehealth (6/21) – Many health systems took advantage of expanded coverage and access to telehealth during the pandemic to try out asynchronous services, which give consumers the ability to access care without the hassle of driving to a doctor's office or ER, or scheduling a video visit. Asynchronous telehealth platforms typically allow people to fill out an automated questionnaire on their health concern, which is then screened by the health system and sent to a care provider, who can review the data and send back a diagnosis and care plan.
Politico: ‘Untreated’: Patients with opioid addiction could soon lose access to virtual care (6/20) – Federal regulations that have allowed practitioners the flexibility to prescribe buprenorphine virtually, and to patients outside their state, are due to expire along with the COVID-19 public health emergency. The Drug Enforcement Agency (DEA) has already missed deadlines to facilitate virtual access. However, the director of the NIH’s National Institute on Drug Abuse noted that removing telehealth flexibilities now will make the issue worse and cause patients to go untreated.
Healthcare IT News: How telehealth can help inpatient care, and what a hybrid future looks like (6/20) – In this interview with Mike Brandofino, CEO of Caregility, a vendor of telehealth technology and services, Brandofino discusses how telehealth will evolve beyond today’s uses. More specifically, he highlights how the combination of remote patient monitoring and in-person appointments can hopefully improve outcomes along the way.
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Upcoming Events and Hearings
June 27 - House Oversight and Reform Committee, “Examining the 2022 National Drug Control Strategy and the Federal Response to the Overdose Crisis."
June 29 – United States of Care, “Older Adults’ Experience of Virtual Care: Action Steps to Increase Access and Equity.”
June 29 – Scottsdale Institute, “Fireside Chat: Telehealth – Past, Present and Future.”
July 12-13 – TexLa Telehealth Resource Center, “Telehealth at the Crossroads.”
July 13 - Congressional Diabetes Caucus / Diabetes Advocacy Alliance, "A Call to Action: Rising to Meet the Challenge of the Diabetes Epidemic (will include discussion of policy on virtual chronic disease tools).
July 13 – Manatt and the American Medical Association, “Post-PHE State Telehealth Policy Trends: What Does the Permanent Policy Landscape Look Like?”
July 21 – National Conference of State Legislatures, “Keeping Health Care Accessible: Provider Licensing and Interstate Compacts Webinar.”
August 9-10 – California Telehealth Resource Center, “The Golden State for Telehealth: What’s Next for California.”
September 13-14 – Upper Midwest Telehealth Resource Center, “2022 UMTRC Annual Conference.”
September 26-28 – Northwest Regional Telehealth Resource Center, “Annual Conference: Innovation in Telehealth.”
September 29-30 – Northeast Telehealth Resource Center, “8th Annual Regional Conference: Exploring the Telehealth Universe.”
Previous Events, Podcasts, and Videos
The US Oncology Network, “Telemedicine’s Contribution to Cancer Care Robust and Meaningful.” Debra Patt, MD, PhD, MBA, executive vice president of Texas Oncology, discusses how enhancements to telemedicine precipitated by the COVID-19 pandemic have made lasting and meaningful changes to oncology care, including that these care improvements will persist post-pandemic.
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