January 17, 2023

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

Alliance for Connected Care: Alliance Urges CMS to Preserve Beneficiary Access to Telehealth Services (1/13) - On January 13, 2023, the Alliance for Connected Care sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the implementation of the telehealth provisions in the Consolidated Appropriations Act, 2023. Some Medicare telehealth codes are currently scheduled to expire 151 days after the expiration of the COVID-19 public health emergency (PHE). While most telehealth codes can simply be extended in the annual calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) rulemaking, the timeline is too rapid to address the issue. The Alliance requests that CMS issue an interim final rule to implement the date changes as per the Consolidated Appropriations Act, 2023.

PoliticoPro: COVID-19 PHE's End Could Curtail Access to Opioid Disorder and Mental Health Drugs (1/12) - Pandemic waivers made it easier for people suffering from substance use disorders and mental health problems to get virtual care, including for medicine prescribed after telehealth visits. But if the Biden Administration ends the COVID-19 PHE in April, as it is considering, those exemptions could end. While some major telehealth provisions were extended through the end of 2024, virtual prescribing of controlled substances used to treat opioid use disorder and some mental health conditions require action from the DEA. More information around the Alliance's advocacy on this issue can be found here.

"Congress has already used the levers they have to push the DEA," said Krista Drobac, executive director of the Alliance for Connected Care. "At this point, it's up to the [White House Office of Management and Budget] and DEA to get the proposal out … before there’s a gap in coverage”

Congress

Congressional Budget Office (CBO): CBO Estimate of the Consolidated Appropriations Act, 2023 (1/12) - On January 12, CBO released cost estimates of provisions from the Consolidated Appropriations Act, 2023. Medicare telehealth provisions scored at $2.3 billion over two years. the HDHP-HSA telehealth provision scored at $298 million over two years.

House Ways & Means Committee: Rep. Jason Smith (R-MO) Selected as Chairman of the House Ways & Means Committee (1/9) - Rep. Jason Smith (R-MO) was selected as the chairman of the House Ways & Means Committee. The House Ways & Means Committee has significant influence on health care policy with jurisdiction over Medicare, Medicare Advantage and Medicare prescription drug benefits, as well as a recently extended provision allowing employers and plans to cover telehealth services on a pre-deductible basis for individuals with high-deductible health plans coupled with a health savings account (HDHP-HSA). Rep. Smith (R-MO), who has served on the House Ways & Means Committee, Health Subcommittee, has advocated for expanding telehealth access in the Medicare program. He has introduced legislation to make audio-only telehealth access permanent. For additional coverage, see PoliticoPro. 

Rep. Buchanan (R-FL): Introduction of H.R. 134 (1/9) - On January 9, Reps. Buchanan (R-FL), Steel (R-CA), Johnson (R-OH), and Rutherford (R-FL) introduced H.R. 134, which would remove geographic requirements and expand originating sites for telehealth services. 

Administration

Administration for Strategic Preparedness & Response (ASPR): Renewal of the COVID-19 PHE (1/11) - On January 11, the Department of Health and Human Services (HHS) Secretary Becerra renewed the COVID-19 PHE. The COVID-19 PHE is now expected to end on April 11, 2023. While some major telehealth provisions were extended to December 31, 2024 in the omnibus package, regulations around the prescribing of controlled substances via telehealth are still yet to be addressed by the Drug Enforcement Administration (DEA). For more information on the Alliance's advocacy on this, see here. 

EXPECTED END OF THE COVID-19 PHE

Department of Veterans Affairs (VA): Telehealth Education (1/11) - The VA's Office of Connected Care released a webpage that has programs available for Veterans to access via telehealth. Programs include caregiver support services, enhanced fitness groups, self-management of chronic conditions, among others. 

Telehealth Research, Reports and Surveys

American Journal of Managed Care: Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees (1/13) - This study found that during the first year of the COVID-19 pandemic, California managed care enrollees had higher rates of telehealth use compared with Medicare fee-for-service (FFS) enrollees, regardless of insurer. Among FFS enrollees, those enrolled in Medicaid had higher rates of telehealth use compared with those insured by CalPERS. Telehealth policies should be aware of this heterogeneity, as well as its implications for equity of telehealth access.

American Journal of Managed Care: Health Systems and Telemedicine Adoption for Diabetes and Hypertension Care (1/12) - This study examines whether practice size and ownership were associated with more extensive adoption and maintenance of telemedicine for adults with diabetes and/or hypertension during the early stages of the COVID-19 pandemic. The study found that solo physician and advanced practice clinician-only practices had significantly lower telemedicine use among adults with diabetes with or without hypertension, highlighting the need for technical support for small practices. However, practices with higher proportions of Black patients continued to expand telemedicine use through the end of 2020, while practices with lower proportions of Black patients were de-adopting or maintaining telemedicine use levels. Practices with high shares of Black patients may have redesigned care more extensively to accommodate patients during the pandemic.

FAIR Health: Monthly Telehealth Regional Tracker (1/10) - Telehealth use fell 3.7 percent, from 5.4 percent of medical claim lines in September to 5.2 percent in October. The declines varied by regions, with larger dips in the South (6.8 percent), Midwest (4.9 percent) and West (4.1 percent), contrasting increased use in the Northeast (1.7 percent). The rankings of the top five telehealth specialties did not change nationally or regionally from September to October, as social worker remained the number one telehealth specialty. For additional coverage, see Health Leaders, and mHealth Intelligence. 

JAMA Network Open: Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer (1/10) – This economic evaluation of cost savings from completed telehealth visits in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center found that telehealth saves time, travel, and money for patients. The main outcome was estimated patient cost savings from telehealth, which included two components: costs of travel and potential loss of productivity due to the medical visit. Telehealth was associated with savings in patient time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Kaiser Family Foundation: Telehealth Delivery of Behavioral Health Care in Medicaid: Findings from a Survey of State Medicaid Programs (1/10) – Kaiser Family Foundation (KFF) surveyed state Medicaid officials about policies and trends related to telehealth delivery of behavioral health services. The survey found that states most commonly reported adding audio-only telehealth coverage of behavioral health services, which can help facilitate access to care, especially in rural areas with broadband access challenges and for older populations who may struggle to use audiovisual technology. Nearly all states reported expanding behavioral health services that are allowed to be delivered via telehealth, such as to newly allow telehealth delivery of group therapy or medication-assisted treatment (MAT). Finally, most states reported expanding the provider types that may be reimbursed for telehealth delivery of behavioral health services, such as to allow specialists with different licensure requirements (e.g. marriage and family therapists, addiction specialists, and peer specialists). See KFF’s press release for more information.

JAMA Health Forum: Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic (1/6) – This study found that the weekly rate of in-person mental health service utilization decreased by more than 50 percent after the start of the COVID-19 pandemic but concurrent increases in telehealth led to a slight increase in total utilization for anxiety disorders and stability in total volume of service for other disorders. For the three highest-prevalence diagnostic categories, researchers also found that service utilization continued to increase throughout 2020, primarily in the telehealth context. The findings suggest that the pandemic disrupted in-person mental health care but expansion of telehealth enabled care for an increasing number of patients. For additional news coverage, see Fierce Healthcare, Politico, and Stat News.

“The policy takeaway is that telehealth is a widely used modality for behavioral health care. Restricting telehealth use of behavioral health services would likely lead to reductions in behavioral health care.” 

Christopher Whaley, Health Economics, RAND Corporation

Journal of Telemedicine and eHealth: Environmental Impact of Ambulatory Telehealth Use by a Statewide University Health System During COVID-19 (12/23) - A study by UC Davis Health researchers assessed telehealth visits’ carbon footprint and their potential savings in lives, costs and time compared to in-person visits. The study found substantial savings for patients and the environment, including eliminating the need to commute 53,664,391 miles. Telehealth also saved an estimated 204 years of travel time, $33,540,244 travel-related costs and 42.4 injuries and 0.7 fatalities. The findings showed that telehealth can be a safe, efficient and cost-effective method to address climate change. Researchers recommended telehealth ambulatory services as a patient-friendly mode of care, even when the pandemic is over. For additional coverage, see Newswise and Becker's Hospital Review. 

Telehealth News and Market Developments

PR Newswire: Remote Patient Monitoring Solutions Can Help The Nearly 143 Million Americans Keep Weight Loss Resolution During National Staying Healthy Month (1/12) - During January's National Staying Healthy Month, millions of Americans have made a resolution to lose weight in 2023. Remote patient monitoring (RPM) devices and data can provide these people with key resources to help them reach their goals of a healthier life this year and beyond. Smart Meter's iScale immediately sends an individual's self-weighing reading to a portal where the individual can track their progress over time. In addition, it is also sent to their health care professional who can provide guidance and support without the need for an office visit. 

Fierce Healthcare: Telehealth Expansion Allies to Helm Key House Committees (1/11) - The new leaders of the influential House Ways & Means Committee and the House Energy & Commerce Committee have previously been fierce advocates for extending telehealth services. Both House Energy & Commerce Committee Chair McMorris Rodgers (R-WA) and House Ways & Means Committee Chair Smith (R-MO) are aligned on how to keep telehealth flexibilities around. Both will likely play a pivotal role in the future of telehealth.

Healthcare IT News: Connecticut Children's Care Network Adds Telehealth Breastfeeding Support (1/10) – As part of a new collaboration with the Connecticut Children's Care Network, Nest Collaborative will provide unlimited same-day telehealth appointments with certified lactation consultants for parents in need of prenatal and perinatal breastfeeding support. The network is collaborating with the nation's first and largest virtual lactation consultation platform, which provides services in more than 10 languages seven days a week in all 50 states, to improve the success of breastfeeding. The virtual care services will be delivered without copays, out-of-pocket costs or deductibles for families with active insurance or Medicaid coverage.

Kaiser Health News: Behavioral Telehealth Loses Momentum Without a Regulatory Boost (1/10) - To help patients get access to care while maintaining physical distance, the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) waived restrictions on telehealth for controlled substances. Congress also tweaked rules around buprenorphine, doing away with a long-standing policy to cap the number of patients each provider can prescribe to. Ultimately, however, the DEA is the main regulatory domino yet to fall for telehealth providers. More clarity on the future of online treatment could result from permanent regulations from the DEA. For more information on this issue, check out the Alliance's advocacy work.

Healthcare IT News: With Epic-Linked RPM, Lee Health Is Sending Fewer People to Hospitals and ERs (1/10) – Not too long ago, about 17 percent of remotely monitored patients needed a higher level of care. Today it's in the three percent to five percent range, keeping more people in their homes and coordinating their care. Remote patient monitoring expands the reach of telehealth by allowing providers to collect questionnaires from patients that could help detect early clues of an exacerbation, decompensation or deterioration. Surveys show Lee Health has highly engaged patients who are very satisfied with their overall care, equipment and the program itself.

"Telehealth isn't meant to just be a replacement for in-person visits – it's a complement. After someone is seen by their primary care physician, they can use telehealth to check in and spot-check, so the patient doesn't need to physically come into the office as much, but they still can get the personalized care they need to help with their condition." 

Dr. Zsolt Kulscar, Lee Health

American Medical Association: What it Takes to Create a First-Class Telehealth Experience (1/10) - A first-class telehealth experience means providing the proper care to patients after the visit and promptly giving them information and instructions. Offering a virtual visit desktop and a mobile app creates a convenient, streamlined way for patients to access their information. It captures the physician’s notes, prescriptions, and care plans and makes these easily accessible to patients. Also, it’s critical to have a responsive product and support team that listens to your needs. 

Business Wire: Omada Health Partners with Intermountain Healthcare (1/9) - Omada Health, a virtual, integrated chronic care health care provider, and Castell, Alliance board member Intermountain Healthcare’s value-based care subsidiary, have entered into a partnership that expands the access of Omada’s Diabetes Prevention Program and Diabetes Program to patients and caregivers receiving care from Intermountain Healthcare’s primary care providers within its Utah Medical Group. Castell will help to target and enroll eligible patients through their existing care pathways. Patients who have, or are at risk for, diabetes will be proactively contacted by Castell care coordinators and Intermountain providers to give them the option to enroll into the appropriate Omada program. For additional coverage, see mHealth Intelligence.

Healthcare IT News: Taming the Beast of Multistate Provider Licensure for Telemedicine (1/9) – Healthcare IT News sat down with Eric Demers, CEO of Madaket, vendor of a provider data management platform, to discuss his point of view on how to streamline telehealth licensing and ensure top-level, on-demand care for the patients who need it most. Demers noted, “…there are real economic consequences to delays in the licensing process. Individual providers will not be allowed to practice until their license is approved, which can extend for several months if the information supplied is not accurate and complete.”

State Telehealth Activity

Inside Telehealth: Interstate Compacts, Controlled Substance Prescribing, Payment Parity: Over 200 State Telehealth Bills Pre-Filed For 2023 (1/12) - More than 200 telehealth bills were pre-filed by states last year for the 2023 legislative session, including proposed laws letting states join interstate compacts, prescribing laws that include controlled substances, and payment parity laws. Interstate licensure is the next frontier for states in the expansion of telehealth. Cross-state licensing has been made available by interstate compacts, which an increasing number of states are attempting to join this year. 

Inside Telehealth: FBI Misinterpreting Law, Slowing Interstate Telehealth (1/10) – Five interstate licensure compact leaders say the FBI is misinterpreting state laws that require federal background checks of providers, which is preventing, or slowing, states from joining interstate licensure compacts as demand for treatment across state lines via telehealth skyrockets with the recent two-year extension of most COVID-19 pandemic-era waivers. Confusion among compact leaders remains as they scramble to find a way to remedy the miscommunication on background checks and question whether proposed solutions would even be effective due to a lack of response from the FBI. Last Congress, Rep. Mann (R-KS) introduced the States Handling Access to Reciprocity for Employment Act to expedite and streamline the current licensing process and clarify any misconceptions surrounding background check requests. If reintroduced and passed, the legislation would in essence direct the FBI that if a state has a background check requirement because it has joined a state compact, the agency must approve the request eliminating some of local FBI’s discretion.

Government Technology: Telemedicine Gets a Doctor's Eyes in the Ambulance in South Dakota (1/10) - South Dakota’s Telemedicine in Motion program mitigates a critical shortage of experienced paramedics by connecting a doctor or nurse via video and audio to the paramedic in the back of the ambulance. It’s one of three funding initiatives that resulted from Gov. Kristi Noem’s request to infuse up to $20 million into EMS in South Dakota. The other two are for equipment and regional or legislative structure.

Inside Telehealth: Alabama Lawmaker Gears Up To Expand State’s Use Of Telehealth In 2023 (1/9) – Alabama state senator Bobby Singleton (D) hopes to overcome state medical board objections and generate enough bipartisan support in 2023 to allow telehealth prescribing of controlled substances and expand virtual care’s role in Alabama’s Medicaid program. According to the senator, Alabama is the only state in the country that has not allowed providers to prescribe narcotics via telehealth during the COVID-19 pandemic as allowed by the federal government. The state senator also hopes to expand telehealth coverage for Alabama residents on Medicaid.

Upcoming Events & Hearings 

January 17 – California Telehealth Resource Center, "School Health Services Provided via Telehealth: Where are we now?"

January 18 – Center for Connected Health Policy, “Telehealth Policy in 2023.”

January 31 – American College of Healthcare Executives, "Telemedicine and the Changing Healthcare Landscape." 

February 9 – California Telehealth Resource Center, “Remote Patient Monitoring Event: Learn, Engage, Advance.”

February 16 – Mid-Atlantic Telehealth Resource Center, "Utilizing Innovations in Telehealth to Advance the Care of Patients in Congregate Settings." 

February 24 – Central Michigan University, "Tele-Mental Health Symposium." 

March 15 – Mid-Atlantic Telehealth Resource Center, “2023 Summit.”

April 17-21 – Healthcare Information and Management Systems Society, “HIMSS23 Global Conference & Exhibition.”

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