Alliance News2024-04-18T13:05:37-04:00

Finally – Action on Prescribing Through Telehealth

Last week, we finally saw a proposed rule – “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have not had a Prior In-Person Medical Evaluation” arrive at OMB.  We expect that this proposed rule will avert the current end of telehealth prescribing flexibility on December 31, 2024.  However, there remains significant risk of patients losing access to care due to the rulemaking.

We also saw two major policy developments in this space last week, outlining the opportunities and risks for telehealth access.

  • First – our nation’s foremost medical societies and behavioral health voices called on the Administration to ensure that patients – both child and adult – are able to receive prescriptions to non-narcotic stimulants necessary for care through telehealth.
  • Second, the Department of Justice made a major arrest related to the prescribing of Adderall over the internet.

So, what does this mean?

The letter to Drug Enforcement Administration (DEA) demonstrated the widespread agreement that telehealth is absolutely crucial for the ability of psychiatrists, pediatricians, mental health professionals, and patients to offer and receive treatment.  They make it clear that there is no option to go back to a world in which these providers and patients have additional barriers to health care access.

The enforcement actions by DEA put an exclamation point on their previously shared concerns with stimulant prescribing.   In our view, these actions demonstrate that “wild west” period of virtual care spawned in 2020 has come to a close.  The actions show that regulators are closely scrutinizing the practices of organizations that stretched the traditional boundaries of health care and are now taking important steps to rein in those who may have overstepped.

Moving forward, we hope to see a rulemaking that focuses on the special registration process for telemedicine that is required by statute, but without the significant and burdensome in-person visit requirements that were featured in the previous proposed rule – and which would have cut many patients off from access to care.

As you might expect from the updates above, a major area of debate for this rulemaking will be around non-narcotic stimulants – which were heavily restricted by the previous proposed rule.  It’s clear that access to these treatments through telehealth are needed by patients and medical providers.  Its also now clear that the DEA has the will and enforcement capability to monitor this space and protect patients.  With a special registration process in place, the DEA would have even more tools and capability to monitor prescribing and intervene when needed.

Will an answer as simple as registration and enforcement emerge in the proposed rule?  It’s unlikely.  We are eagerly awaiting the details of the proposal from DEA.  Ideally one that listens to clinical voices, continues investigating potential bad actors, and – most importantly – ensures the lifeline of telehealth is not severed.

Join us in advocating for continued access to telehealth!

June 17th, 2024|

Mental Health Groups Sent Letter on Schedule IIN Non-Narcotic Prescribing

Mental Health Groups Sent Letter on Schedule IIN Non-Narcotic Prescribing

Mental health groups are pushing the agency to allow Schedule IIN non-narcotic drugs to be prescribed without an in-person visit. Those include stimulants used to treat attention-deficit/hyperactivity disorder.

A coalition of mental health groups, including the American Psychiatric Association, the American Academy of Pediatrics and the Kennedy Forum, wrote to the DEA on Tuesday, saying that not allowing such drugs to be prescribed without an in-person visit as it previously proposed would be a mistake.

The Alliance was pleased to support the effort around this letter.

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June 11th, 2024|

Over 380 Clinicians Send Letter to DEA

Over 380 clinicians and practitioners signed a letter, requesting the DEA to issue a revised proposed rule to regulate the prescribing of controlled substances through telehealth as soon as possible to ensure adequate time for patients to continue existing care.

To read a full copy of the stakeholder letter, please click here.

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May 9th, 2024|

Alliance Submits Letter to AMA On Remote Monitoring

The Alliance for Connected Care sent a letter to the American Medical Association’s (AMA) CPT Editorial Panel in response to its May 2024 meeting agenda, which includes Tab 38 – Remote Monitoring.

The Alliance appreciates the consideration of stakeholder feedback into the revised proposal to ensure coding for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) accurately and appropriately represents the clinical utilization of these services by clinicians and care teams.

Read the full letter here, or below.

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April 25th, 2024|

Alliance Submits Statement for the Record for House Energy & Commerce Hearing on Telehealth Legislation

The Alliance for Connected Care submitted a statement for the record to the House Energy & Commerce Committee, Health Subcommittee for the legislative hearing, “Legislative Proposals to Support Patient Access to Telehealth Services.”

The Alliance focused its comments on:

  1. The need for urgent action in extending Medicare telehealth provisions through December 31, 2024 to provide certainty around the future of telehealth.
  2. Endorsed telehealth legislation and urged the Subcommittee to advance bipartisan legislation.
  3. Several recommendations that Committee should consider to permanently expand access to telehealth.
  4. Recommendations for fraud, waste, and abuse.

Read the full letter here, or below.

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April 9th, 2024|

Alliance Co-Leads Letter to DEA Urging Action on Telehealth Rule Crucial for Mental Health, Substance Use Disorders

FOR IMMEDIATE RELEASE                                                     

Stakeholders Send Letter to DEA Urging Action on Telehealth Rule Crucial for Mental Health, Substance Use Disorders

WASHINGTON, DC, APRIL 2, 2024 – The Alliance for Connected CareAmerican Telemedicine Association, ATA Action, the Consumer Technology Association, and the Healthcare Information and Management Systems Society, co-leading the effort, submitted a letter to the U.S. Drug Enforcement Administration (DEA) requesting the expedited release of a revised proposed rule to permit and regulate the prescribing of controlled substances through telehealth. The letter was signed by 214 stakeholders. Current flexibilities allowing for the remote prescribing of controlled substances are set to expire at the end of this year, necessitating regulatory action to ensure their continuation.

Stakeholders praised the DEA for their leadership and actions taken to ensure continued patient access to care be delivered through telemedicine in advance of the final telemedicine regulations expiring at the end of this year. The letter also urged DEA to propose the updated rules immediately for the following reasons:

  • To ensure stakeholders have adequate time to provide feedback on any policy proposal.
  • If DEA were to create a special registration process for telehealth prescribers, as proposed by DEA and many stakeholders, substantial operational lead-time would be needed to implement the new process and comply with other potential operational requirements and guardrails.
  • A rulemaking late in the year that makes significant policy changes would affect the ability of patients and clinicians to make appointments and ensure consistent access to care.
  • There will be operational staff training needs for pharmacies and other parts of the healthcare delivery system to ensure patients uninterrupted access to needed medical treatments offered through telehealth.
  • DEA’s national leadership is needed to set a clear path forward for the nation and to encourage more consistent definitions and aligned requirements from state regulatory bodies – to encourage care in our most underserved areas, without geographic barriers limiting access to care.

To read a full copy of the stakeholder letter, please click here.

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April 2nd, 2024|

Alliance Statement – Correcting the Record for House Ways & Means Hearing on Care in the Home

Correcting the Record on Telehealth
March 2024

During the March 12 House Ways and Means Committee Hearing on Expanding Access to Care at Home in Rural and Underserved Communities, a number of already disproven myths about telehealth were publicly repeated. While broader understanding of the benefits and use of telehealth have come a long way, these outdated misconceptions continue to undermine policymaking and must be corrected.

Importantly, the Alliance and its members believe that an in-person visit requirement is never the right guardrail for a telehealth service – because these requirements harm patients with access challenges, such those who are frail or homebound, have transportation issues, or live in rural or underserved areas. Similarly, we believe that a clinician’s time has the same value, no matter if they are supporting a patient virtually or in-person.

Correction #1 – Telehealth Does Not Lead to Increased Fraud

In 2021, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a statement clarifying the difference between telehealth fraud and “telefraud”, with the latter involving the use of telemarketing to defraud patients. The letter emphasizes OIG’s investigations, which found that perpetrators billed fraudulently for other items and services, like durable medical equipment or genetic tests, but did not bill for a telehealth visit.  Importantly, OIG did not document telehealth services fraud.

In February of 2024, OIG released a report, which found that telehealth services provided to Medicare beneficiaries complied with Medicare requirements and did not show evidence of fraud. The report examined telehealth services provided to Medicare beneficiaries from March 2020 through November 2020, the peak of telehealth usage.

Telehealth is no more susceptible to billing fraud than in-person services.  Rather than focusing on telehealth, Congress and the Administration should continue to focus on identifying and addressing fraudulent behavior across the entire Medicare program through tools like a stronger provider enrollment process and enhanced monitoring.

Correction #2 – Telehealth Has Not Been Shown to Drive Overutilization

The Assistant Secretary for Planning and Evaluation (ASPE) has consistently found that the utilization of telehealth among Medicare fee-for-service (FFS) beneficiaries continue to be above pre-pandemic levels, but is not showing signs of growth.  As you might expect telehealth service utilization is higher among vulnerable populations due to their greater need for care from the severity and complexity of their illness.

The Alliance and many other organizations have looked telehealth utilization in the context of total Medicare utilization and shown that telehealth services have generally leveled off around 5 percent, while total utilization has not significantly grown. Telehealth did not add to the total volume of Medicare services in nearly all of the telehealth-eligible services examined.

Robust research has found that telehealth substitutes for in-person care rather than contribute to overutilization. An Agency for Healthcare Research and Quality (AHRQ) funded study, analyzed more than four million primary care encounters, and found little change in health care utilization as telehealth became widely accessed.

The Alliance’s commissioned independent Medicare claims data also found no evidence that patients initiating care who used telehealth had more E&M revisits for the same medical issue than patients with in-person visits.

A study conducted by Epic Research found that follow-up rates were less for telehealth than in-person office visits. Most specialties have greater rates of same-specialty in-person follow-up in the 90 days after in-person office visits than after telehealth visits.

Correction #3 – Telehealth Has Not Been Shown to Increase Spending

A growing body of evidence has found that telehealth is associated with lower no-show and cancellation rates. No-shows cost health care providers $150 billion every year.

An AHRQ-funded study fund that telehealth reduced primary care spending due to lower emergency department utilization and inpatient hospitalizations.

The Alliance’s commissioned independent Medicare claims data also found that the average per service cost of an E&M telehealth visit to the Medicare program is less than in-person services by approximately 20 percent. The reason for this difference was that telehealth clinicians generally billed shorter visit codes than in-person providers.

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March 14th, 2024|

Alliance Submits Statement for the Record for House Ways & Means Hearing on Care in the Home

The Alliance for Connected Care submitted a statement for the record to the House Ways & Means Committee for the hearing, “Enhancing Access to Care at Home in Rural and Underserved Communities.”

The Alliance focused its comments on:

  1. The need for urgent action in extending Medicare telehealth provisions through December 31, 2024 to provide certainty around the future of telehealth.
  2. Committee to work with the Centers for Medicare and Medicaid Services (CMS) to ensure virtual care meet the needs of Medicare beneficiaries is valuable and should be continued.
  3. Several recommendations that Committee should consider to permanently expand access to telehealth, particularly for those patients in rural and underserved areas.
  4. Recommendations for fraud, waste, and abuse.

Read the full letter here, or below. The Alliance also released a statement correcting the record on some misconceptions mentioned from the hearing.

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March 12th, 2024|

Alliance Joins Statement to DEA on Geographic Red Flag in Telemedicine

The Alliance for Connected Care joined over 45 organizations in a statement to the Drug Enforcement Administration (DEA), requesting explicit guidance to the pharmacy community that the geography of a prescriber in relation to the patient or the pharmacy should not be a “red flag” when a prescription is a result of a telehealth visit.

Read the letter here or below:

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March 6th, 2024|

Alliance Leads Over 200 Organizations in a Letter Urging Congress to Act on Telehealth

The Alliance for Connected Care convened well over 200 organizations on a letter, urging congressional leaders to act on telehealth earlier this year, to allow for implementation time prior to the expiration of statutory restriction on December 31, 2024.

Without timely and decisive action from Congress, many Americans risk losing access to telehealth services they rely upon due to challenges with 2024 timelines needed to ensure 2025 benefits – such as federal payment rules, employer and health plan benefit decisions, and health provider workforce decisions.

For more information and the Alliance’s advocacy, please click here.

Read the letter here or below:

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February 22nd, 2024|
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