Alliance Submits Comments to the Proposed CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS)
The Alliance for Connected Care submitted comments in response to the CMS Calendar Year (CY) 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule.
The Alliance applauded the proposal to ensure the continuation of patient access to mental health services from hospital-based providers after the conclusion of the COVID-19 public health emergency (PHE). The Alliance is committed to leveraging telehealth and remote patient monitoring to improve the quality of care while also lowering costs and improving efficiency, and we believe this extension will help to serve all three of those aims.
To read the full letter, click here or see below:
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Open in new tab Hundreds of Stakeholders Call on Senate Leaders to Make Telehealth a Priority This Fall
Washington, DC, September 13, 2022 – Today, an astounding 375 organizations sent a joint letter to bipartisan leadership of the U.S. Senate urging action on telehealth legislation this fall. Policy certainty beyond the COVID-19 public health emergency (PHE) is essential to continuing access to telehealth for both Medicare and commercial market patients.
The letter urges the Senate to pass a two-year extension of important telehealth policies enacted at the start of the COVID-19 pandemic, which are currently set to expire 151 days after the end of the PHE. The letter represents the diversity of groups across the health care spectrum whose constituencies are impacted by telehealth policy – from consumer groups representing mental health, chronic disease, primary care; and providers including physicians, nurses, physical therapists; to employers representing millions of Americans who receive their coverage through their jobs.
The letter calls on the Senate to pass legislation that would extend critical telehealth flexibilities, including provisions to waive provider and patient location limitations, remove in-person requirements for telemental health, ensure continued access to clinically appropriate controlled substances without in-person requirements, and increase access to telehealth services in the commercial market, including for those with a high-deductible health plans coupled with a health savings account (HDHP-HSA).
“More than 400 members of the House voted to extend telehealth flexibilities in July, and it’s time for the Senate to follow. Without more policy certainty around telehealth, beneficiary access could be compromised,” said Krista Drobac, Executive Director, Alliance for Connected Care. “The House created the momentum, we hope the Senate will seize it and enact comprehensive telehealth legislation this fall.”
Patient satisfaction surveys and claims data from CMS and private health plans demonstrate that many Americans have come to see telehealth as one of the most positive improvements to our nation’s health care system in recent memory. Telehealth has also helped to bridge gaps in care, especially in communities facing significant workforce shortages. Importantly, almost three in four Americans “strongly agree” or “somewhat agree” that patients should have the option to receive telehealth, even after the pandemic, which increases to 84 percent among recent telehealth patients. Most recently, reports from the HHS Office of Inspector General showed that that dually-eligible beneficiaries were more likely than others to use telehealth to ensure access to care and that telehealth expanded access for minority populations.
The joint letter was co-led by the Alliance for Connected Care, American Telemedicine Association (ATA), College of Healthcare Information Management Executives (CHIME), Connected Health Initiative, Consumer Technology Association, Executives for Health Innovation, Health Innovation Alliance, HIMSS, and Partnership to Advance Virtual Care.
To read the full letter, click here or see below:
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FOR IMMEDIATE RELEASE
CONTACT:
Chris Adamec
(571) 225-6792
cadamec@connectwithcare.org
Alliance Statement on HHS OIG Telehealth Reports
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September 7, 2022, Washington, D.C. – The only way to truly understand the impact of covering telehealth in Medicare on fraud is the analysis of real data. The HHS Office of the Inspector General (OIG) continues to do just that, and we applaud their efforts. These reports add to the growing body of evidence showing that telehealth meaningfully expands access to care, and that long-term telehealth expansion is feasible with some limited steps to ensure continued oversight and evaluation.
We agree with most of the findings and recommendations of HHS Office of the Inspector General (OIG) thus far, and look forward to a more conclusive finding that covering treatment of seniors virtually does not uniquely expose Medicare to fraud.
The reports released today build on the OIG report “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic” from earlier this year. The new reports include:
- HHS OIG: Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others To Use Telehealth During the First Year of the COVID-19 Pandemic
- OIG Report: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks
The Alliance was pleased to see the continued evaluation of beneficiary access through telehealth show that that dually-eligible beneficiaries, and some minority populations were more likely than others to use telehealth to ensure access to care. The finding that audio-only services benefitted older beneficiaries, the dually eligible, and Hispanic populations emphasize the importance of maintaining access to audio-only telehealth services. While OIG found greater utilization of telehealth in urban areas, we believe this number is likely skewed by the effect of COVID-19 on urban populations, rather than to indicate any long-term utilization trend. OIG made the following subsequent recommendations:
- Take appropriate steps to enable a successful transition from current pandemic-related flexibilities to well-considered long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary’s home,
- The Alliance agrees with this recommendation
- Temporarily extend the use of audio-only telehealth services and evaluate their impact,
- The Alliance agrees with this recommendation
- Require a modifier to identify all audio-only telehealth services provided in Medicare, and
- The Alliance supported a modifier in our 2023 Physician Fee Schedule comments
- Use telehealth to advance health care equity.
- The Alliance strongly agrees that telehealth can help reach underserved populations
The Alliance also appreciated OIG’s evaluation of program integrity risks related to telehealth during the COVID-19 pandemic. OIG examined a selected group of providers that they believe pose a higher risk to the Medicare program, but did not draw any conclusions around the use of telehealth and if there is any relation to fraud. OIG recommends the following actions:
- Strengthen monitoring and targeted oversight of telehealth services,
- The Alliance has supported additional oversight to ensure bad actors do not undermine access to telehealth in Medicare.
- Provide additional education to providers on appropriate billing for telehealth services,
- The Alliance strongly agrees that provider education is useful, as accidental misbilling has in the past been interpreted as fraudulent. Similarly, HHS steps to simplify telehealth billing are welcomed.
- Improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service,
- The Alliance recognizes the importance of accurate data for analysis. We also stress the importance maintaining “incident to” services for healthcare practitioners unable to bill the Medicare program directly.
- Identify telehealth companies that bill Medicare, and
- If a provider, including a virtual-only provider, wants to bill Medicare directly, they must enroll in Medicare, thereby giving CMS oversight of that provider. We don’t believe there is clear justification for singling out virtual-only providers, particularly when Medicare beneficiaries are overwhelmingly seeing providers that use telehealth services in addition to maintaining brick and mortar. Given that virtual-only is a new modality, limited steps to improve CMS’s understanding and oversight of these providers seems logical, and if it helps prevent limits on beneficiary access to telehealth, then we support it.
- Follow up on the providers identified in this report.
- The Alliance supports OIG investigations into fraudulent behavior in the Medicare program, because these investigations are necessary to differentiate between possible telehealth services issues and much more likely marketing fraud that OIG has continued to identify and report on.
HHS OIG: Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others To Use Telehealth During the First Year of the COVID-19 Pandemic
HHS OIG: Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others To Use Telehealth During the First Year of the COVID-19 Pandemic
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report which
- Expands on the telehealth utilization report released earlier this year; and
- Examines the characteristics of beneficiaries who used telehealth during the first year of the pandemic.
The full report can be found here.
What OIG Found
Beneficiaries in urban areas were more likely than those in rural areas to use telehealth during the first year of the pandemic. Beneficiaries in Massachusetts, Delaware, and California were more likely than beneficiaries in some other States to use telehealth. Dually eligible beneficiaries (i.e., those eligible for both Medicare and Medicaid), Hispanic beneficiaries, younger beneficiaries, and female beneficiaries were also more likely than others to use telehealth. In addition, beneficiaries almost always used telehealth from home or other non-health-care settings. Furthermore, almost one-fifth of beneficiaries used certain audio-only telehealth services, with the vast majority of these beneficiaries using these audio-only services exclusively. Older beneficiaries were more likely to use these audio-only services, as were dually eligible and Hispanic beneficiaries.
OIG recommends that CMS: (1) take appropriate steps to enable a successful transition from current pandemic-related flexibilities to well-considered long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary’s home, (2) temporarily extend the use of audio-only telehealth services and evaluate their impact, (3) require a modifier to identify all audio-only telehealth services provided in Medicare, and (4) use telehealth to advance health care equity. CMS did not explicitly indicate whether it concurred with our four recommendations.
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OIG Report: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks
OIG Report: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks
The Department of Health and Human Services (HHS) Office of Inspector General released a report which describes
- Providers’ billing for telehealth services; and
- Identifies ways to safeguard Medicare from fraud, waste, and abuse related to telehealth.
The full report can be found here.
What OIG Found
OIG identified 1,714 providers whose billing for telehealth services during the first year of the pandemic poses a high risk to Medicare. These providers billed for telehealth services for about half a million beneficiaries. They received a total of $127.7 million in Medicare fee-for-service payments. Each of these 1,714 providers had concerning billing on at least 1 of 7 measures OIG developed that may indicate fraud, waste, or abuse of telehealth services. All of these providers warrant further scrutiny. For example, they may be billing for telehealth services that are not medically necessary or were never provided. In addition, more than half of the high-risk providers we identified are a part of a medical practice with at least one other provider whose billing poses a high risk to Medicare. This may indicate that certain practices are encouraging such billing among their associated providers. Further, 41 providers whose billing poses a high risk appear to be associated with telehealth companies; however, there is currently no systematic way to identify these companies in the Medicare data.
OIG recommends that CMS: (1) strengthen monitoring and targeted oversight of telehealth services, (2) provide additional education to providers on appropriate billing for telehealth services, (3) improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service, (4) identify telehealth companies that bill Medicare, and (5) follow up on the providers identified in this report. CMS concurred with our recommendation to follow up on the providers identified in this report, but CMS did not explicitly indicate whether it concurred with the other four recommendations.
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Comment Letter on CY 2023 Physician Fee Schedule Proposed Rule
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The Alliance for Connected Care submitted comments on the Medicare Physician Fee Schedule (PFS) Proposed Rule for calendar year (CY) 2023, which includes several important reforms with respect to telehealth.
The Alliance emphasized the following overarching priorities:
- While we appreciate and support the effort from CMS to create more temporary Category 3 codes (and its proposal to retain these codes through the end of CY 2023), we are disappointed CMS did not find sufficient clinical benefit to add any of the proposed Category 1 or Category 2 codes. We continue to believe these temporary codes do not represent the forward movement on telehealth needed. The Administration should be moving to create the stability and predictability needed for health care providers and patients to plan for future health needs. Additionally, we believe that the lack of forward movement on codes does not align with the significant body of evidence that has developed around the usage of telehealth services and their impact on quality and patient access.
- While we recognize statutory requirements exist, we remain concerned with steps taken by CMS around in-person visit requirements and we encourage CMS to apply these requirements to the minimum extent required by law. The Alliance and its members strongly believe that an in-person requirement constrains telehealth from helping individuals that are homebound, have transportation challenges, live in underserved areas, or have other needs. This reduces access for those who need it the most, while allowing access for those capable of in-person care.
- There continues to be a misconception among many that telehealth is separate and different from in-person care. It is not. It was shown during the pandemic that Medicare telehealth services were used simply as a different modality for a patient’s existing providers to improve access and maintain continuity of care. Given this evidence, we believe limiting non-facility providers to a lower facility payment rate for telehealth would have the effect of disincentivizing telehealth usage by a patient’s existing in-person provider and undermining opportunities to increase patient access.
- We strongly support the continued availability of direct supervision through telehealth. The option for virtual direct supervision has been proven to be a meaningful tool to maintain teams remotely during a public health emergency. However, this expansion of health system capability is needed for more than just public health emergencies – it is also a meaningful tool to meet health care workforce challenges – both in the delivery of care and to grow the workforce through more flexible academic settings.
Please find the full comments below or here.
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Alliance Submits Comments in Response to CMS RFI on Medicare Advantage
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The Alliance for Connected Care submitted comments in response to the request for information from the Centers for Medicare & Medicaid Services (CMS) on the Medicare Advantage (MA) program.
The Alliance specifically commented on the role that telehealth has played in providing access to care in the MA program and key policy considerations for CMS to ensure this care modality is available and effectively utilized within the MA program moving forward. Top recommendations to CMS include:
- Move forward with dramatic expansions to the use of telehealth to meet network adequacy requirements;
- Clarify that the use of diagnoses obtained through audio-visual telehealth for risk adjustment purposes will continue after the end of the PHE; and
- Promote additional paths to access practitioners across state lines by supporting licensure portability and ensuring that these providers count toward appropriate network adequacy requirements.
The Alliance believes telehealth has the potential to broaden access to care and improve patient engagement. It is imperative to ensure critical telehealth services continue to be available to MA beneficiaries, especially those in underserved communities, once the public health emergency ends.
To read the full letter, click here or see below:
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Alliance Submits Comments in response to the Health and Human Services’ Strengthen Primary Health Care RFI
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The Alliance for Connected Care submitted comments in response to the request for information from the Department of Health and Human Services (HHS) on strengthening primary health care.
The Alliance specifically commented on impact of telehealth in primary care access. The Alliance recommends the HHS to:
- Prevent restrictions, such as in-person visits requirements on primary care, that prevent telehealth from effectively bridging primary care gaps, especially in areas where the primary health care workforce is already limited;
- Reduce payment or practice barriers restricting the locations from which providers can offer telehealth (such as their homes) – creating greater flexibility for care that meets patient needs;
- Promote additional paths to cross-state licensure and support licensure portability by convening experts and support the development of a voluntary, national framework for interstate licensure using a policy of mutual recognition;
- Continue and enhance ongoing efforts to ensure equitable broadband infrastructure;
- Work with Congress to continue access to pre-deductible coverage of telehealth services for HDHPs-HSAs as created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (P.L. 116-136); and
- Continue access to audio-only telehealth when clinically appropriate and needed or requested by the patient.
The Alliance believes telehealth and remote patient monitoring are a solution to improve primary care. The value of telehealth and cross-state care provides greater access to primary health care, addresses primary care access in rural and medically underserved communities, and provides patients affordable ways to access primary care via telehealth.
To read the full letter, click here or see below:
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Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder
American Journal of Psychiatry: Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder
According to this study, drug treatment of veterans with opioid use disorder increased during the first year of the pandemic. This suggests that the rapid shift from in-person to telehealth visits at Veterans’ Affairs (VA) medical centers enabled patients to access care despite COVID-related disruptions. The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits, suggesting that any reversal of COVID-19 policies must be carefully considered as it could prevent VA patients from receiving buprenorphine via telehealth. For additional coverage, see Stat News, U.S. News & World Report, and University of Michigan.
Senate Includes Numerous Telehealth Provisions in the FY 2023 Senate Appropriations Committee Report
On July 28, 2022, the Senate Committee on Appropriations released the Report for the Departments of Labor, Health and Human Services, Education, and Related Agencies for Fiscal Year 2023 Appropriations, as well as the bill text making appropriations for these departments for FY2023. The report includes specific instructions with respect to the appropriated amounts. The House previously released its Report for the Departments of Labor, HHS, Education, and Related Agencies for FY2023 on June 29, 2022.
Final text merging the House and Senate appropriations provisions will be available later this year. Below is a topline of the key telehealth provisions included in the Senate report language. For reference, a list of the notable telehealth provisions included in the House report language can be found here.
HHS Office of the Secretary
- Ensuring Equity in Telehealth Policies. —The COVID–19 pandemic has exposed an array of related health disparities, including a difference in severity and outcomes by race and ethnicity; geographic location; and socioeconomic status. The rapid expansion of telemedicine has been an effective tool in mitigating barriers to care during the pandemic. The Committee recognizes that focusing on health equity when considering telehealth policies is imperative to ensuring the needs of underserved communities are met. Therefore, the Committee directs HHS to prioritize equity as a consideration when making decisions on telehealth policy during and after the COVID–19 public health emergency and to report to Congress within 60 days after the end of the public health emergency how it is using telehealth to sustain equitable access.
Substance Abuse and Mental Health Services Administration (SAMHSA)
- Opioid Use in Rural Communities. — The Committee encourages SAMHSA to support initiatives to advance opioid use prevention, treatment, and recovery objectives, including by improving access through telehealth.
Health Resources and Services Administration (HRSA)
- Telehealth. — The Committee provides $40,050,000, an increase of $5,000,000, for the Office for the Advancement of Telehealth [OAT], which promotes the effective use of technologies to improve access to health services for people who are isolated from health care and to provide distance education for health professionals. The Committee strongly supports OAT and their mission to expand high quality medical care to rural communities that do not have adequate access to medical providers including many medical specialties.
- Telehealth Centers of Excellence. — The Committee provides $8,500,000 for the Centers to continue to validate technologies and reimbursement mechanisms, establish training protocols, and develop comprehensive templates for States to integrate telehealth into their State health provider networks. The Centers identify best practices, serve as national training resources and test the efficacy of different telehealth clinical applications. The Centers serve to promote the adoption of telehealth programs across the country by validating technology, establishing training protocols and by providing a comprehensive template for States to integrate telehealth into their State health provider network. Funding should serve to promote the adoption of telehealth services nationwide and help address the access to care issue faced by rural America.
- Pediatric Mental Health Care Access. — The Committee provides $11,000,000 for expanding access to behavioral health services in pediatric primary care by supporting the development of pediatric mental healthcare telehealth access programs.
Other Notable Provisions
- CDC – Sexually Transmitted Infections. — The Committee includes an increase of $15,000,000 to combat the high incidence of STIs. The Committee encourages the Centers of Disease Control and Prevention (CDC) to work with other agencies, as appropriate, to develop innovative approaches including the use of telehealth platforms and at home specimen collection to increase screening, treatment, and education to curb the spread of STIs in vulnerable populations.
- AHRQ – Center for Primary Care Research. — The Committee includes $5,000,000, an increase of $3,000,000 over fiscal year 2022, for the Center for Primary Care Research, which supports primary care clinical research and dissemination including translating science into patient care, better organizing health care to meet patient and population needs, evaluating innovations to provide the best health care to patients, and engaging patients, communities, and practices to improve health. The center should also help coordinate and inform AHRQ’s efforts in research areas such as multiple chronic conditions, symptom syndromes, behavioral and social health integration, and telehealth in primary care.