Home Blood Pressure Telemonitoring With Remote Hypertension Management in a Rural and Low-Income Population
Home Blood Pressure Telemonitoring With Remote Hypertension Management in a Rural and Low-Income Population
The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline provides a Class IA recommendation for the use of home BP monitoring, team-based care, and telehealth strategies to improve BP control among patients with hypertension.1 However, most studies have been conducted in integrated health systems among White populations with higher socioeconomic status. This study aimed to evaluate the feasibility, safety, and effectiveness of home BP telemonitoring with remote hypertension management among a predominately rural and low-income population.
Alliance Submits Comments to Senate Finance Committee on Mental Health
The Alliance for Connected Care submitted a letter to the Senate Finance Committee providing input into the development of bipartisan legislation to enhance behavioral health and substance use disorder care for all Americans.
Our letter includes recommendations to answer the following questions:
- What policies would encourage greater behavioral health care provider participation in these federal programs? What barriers, particularly with respect to the physician and non-physician workforce, prevent patients from accessing needed behavioral health care services?
- Should federal licensing and scope of practice requirements be modified to reduce barriers for behavioral health care workers seeking to participate in federal health care programs? If so, how?
- What programs, policies, data, or technology are needed to improve patient transitions between levels of care and providers?
- How can Congress craft policies to expand telehealth without exacerbating disparities in access to behavioral health care? How has the expanded scope of Medicare coverage of telehealth for behavioral health services during the COVID-19 pandemic impacted access to care?
- How should audio-only forms of telehealth for mental and behavioral health services be covered and paid for under Medicare, relative to audio-visual forms of telehealth for the same services? Are there specific mental health and behavioral health services for which the visual component of a telehealth visit is particularly important, and for which an audio-only visit would not be appropriate? For which specific mental health and behavioral health services is there no clinically meaningful difference between audio-visual and audio-only formats of telehealth? How does the level of severity of a mental illness impact the appropriateness of a telehealth visit?
- Should Congress make permanent the COVID-19 flexibilities for providing telehealth services for behavioral health care (in addition to flexibilities already provided on a permanent basis in the SUPPORT for Patients and Communities Act and the Consolidated Appropriations Act, 2021)? If so, which services, specifically? What safeguards should be included for beneficiaries and taxpayers?
- What legislative strategies could be used to ensure that care provided via telehealth is high-quality and cost-effective?
- What barriers exist to accessing telehealth services, especially with respect to availability and use of technology required to provide or receive such services?
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Open in new tab Summary: CY 2022 Final Physician Fee Schedule
On November 2, 2021, CMS issued the final Calendar Year 2022 (CY2022) Physician Fee Schedule (PFS), which makes payment and policy changes under Medicare Part B.
View a summary produced by the Alliance for Connected Care here. Additional links are provided below:
Overview of Major Policies
CMS has finalized its proposal to retain all services added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023 – December 31, 2023. In addition, CMS is adding CPT codes 93797 and 93798 and HCPCS codes G0422 and G0423 to the Category 3 Medicare telehealth services list. These codes relate to outpatient cardiac rehabilitation and intensive cardiac rehabilitation.
CMS finalized its proposal to amend the current regulatory requirement for interactive telecommunications systems to include audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. CMS has also finalized policy to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology. Note that CMS had originally included an additional parameter for patients who do “not wish to use” audio-video, however, CMS has eliminated the patient’s choice to refuse audio-video in the final rule.
CMS has also finalized its proposal to require an in-person visit be provided by the physician or practitioner furnishing mental health telehealth services within 6 months prior to the initial telehealth service, and at least once every 12 months – instead of the proposed 6 months – thereafter.
- CMS is allowing for limited exceptions to the 12 month in-person requirement. Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period.
- CMS notes that there is no exception to the statutory requirement that the physician or practitioner must furnish to the beneficiary an in-person, non-telehealth service within 6 months prior to initiation of mental health services via telehealth.
Finally, in response to comments that CMS implement a broad definition of the term “home” in terms of mental healthcare delivery site, CMS has clarified that the definition of home can include temporary lodging, such as hotels and homeless shelters. Furthermore, CMS notes that in circumstances where the patient, for privacy or other personal reasons, chooses to travel a short distance from the exact home location during a telehealth service, the service is still considered to be furnished “in the home of an individual.”
Below is a summary of key payment and policy changes within the rule.
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Alliance signs letter urging Congress to expand telehealth options for employees
On November 1, the Alliance for Connected Care and nearly 50 stakeholder groups sent a letter to Congress urging lawmakers to make permanent the current regulatory flexibility that allows telehealth and remote care services to be treated as an excepted benefit for certain employees.
Including standalone telehealth as an excepted benefit will help ensure hardworking Americans can access high-quality, cost-effective care when and where they need it most, regardless of employment status. Without Congressional action, employers will be unable to offer basic virtual health services to millions of Americans in part-time and seasonal jobs or workers otherwise not participating in their employer’s full medical plan.
The COVID-19 pandemic has illustrated the immense benefits of telehealth and remote care services. American workers want these benefits, and employers want to provide them. With temporary flexibilities that allowed employers to fill gaps in care set to expire, this letter urges Congress to consider making permanent the current policies that allow telehealth and remote care services to be treated as an excepted benefit.
To read the full letter, click here or see below:
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Protecting Patients and Telehealth Access: More Than 230 National Organizations Urge Governors Across the Country to Maintain and Expand Licensure Flexibilities Throughout Federal Public Health Emergency
Letter to Governors Stresses Urgency of Expiring Licensure Waivers and its Impact on Patient Access to Care
Washington, DC – November 1, 2021 – Today, more than 230 organizations sent a letter to all 50 state governors urging them to maintain and expand licensure flexibilities enacted at the start of the pandemic for the duration of the federal public health emergency, to better address patient needs during the ongoing pandemic. The letter was convened by the Alliance for Connected Care, ALS Association, and National Organization for Rare Disorders (NORD), and includes a diverse mix of signers ranging from patient advocacy organizations, hospitals and health systems, academic medical centers, higher education, digital health companies, health information management associations, and many more.
During the public health emergency, governors across the country used emergency authority to waive some aspects of state licensure requirements to facilitate greater patient access to care, allowing providers more flexibility to treat patients across state lines. However, over the past few months, many states have allowed such flexibilities to expire along with the expiration of COVID-19 emergency declarations, leading to a reduction in access to vital care as the pandemic continues.
Many patients relied on telehealth throughout the pandemic to see their specialists who reside in another state, made possible by licensure flexibilities enacted at the start of the pandemic, so as not to risk exposure to the virus and to maintain continuity of care through virtual options. These patients are now faced with canceling these vital appointments or risking an in-person visit and thus exposure to COVID-19. As such, this letter urges state governors to act now to ensure patients can access the care they need where they reside and when they need it, and outlines a set of principles to consider for licensure policies that should be in place right now to ensure patient access to care.
“Improved access to telehealth services during the pandemic has been a lifeline for many in the rare disease community,” said Peter Saltonstall, President and CEO, NORD. “A 2020 NORD survey found that nearly 40% of rare disease patients travel more than 60 miles for their medical care, which means robust telehealth access, including access to providers across state lines, is critical. NORD has been working to ensure that state-based licensure flexibilities do not expire, so that rare disease patients can continue to have access to ongoing and necessary patient care while the threat of COVID-19 remains. NORD is proud to come together with this diverse coalition to prevent a reduction in access for patients, many of whom are still at high risk for COVID-19. Our state governments must heed the call of all stakeholders – from patient advocacy organizations to hospitals to digital health companies – and maintain access to vital health care providers now and into the future.”
“Telehealth has provided much-needed and cost-effective opportunities for people with ALS to access specialized ALS care,” said Neil Thakur, Chief Mission Officer of The ALS Association. “The debilitating nature of ALS — which robs people of their ability to move, eat, and eventually, breathe – makes travel very challenging. Because the number of ALS clinics is very limited, some people with ALS need to access care across state lines. Access to multidisciplinary care is critical and has been shown to extend life, which is significant considering the average life expectancy after ALS diagnosis is two to five years. We strongly urge Governors to take the steps needed to keep or restore access to specialized care for ALS and similar conditions.”
“We must build on the lessons learned from the pandemic and ensure patients can access care from their providers regardless of where they live, especially as the pandemic continues. Patients and their families seek care across state lines for many reasons, and the licensure flexibilities put in place throughout the pandemic have been critical for expanding patient access to care, improving care coordination and continuity of care, and addressing workforce shortages. State governors must act to ensure these flexibilities continue, and consider solutions to address the ongoing needs of patients both during the pandemic and in the future,” Krista Drobac, Executive Director, Alliance for Connected Care
The letter has been sent to all 50 governors across the United States. To read the full letter and view the list of organizations who signed on, click here or see below. State-specific letters can be found linked here: AL, AK, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY.
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More Than 70 Organizations Urge Congress to Extend Virtual Care Provisions in the CARES Act for Individuals with HDHP-HSAs
Letter to Congressional Leaders Stresses Urgency of Impending Expiration of Telehealth Safe Harbor
Washington, DC – October 26, 2021 – Today, more than 70 organizations sent a letter to Congress to urge policymakers to address the impending expiration of the telehealth safe harbor enacted in the CARES Act that enabled employers and insurers to provide pre-deductible coverage for telehealth services for individuals with high-deductible health plans coupled with Health Savings Accounts (HDHP-HSAs). The letter was convened by the Alliance for Connected Care and includes a diverse mix of signers including patient groups, clinician organizations, and employer coalitions.
During the pandemic, Congress took swift action as part of the CARES Act to ensure employees could receive covered telehealth services before their deductible is met by allowing employers to provide pre-deductible coverage for such services for individuals with HDHP-HSAs. This safe harbor is not tied to the public health emergency (PHE), and will expire on December 31, 2021 regardless of how long the PHE lasts if Congress does not act.
The ability to offer pre-deductible telehealth services for employees is a meaningful expansion of health care access for the 35 million Americans with HDHP-HSAs. Congress must act soon to extend the virtual care provisions in the CARES Act for individuals with HDHP-HSAs beyond the current deadline of December 31 2021, especially as we approach open enrollment for plan year 2022.
“During the COVID-19 pandemic, Congress enabled employers to offer pre-deductible coverage for telehealth services, expanding access to care and reducing out-of-pocket costs for millions of Americans,” said Alliance for Connected Care executive director Krista Drobac. “Congress must act now to ensure individuals with HDHP-HSAs can continue to have ready access to virtual care services before the end of the year when this provision will expire.”
Bipartisan and widely supported legislation recently introduced in the U.S. Senate and House of Representatives incudes language that would extend this access for patients. The Telehealth Expansion Act of 2021 (S. 1704) would permanently extend the CARES Act authority for employers and health plans to offer pre-deductible coverage for telehealth services for individuals with HDHP-HSAs. The Primary and Virtual Care Affordability Act (H.R. 5541) would extend this CARES Act authority through December 31, 2023, and expand this provision to primary care. We strongly urge Congress to take up and consider this legislation before the end of this year, when existing access will end.
To read the full letter, click here or see below:
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Alliance Statement on the Primary and Virtual Care Affordability Act
STATEMENT ON THE PRIMARY AND VIRTUAL CARE AFFORDABILITY ACT
October 18, 2021
WASHINGTON DC – There are more than 35 million Americans with high-deductible health plans coupled with a Health Savings Account (HDHP-HSAs). More than 50 percent of individuals with HSAs live in zip codes where the median income is below $75,000 annually. Reaching the deductible threshold of $1,400 for an individual and $2,800 for a family is often a financial strain.
Allowing employers to subsidize access to telehealth for employees with HDHP-HSAs before the deductible is met, provides meaningful access to health care services. Through the CARES Act, Congress gave employers the ability to provide free or reduced telehealth services to their employees during the pandemic by creating a telehealth safe harbor from certain high deductible health plan rules. The safe harbor is not part of the flexibilities provided by the Public Health Emergency (PHE), and is set to expire on December 31, 2021 regardless of how long the PHE lasts.
The Alliance is pleased to support the introduction of the Primary and Virtual Care Affordability Act (H.R. 5541) and applauds Representatives Schneider (D-IL) and Wenstrup (R-OH) for their leadership in extending the CARES Act authority for employers and health plans to subsidize telehealth visits, and to expand this provision to primary care, for individuals with HDHP-HSAs through December 31, 2023.
A full statement can be found here and below:
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Alliance Statement for the Record to Senate Commerce Hearing on: “State of Telehealth: Removing Barriers to Access and Improving Patient Outcomes”
ALLIANCE FOR CONNECTED CARE STATEMENT FOR THE RECORD
“State of Telehealth: Removing Barriers to Access and Improving Patient Outcomes”
The Alliance submitted a letter to the Senate Commerce, Science, and Transportation Committee, Communications, Media, and Broadband Subcommittee on a hearing examining the importance of access to telehealth services, and the role that broadband plays in the public health response.
Our statement summarizes the following recommendations:
- Congress should invest in efforts that support broadband affordability for patients and providers.
- Congress must continue to coordinate with other federal agencies to ensure improvements are being made to our taxpayer-funded programs, and that all patients deserving of these benefits are being afforded access.
- Congress must make permanent the Emergency Broadband Benefit program.
- Congress must continue to address anticompetitive behaviors in all industries, and explore solutions that support patients.
- Congress should invest in efforts that support the deployment of broadband for all Americans, including those living in rural areas, on Tribal lands and to our nation’s health care providers and centers.
- Congress must maintain access to audio-only services for patients who, in the interim, continue to lack broadband access and/or affordability.
- Congress should pass the Data Mapping to Save Moms’ Live Act (S. 198/H.R. 1218) in the 2022 Consolidated Appropriations package.
- Congress should consider addressing antiquated licensure requirements that impeded access to care to address gaps in the delivery system and provide high-value care directly to consumers in rural or underserved areas.
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Alliance Joins Letter Calling on CMS to Address Critical Access Hospital Telehealth
The Alliance for Connected Care joined roughly 20 other groups in calling on CMS to address Critical Access Hospital (CAH) telehealth.
“We agree that telehealth payment should be addressed for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and also believe outpatient behavioral therapy services offered by Critical Access Hospitals (CAHs) are a key component of a comprehensive rural behavioral health strategy.”
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Alliance Joins Congressional Letter to Support Telehealth Resource Centers
The Alliance for Connected Care joined a letter this week to Senate HELP Chair Murray and Ranking Member Blunt requesting funding support for the Telehealth Resource Centers (TRC) program in the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services (HHS).
This increase in funding would provide a critical boost to the TRCs, which have experienced a high of an 800% increase in demand for telehealth assistance during the COVID-19 pandemic across the nation, yet have been level-funded since 2006.
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