Alliance Written Testimony – New York FY2022 Executive Budget
The Alliance submitted written testimony for the New York State FY2022 Joint Legislative Budget Hearing on Health, which took place on February 25, 2021.
The Alliance applauds the telehealth-related proposals included in the Governor’s Executive Budget for the State Fiscal Year 2022, and was particularly thrilled to see specific provisions around the creation of an interstate licensure program to authorize out-of-state practitioners licensed in contiguous states or states in the Northeast region to provide telehealth services to patients in New York.
“While we support and appreciate efforts by the State to acknowledge the importance of interstate licensure capabilities and to implement a program to enable such practice, we believe the language as it currently exists is limited in scope both from a geographic standpoint and in the categories of health care services and provider types that can engage in interstate telehealth practice. This, and other aspects of the current legislation being considered, could add an additional burden to New York-based providers and the patients they serve.”
The Alliance offered comments on how to strengthen this provision to ensure patients can access necessary care from providers of their choice and to support New York-based providers in their effort to deliver care across state lines. The Alliance also offered the Medical Excellence Zone as an alternative to the policy as it stands. Key provisions and additional details on the MEZ can be viewed here.
Read our full testimony here and below:
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Open in new tab Alliance Letter of Support for Alaska SB 67
The Alliance submitted a letter of support to David Wilson, Chair of the Alaska Senate Health and Social Services Committee, for Senate Bill 67.
The bill would allow Registered and Licensed Practical Nurses from 34 states to practice in Alaska as part of a Multistate Nurse Licensure Compact. These registered and practical nurses would not be subject to the burdensome licensing process. The bill would also allow nurses in Alaska to practice in those 34 participating states. Opening up Alaska to licensed nurses will help provide needed access to care across the state.
Read the full letter here and below:
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Alliance Statement for the Record to House Energy & Commerce Committee Hearing on Telehealth
ALLIANCE FOR CONNECTED CARE STATEMENT FOR THE RECORD
“The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care”
The Alliance submitted a letter to the House Energy & Commerce Committee, Subcommittee on Health on the ““The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care.”
The Alliance provided 1) overarching comments about telehealth research and evidence, 2) recommendations for telehealth expansions that Congress should consider and 3) recommendations for telehealth “guardrail” provisions that Congress could consider.
Top Telehealth Priorities
These priorities were also outlined in the July 2020 group letter to Congress with 340 endorsing organizations. The following four items should be the core of any serious telehealth expansion.
- Removal all geographic and originating site restrictions on telehealth in Medicare. The COVID-19 pandemic has clearly demonstrated the need for telehealth in rural areas, in urban areas, at work, at school, at home and many other locations. These provisions are obsolete and outdated and should be removed from statute entirely. The location of the patient should not matter for telehealth.
- Remove distant site provider list restrictions to allow all Medicare providers who deliver telehealth-appropriate services to provide those services to beneficiaries through telehealth when clinically appropriate and covered by Medicare – including physical therapists, occupational therapists, speech-language pathologists, social workers, and others.
- Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics can furnish telehealth in Medicare and be reimbursed fairly for those services, despite unique payment characteristics and challenges for each. Please note that critical access hospitals are sometimes omitted from this list, but are a crucial component of a healthcare system able to reach all Medicare beneficiaries and must be able to directly bill for telehealth services.
- Make permanent the Health and Human Services (HHS) emergency waiver authority for virtual care so that it can be quickly leveraged during future emergencies. Telehealth has maintained critical connections between patients and healthcare practitioners during the pandemic, and should be enabled for a future wildfire, flood, hurricane, or other emergency.
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Alliance Written Testimony in Maryland
The Alliance submitted written testimony offering the Medical Excellence Zone as an alternative to Maryland House Bill 732.
“We request that the Committee consider an alternative called the Medical Excellence Zone. The Medical Excellence Zone is an area defined by multiple state borders where medical practitioners may practice across state lines. Practitioners may not establish physical practices in states where they are not licensed but as long as they are licensed and in good standing with one state in the Zone, they may practice across state lines.” Key provisions and additional details on the MEZ can be viewed here.
Read our full testimony here and below:
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Alliance Letter Regarding Telehealth Fraud
The Alliance for Connected Care sent a letter to HHS Office of Inspector General (OIG) Principal Deputy Inspector General Grimm urging OIG to update posts on “telehealth fraud” to better distinguish traditional fraud from telehealth fraud. The Alliance supports several recommendations to address improper telehealth payments:
- Conduct periodic post-payment reviews to disallow payments for errors for which telehealth
claim edits cannot be implemented (for example, unallowable originating sites or unallowable
means of communication - Work with MACs to implement all telehealth claim edits listed in the Medicare Claims Processing
Manual; - Offer education and training sessions to practitioners on Medicare telehealth requirements and
related resources.
In addition, the Alliance requested OIG consider meeting with experts to learn about the tools and tactics that can best differentiate legitimate telehealth providers from fraud actors pretending to offer telehealth.
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A current and future outlook on upcoming technologies in remote monitoring of patients with heart failure
A current and future outlook on upcoming technologies in remote monitoring of patients with heart failure
Heart failure is a major health and economic challenge in both developing and developed countries. Despite advances in pharmacological and device therapies for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure, their quality of life and exercise capacity are often persistently impaired, morbidity and mortality remain high and the health economic and societal costs are considerable. For patients with heart failure and preserved LVEF, diuretic management has an essential role for controlling congestion and symptoms, even if no intervention has convincingly shown to reduce morbidity or mortality. Remote monitoring might improve care delivery and clinical outcomes for patients regardless of LVEF. A great variety of innovative remote monitoring technologies and algorithms are being introduced, including patient self-managed testing, wearable devices, technologies either integrated into established clinically indicated therapeutic devices, such as pacemakers and defibrillators, or as stand-alone are in development providing the promise of further improvements in service delivery and clinical outcomes. In this article, we will discuss unmet needs in the management of patients with heart failure, how remote monitoring might contribute to future solutions, and provide an overview of current and novel remote monitoring technologies.
Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review
Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training—with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow—much less skill development—lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
Regulatory Relief to Support Economic Recovery Request for Information (RFI)
The Alliance for Connected Care submitted comments in response to the HHS request for information on the health and economic emergency created by the COVID-19.
The Alliance responded to over 20 recent policy changes with recommendations. We believe some should become permanent and some were only appropriate during the PHE and should cease at its end.
Review our full comments here and below:
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Input for the CONNECT for Health Act of 2021
The Alliance for Connected Care provided feedback on the Senate Telehealth Working Group and Congressional Telehealth Caucus’ request for information (RFI) on
the 117th Congress’ iteration of the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act.
The Alliance provided 1) overarching comments about top priorities for telehealth legislation, 2) recommend new provisions for inclusion in the CONNECT package and 3) provide feedback on the continued relevancy of 2019 CONNECT provisions.
Review the Alliance’s comments here and below
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Alliance Joins Letter to Hill in Support of Temporary Extension of DEA Waiver in COVID Relief Package
The $908 Billion Bipartisan Emergency COVID Relief Act of 2020 – While its outcome remains very much in doubt, the $908 Billion bipartisan compromise proposal put forward in the Senate includes a provision to temporarily extend the DEA waiver of the in-person requirement through the end of 2021.
We urge Congress to extend the Drug Enforcement Administration (DEA) waiver of the prior in-person requirement before telemedicine is allowed for prescribing of controlled substances under the Ryan Haight Act through the end of 2021. The DEA has waived this requirement for the duration of the COVID-19 Public Health Emergency (PHE). To provide stability and time for work on a more permanent policy, the waiver should be extended at least until the end of 2021. This provision is included in the $908 billion Bipartisan Emergency COVID Relief Act of 2020.
View the letter
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