Alliance Calls for More Broadband Funding
The Alliance for Connected Care endorsed H.R.6474 – the Healthcare Broadband Expansion During COVID-19 Act. This legislation would significantly expand funding for the Federal Communications Commission to support healthcare broadband deployment in response to COVID–19.
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COVID-19 State Telehealth and Licensure Expansion Dashboard
State Expansion of Telehealth and Licensing Waivers
During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure requirements to facilitate patients getting care. This has provided an unprecedented opportunity for patients, providers, and policymakers to explore the impact of cross-state care. This has benefited the delivery of health care in many ways, but perhaps most notably, it has opened up many new avenues for patient choice and access to care.
As states begin to lift their COVID-19 emergency waivers or let them expire, many of the telehealth and licensure flexibilities enacted at the start of the pandemic to ensure continuity and access to care for patients are also expiring. As such, the Alliance has created a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state. This document is no longer updating this document after its last updated date given most states have or plan to terminate their emergency declarations. It was last updated on December 16, 2022.
As of December 16, 2022:
- 42 states and D.C. have ended their emergency declarations: AL, AK, AZ, AR, CO, DC, FL, GA, HI, ID, IN, IA, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, SC, SD, TN, UT, VT, VA, WA, WI, WY.
- IN, NH, and VT, however, have licensure flexibilities still in place.
- IN will extend out-of-state health care registry through the duration of the federal PHE.
- NH SB 277 extends the expiration for temporary and emergency licenses for health care workers, if they were obtained on or before Jan. 31, 2022, through June 30, 2023.
- VT passed legislation that extends pandemic-era license waivers through June 30, 2023.
- IN, NH, and VT, however, have licensure flexibilities still in place.
- 8 states continue to have emergency declarations in place: CA, CT, DE, IL, KS, RI, TX, WV.
- Of these 8 states, 6 states still have licensure flexibilities in place. Licensure flexibilities have expired in CT and DE, despite emergency declarations still in place.
- CA is going through a phased rollback of COVID-era waivers, however waivers on telehealth and licensure are still in place.
- In total, 9 states still have licensure flexibilities in place.
Note: The Alliance is no longer updating this document after its last updated date given most states have or plan to terminate their emergency declarations. It was last updated on December 16, 2022.
Figure 1. Map highlighting status of COVID-era telehealth and licensure waivers state-by-state. Last updated December 16, 2022.
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CMS Approved 1135 Waivers
Under a disaster or emergency declaration and a public health emergency, the HHS Secretary is authorized to take additional actions to provide programmatic flexibility in Medicare, Medicaid and the Children’s Health Insurance Program through section 1135 waivers. The Secretary may issue blanket waivers, or may approve state specific waivers. Waivers end no later than the termination of the emergency period. CMS released a checklist for states to aid in the development of 1135 waivers requests.
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
Several states requested flexibility to incent greater use of telehealth through Medicaid Section 1135 Waivers during the pandemic. For example:
- IL, LA, NC, and WA requested CMS to allow providers to use non-HIPAA compliant telehealth modes from platforms like Facetime, WhatsApp, and Skype to facilitate visits.
- CA requested flexibility to make it easier for providers to care for people in their own homes by allowing telehealth and virtual/telephonic communications for covered State plan benefits, a Waiver of face-to-face encounters for FQHCs and Rural Health Clinics, and Reimbursement of virtual communication and e-consults for certain providers.
- MD requested flexibility so that Medicaid and Managed care enrollees could use telephones to receive care if they did not have an appropriate device.
- SD requested flexibility to allow Medicaid to pay for the same telehealth services that Medicare has been granted authority to pay for, including services furnished while a patient is at home.
As of April 2020, CMS had approved 53 state waivers. A full list of the approved 1135 waivers (last updated April 23, 2020) can be found here.
COVID-19 Resources and Guidance from Alliance Members and Partners
The Alliance is closely monitoring developments regarding COVID-19 and will continue to update this page. Please send resources to cadamec@connectwithcare.org for inclusion on this page.
The Alliance has compiled a resource detailing state-by-state expansion of telehealth and licensing waivers during the COVID-19 pandemic. during the COVID-19 pandemic. The Alliance also has a list of federal agency telehealth guidance documents. These pages are updated regularly.
Recent Alliance webinars on COVID-19:
- Video: Using Telehealth to Address the Coronavirus Public Health Emergency. During this event, telehealth leaders from Stanford, Intermountain, and Medstar Health spoke to what their systems are doing and how they delivering dramatically more care via telehealth during the COVID-19 pandemic.
- Video: Lunch and Learn – Telehealth Policy Developments COVID-19 and Beyond. During this event, the Alliance reviewed the multitude of legislative and regulatory changes for telehealth and remote patient monitoring over the past month and discussed new opportunities beyond COVID-19.
External Telehealth Resources:
American Academy of Family Physicians telehealth resources page featuring tools for practices to build telehealth capacity. Additionally, the Financial Relief for Family Physicians page breaks down available financial relief programs, plus offers a related cost calculator, Medicare Administrative Contact list and application instructions.
American Association of Nurse Practitioners (AANP)has a tracking page with federal and state policy resources, including an Emergency State Licensure page tracking state orders to consider emergency licensing for the nurse workforce to meet increased demands resulting from COVID-19.
American Academy of PAs (AAPA) website includes a map showing the states that have taken action to suspend or waive certain practice requirements for PAs in response to the COVID-19 pandemic.
American Medical Association (AMA)has a page with special coding advice during the COVID-19 public health emergency.
American Speech-Language-Hearing Association telehealth resources page includes State-by-State Tracking of Laws and Regulations for Telepractice and Temporary Practice and COVID-19 Commercial Insurance Telepractice Policy Tracking.
American Urological Association page on telehealth and urology during COVID-19.
Association for Behavioral Health and Wellness lists COVID-19 Behavioral Health Resources
The California Health Care Foundation has resources page on telehealth delivery, with a specific emphasis on California Telehealth Policy changes .
Center for Connected Health Policy includes a CCHP COVID-19 Related State Actions to Date – States waiving licensure requirements/renewals and states waiving in-state licensure requirements for telehealth and CCHP COVID-19 Telehealth Coverage Policies.
National Alliance on Mental Illness (NAMI) NAMI released a NAMI COVID-19 Resource and Information Guide to answer frequently asked questions regarding the intersection between Coronavirus, or COVID-19, and people affected by mental illness, their caregivers and loved ones.
National Association for Home Care & Hospice Coronavirus resource page for home health and hospice community includes Info for Patients & Family Caregivers
National Council for Behavioral Health site includes resources for behavioral health organizations including economic assistance for small businesses, training and technical assistance resources, and a COVID-19 Guidance for Behavioral Health Residential Facilities.
National Consortium of Telehealth Resource Centers has a COVID-19 Telehealth Toolkit provides an overview of telehealth policy, how telehealth can be used in response to COVID-19 and additional resources. Video: Telehealth Best Practices for Providers (Providers) Video: What to Expect from a Telehealth Visit (Patients)
Alliance Comments on the COVID-19 Interim Final Rule
On April 14, the Alliance for Connected Care wrote the Centers for Medicare and Medicaid Services in response to the COVID-19 Interim Final Rule. The Alliance emphasized the importance of the many changes that were made, and requested several next steps for CMS, leveraging new authorities that is has received under the Coronavirus Aid, Relief, and Economic Security Act. Alliance priorities included:
- Expanded flexibility for audio-only telehealth to a broader set of services
- Technical fixes to ensure telehealth can be delivered by more clinicians, including changes to distant site provider rules.
- Additional flexibility for E-Visits and Virtual Check-ins
- Ensure robust data collection during this time period so that the nation may learn from its experience with telehealth and remote patient monitoring
- Expand efforts to educate Medicare beneficiaries about utilizing telehealth.
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Recording Available: Lunch and Learn – Telehealth Policy Developments COVID-19 and Beyond
The Alliance for Connected Care reviewed the multitude of legislative and regulatory changes for telehealth and remote patient monitoring over the past month and discussed new opportunities beyond COVID-19. Presentation PDF
Alliance Comments on Medicare Advantage Regulation
The Alliance for Connected Care commented on the Centers for Medicare and Medicaid Services proposed rule on “Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.”
In our comments, we address four key areas for telehealth and remote patient monitoring: 1) Telehealth for Medicare Advantage network adequacy, 2) telehealth for Special Needs Plans, 3) additional telehealth benefit requirements, and 4) telehealth changes to the medical loss ratio.
Please find the full comments below.
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Telehealth Funding Announcements and Opportunities – COVID-19
The Alliance has compiled telehealth funding opportunities below. A list of appropriations from the third COVID-19 legislative package, the CARES Act, can be viewed here.
Federal Communications Commission Report and Order
On April 2, FCC released a report and order on the COVID-19 Telehealth Program and Connected Care Pilot Program. These programs provide funding for telecommunications, and telehealth services to nonprofit healthcare organizations.
COVID-19 Telehealth Program – $200 million to be used immediately (APPLY HERE)
- The COVID-19 Telehealth Program will be open to eligible health care providers, whether located in rural or non-rural areas, and will provide eligible health care providers support to purchase telecommunications, information services, and connected devices to provide connected care services in response to the coronavirus pandemic. The COVID-19 Telehealth Program will only fund monitoring devices (e.g., pulse-ox, BP monitoring devices), that are themselves connected. The COVID-19 Telehealth Program will not fund unconnected devices that patients can use at home and then share the results with their medical professional remotely.
- The COVID-19 Telehealth Program will provide selected applicants full funding for eligible services and devices through its congressionally appropriated $200 million budget, and these funds will be available until they are expended or until the current pandemic has ended. FCC does not anticipate awarding more than $1 million to any single applicant.
- Eligibility: (1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; (2) community health centers or health centers providing health care to migrants; (3) local health departments or agencies; (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; or (8) consortia of health care providers consisting of one or more entities falling into the first seven categories.
- Applications will be accepted after publication of this Report and Order and notice of OMB’s approval of the COVID-19 Telehealth Program information collection requirements in the Federal Register.
Connected Care Pilot Program – up to $100 million in total funding over three years
- The Pilot Program we adopt today is a discrete, limited duration program that will provide universal service support to help defray health care providers’ qualifying costs of providing connected care services, with a primary focus on providing these services to low-income or veteran patients.
- The Pilot Program will provide funding for selected pilot projects to cover 85% of the eligible costs of broadband connectivity, network equipment, and information services necessary to provide connected care services to the intended patient population. They decline to set a number of pilot projects or indicate an expected amount per project and will evaluate proposals received.
- They seek diverse participation to maximize the potential for the Pilot Program to provide meaningful data about the benefits of connected care, and how and whether Universal Service Fund support could be used more broadly in the future to enable the adoption of connected care services among patients and their health care providers.
- Eligibility: (1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; (2) community health centers or health centers providing health care to migrants; (3) local health departments or agencies; (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; or (8) consortia of health care providers consisting of one or more entities falling into the first seven categories.
Health Resources & Services Administration Funding
- The CARES Act signed into law on March 27, provides HRSA $275 million to remain available until September 30, 2022 for Ryan White programs, rural health programs, and telehealth programs.
- On March 24, HHS, through HRSA, awarded $100 million to 1,381 health centers across the nation to expand screening and testing, acquire additional medical supplies and expand telehealth capacity in response to the COVID-19 pandemic. The funding was provided by the Coronavirus Preparedness and Response Supplemental Appropriations Act, the first coronavirus relief package.
Agency for Healthcare Research and Quality Funding Opportunity
- On March 26, AHRQ issued a notice of intent to publish a funding opportunity to support novel, high-impact studies evaluating health system and healthcare professional responsiveness to the COVID-19 pandemic. AHRQ is interested in challenges with the rapid expansion of telemedicine, and how digital health innovations have contributed to health system and provider capabilities to meet the needs of vulnerable populations. AHRQ plans to make up to $5 million available.
Department of Defense Funding Opportunity
- The Medical Technology Enterprise Consortium (MTEC) posted a pre-announcement request for project proposals (RPP) to develop and deploy the National Emergency Telecritical Care Network (NETCCN) — a cloud-based, low-resource, stand-alone health information management system to create virtual critical care wards. The U.S. Government (USG) Department of Defense (DoD) is anticipated to have approximately $30 to $37 million in FY20 funds. The upcoming RPP(s) will be posted to the MTEC website (mtec-sc.org).
Letter to CMS on MA-PD Rule
The Alliance submitted comments on the MA-PD Rule. Within the Proposed Rule, we have identified four priorities for telehealth and connected care:
- Medicare Advantage (MA) and Cost Plan Network Adequacy
- Improvements to Care Management Requirements for Special Needs Plans (SNPs)
- Additional Telehealth Benefits
- Medical Loss Ratio (MLR)
Mount Sinai Uses Remote Patient Monitoring to Rapidly Respond to COVID-19
Mount Sinai Uses Remote Patient Monitoring to Rapidly Respond to COVID-19
A new remote monitoring platform developed by the Mount Sinai Health System is helping health care providers to care for COVID-19 patients who are recovering at home. With the platform, providers can monitor the patients’ symptoms and adjust care as necessary, including sending the patient to the hospital if symptoms worsen.
A patient can enroll in the program by a Mount Sinai Health System physician or the patient can text the words “Precision Recovery” to (332) 213-9130. A Mount Sinai provider from the Precision Recovery team will then contact them as soon as possible to establish an online video chat for on-boarding. As part of the on-boarding, the patient downloads a daily symptom tracking application, MyCap, which is completed via smart device to help the team track symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. If a health care provider on the team sees concerning data during the home monitoring, the provider can enlist one of the Mount Sinai doctors on the team to have an online video chat with the patient. If necessary, they can organize an emergency medical team for mobilization.
