Alliance News2021-05-05T14:08:38-04:00

States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues

Kaiser Family Foundation: States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-state Medicaid Budget Survey for State Fiscal Years 2021 and 2022

This report highlights certain policies in place in state Medicaid programs in state FY 2021 and policy changes implemented or planned for FY 2022. The report also highlights state experiences with policies adopted in response to the COVID-19 pandemic. Notably, an overwhelming majority of states noted the benefits of telehealth in maintaining or expanding access to care during the pandemic, particularly for behavioral health services. Nearly all responding states report covering a range of services via audio-visual telehealth as of July 2021, with slightly fewer reporting audio-only coverage. Post-pandemic telehealth coverage and reimbursement policies are being evaluated in most states, with states weighing expanded access against quality concerns, especially for audio-only telehealth.

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October 27th, 2021|

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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October 27th, 2021|

Medicaid OIG Reports – Parts 1 and 2 of a three-part report on tele-behavioral health and Medicaid

Medicaid OIG Reports – To-date, OIG has released parts 1 and 2 of a three-part report on tele-behavioral health and Medicaid. Below we summarize the key findings, particularly noting successful findings on access and cost. HHS OIG currently has eight different national audits, evaluations and inspections of telemedicine services under the Medicare and Medicaid programs – which we have summarized below.

  • Increased access and positive effects  Among states who evaluated their telehealth programs, both found positive effects, and among those basing their judgements on experience, more than half reported telehealth increased access.
  • Produced savings – In addition, one of the states that also analyzed its data on access—found that, prior to the pandemic, telehealth produced savings of $8,600 in emergency room avoidance for one managed care plan, as well as $484,000 in reduced transportation costs for another managed care plan.
  • Recommending licensure reciprocity – OIG recommended states examine the use of licensure reciprocity and compacts – and specifically used the nursing compact as an example of a successful compact.
  • States Reported Multiple Challenges with Using Telehealth to Provide Behavioral Health Services to Medicaid Enrollees – This report examined challenges states reported prior to the pandemic on the use of telehealth for behavioral health services in Medicaid. States reported several challenges with using telehealth, some of them more operational, such as lack of training for providers and enrollees, limited connectivity, and cost of infrastructure. Interestingly though, states also reported challenges with licensing, and the burdensome process for providers to become licensed to practice in another state. The report recommends states examine the use of licensure reciprocity and compacts – and specifically used the nursing compact as an of example of a successful compact.
  • Opportunities Exist to Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid – The second report examined the effects of telehealth on access, cost and quality of tele-behavioral health services. A few states reported that they were unable to identify which services were being provided via telehealth versus in-person. To that concern, HHS OIG recommended that CMS support Medicaid programs in distinguishing between in-person and telehealth services. The second big takeaway on the access and cost side is that HHS OIG found that – among the two states who were able to evaluate the effects of telehealth in their state – these states found that telehealth increased access and reduced costs. Note that two states reported they were able to adequately evaluate the effect of telehealth – other states supported their evaluation based on experiences. Remarkably, both of the states who were able to conduct specific evaluations found positive effects, and among those basing their judgements on experience, more than half reported telehealth increased access. In addition, one of the states that also analyzed its data on access—found that, prior to the pandemic, telehealth produced savings of $8,600 in emergency room avoidance for one managed care plan, as well as $484,000 in reduced transportation costs for another managed care plan.

 

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October 27th, 2021|

Medicare OIG Report – Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship

Medicare OIG Report – Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship

  • Patients are seeing their own providers – Most beneficiaries received telehealth services from providers with whom they had an established relationship. Notably, 84 percent of beneficiaries received telehealth services only from providers with whom they had an established relationship. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. This pattern persisted among virtually all of the most common telehealth services. Beneficiaries tended to see their providers in person about 4 months prior to their first telehealth service, on average. As demonstrated, beneficiaries and the community do not need arbitrary guardrails like established relationships and in-person requirements to ensure beneficiaries are getting the care they deserve. Patients are maintaining their own providers when possible and appropriate. We believe this will continue but as telehealth models evolve, patients should have the choice to see other providers with whom that do not have a previous relationship.
  • HHS OIG concludes that this data should be used to inform decisions about how to best use telehealth in Medicare and should be taken into account as policymakers continue to examine telehealth utilization and concerns about telehealth being vulnerable to fraud, waste, and abuse. This includes decisions about which services to allow to be delivered via telehealth on a more permanent basis and to what extent Medicare should require that beneficiaries have a relationship with their providers prior to receiving certain telehealth services.
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October 27th, 2021|

State Telehealth Laws and Reimbursement Policies Report, Fall 2021

Center for Connected Health Policy: State Telehealth Laws and Reimbursement Policies Report, Fall 2021

The Center for Connected Health Policy (CCHP) released its State Telehealth Laws and Medicaid Program Policies bi-annual report for Fall 2021, covering updates in state telehealth policy made between June and September 2021. The report offers policymakers, health advocates, and other health care professionals an overview of telehealth policy trends throughout the nation. CCHP also released a corresponding summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting key findings.

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October 26th, 2021|

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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October 18th, 2021|

Impact of Audio-only Telephone in Delivering Health Services During COVID-19 and Prospects for Future Payment Policies & Medical Board Regulations

Center for Connected Health Policy (CCHP): Impact of Audio-only Telephone in Delivering Health Services During COVID-19 and Prospects for Future Payment Policies & Medical Board Regulations

CCHP released a study that examined the use of audio-only as a modality to provide services from a federally qualified health center (FQHC) to patients in the Medicaid program. To select the states, CCHP examined the Centers for Disease Control and Prevention (CDC) website to select the top ten states with the most COVID cases per 100,000 residents as of April 1, 2021. The states selected were: Arizona, Arkansas, Iowa, North Dakota, Oklahoma, South Dakota, Rhode Island, Tennessee, Utah and Wisconsin. The FQHCs in this study all expressed concerns for their patients’ ability to access care should the audio-only waivers not be made permanent or extended.

 

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October 11th, 2021|

A Resilient Primary Care Supported Patients During Summer Surge of COVID

Primary Care Collaborative: A Resilient Primary Care Supported Patients During Summer Surge of COVID

Recently released data from a survey of primary care clinicians in mid-August by the Larry A. Green Center, in collaboration with the Primary Care Collaborative (PCC), shows that primary care remains resilient against increased demands, although the workforce is confronting myriad challenges. Responding clinicians reported that the needs of patients exceeded pre-pandemic levels, and for nearly two-thirds of clinicians (64%), telemedicine was a key way to maintain patients’ access to care. However, if pre-pandemic payment regulations are restored, 41% of clinicians worry their practice will no longer be able to support telemedicine.

 

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October 11th, 2021|

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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October 8th, 2021|

Patient and Supporter Factors Affecting Engagement with Diabetes Telehealth

AJMC: Patient and Supporter Factors Affecting Engagement with Diabetes Telehealth

Telehealth programs are an increasingly popular approach to facilitate diabetes care by enhancing remote monitoring, communication, and collaboration among patients, caregivers, and health care providers. A study of 123 adults with type 2 diabetes and high blood pressure, enrolled with a family supporter, received automated interactive voice response (IVR) and coach-provided visit preparation calls over 12 months. Automated IVR calls were completed more often when urgent issues were identified to patients’ providers, but less often if patients had high blood press or depression. In conclusion, visit preparation call content should be tailored to patient education level, and family help with medications may identify patients needing additional support to engage with telehealth.

 

October 8th, 2021|
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