Secretary Azar Calls on Governors to Allow Telemedicine Across State Lines
On March 25, Department of Health and Human Services Secretary Alex Azar sent a letter to Governors calling on them to take a number of actions to strengthen the healthcare workforce as it faces the COVID-19 pandemic, including:
- Allow licensure across state lines – either in person or through telemedicine
- Waive state-level regulatory barriers to telehealth
- Relax scope of practice limitations
- Allow more telehealth and remote supervision
- Allow rapid certifications
- Develop and share a list of state-level liability protections for healthcare providers
- Modify any laws to allow signature-less delivery of pharmaceutical products.
Please find the full letter below:
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Open in new tab NGA Memos on State Licensure Requirements
National Governors Association Memorandum to Governors on Telehealth and State Licensure Requirements
On March 20 and 24, the National Governors Association (NGA) issued memorandum to State Governors on “Gubernatorial Strategies for Telehealth” and “Gubernatorial Strategies for Health Care Workforce and Facility Capacity.”
The first memo noted the many state actions that have already been taken to increase access to telehealth services – including increasing the types of reimbursable covered services, reducing consumer costs, reducing participation requirements and barriers for providers, and increasing the modalities trough which services may be offered via telehealth. It also provided several recommendations for Governors to consider:
- Ensuring that individuals have coverage of telehealth services with limited or no cost sharing for those services.
- Waiving state specific professional licensure requirements or granting temporary licenses to enable cross-state in-person or telehealth services in states that have declared a state of emergency and activating the Emergency Management Assistance Compact (EMAC).
- Coordinating with health systems and hospitals to ensure capacity and capabilities to deliver telehealth services.
- Streamlining and simplifying provider participation in telehealth.
- Expanding how and where telemedicine can be delivered and still qualify for reimbursement.
- Facilitating continued access for individuals receiving medication-assisted treatment (MAT)
The second memo recommended that Governor’s respond to workforce challenges by:
- Expanding access to out-of-state licensed health care providers and telehealth.
- Maintaining and increasing the number of providers by easing in-state licensure requirements.
- Using state emergency funding to support enhanced training and recruitment efforts.
The Alliance for Connected Care is pleased to contribute to this effort. Please see the full document below:
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Stakeholder Letter – Telehealth for People with High-Deductible Health Plans
On March 20, a group of leading organizations called on Congress to pass legislation that amends the Internal Revenue Code of 1986 to allow employers and health plans to cover telehealth services pre-deductible in Health Savings Account-eligible high deductible health plans during this health care crisis.
This legislation would build on efforts by Congress to ensure access to telehealth during this emergency, when access to care and treatment is more important than ever.
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Letter from Leading Telehealth, Provider, and Expert Groups Asking for a Follow-up Tweak for Healthcare Providers to be able to Better use the Medicare Telehealth Provision from the First Coronavirus Package
Leading telehealth, provider, and expert groups sent a letter to leaders in the House and Senate for a follow-up tweak for healthcare providers to be able to better use the Medicare telehealth provision from the first COVID-19 (coronavirus) package.
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Blog: The Reality of the New Telehealth Authority in Medicare
The Reality of the New Telehealth Authority in Medicare
By Krista Drobac, Executive Director, Alliance for Connected Care
On Friday, Congress passed, and the President signed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This legislation gave the Secretary of Health and Human Services (HHS) the authority to waive telehealth restrictions in Medicare, thereby creating a new pathway for some seniors to get care during this crisis. However, there are practical and operational challenges that may make the reality for seniors and medical practitioners different from the vision of the legislation.
Given the statutory restrictions that prevent medical practitioners from being paid by Medicare for using telehealth, the bill is a step forward in a time when we need many tools to address the spread of the virus, particularly for seniors. Today, practitioners can only get paid if a senior is physically present in a facility that is located in a rural area. The defined boundaries of a rural area are re-calculated every year, and a patient’s home does not count as a facility. That means that seniors must travel to medical institutions for telehealth visits, a situation that public health officials say patients should avoid during the Coronavirus outbreak.
The authority that Congress granted to the Secretary would allow Secretary Azar to lift the Medicare payment restrictions so patients could have telehealth visits with their doctors in their homes during the outbreak as long as a public health emergency has been declared. This is common sense public policy.
Operationally, there are challenges that may limit the number of seniors who can take advantage of the new tool, should the Secretary use his new authority.
- Definition of “Qualified Provider”
To qualify as a medical provider who can receive payment for a telehealth visit under the new authority, the provider must have a previous relationship with the patient. Specifically, they must have provided a service within the last three years that was paid for by Medicare. If the provider seeing that patient is from some other part of the hospital or physician group, the provider must under the same Tax ID Number (TIN) as the provider who has the established relationship.
While the intent was clearly to leverage existing patient-provider relationships, the provision, as written, makes it incredibly difficult to offer covered telehealth visits in Medicare. First, hospitals and large provider offices often contract with vendors to provide telehealth services under their care umbrella (the ability to bring in outside help will become particularly important if the crisis worsens). Those vendors are not often credentialed into the hospital EMR or claims database, making it difficult to determine if there has been a relationship in the past three years. Second, virtual visits generally start with a doctor or medical practitioner. If the hospital doesn’t work through a vendor, under this language, the medical practitioner would have to start a patient visit with a look-back at claims data for the past three years to determine eligibility. That’s not the job of a clinician, but if they don’t do it and claim Medicare reimbursement, they risk incurring a false claim. Finally, if there has been a covered claim within the hospital or provider group in the past three years, but under a different TIN, Medicare will not cover the telehealth visit. Hospitals can have many TIN numbers. For example, if the patient had a visit in the radiology department in the past three years, it wouldn’t count toward eligibility if the patient is having a telehealth visit with the hospital’s primary care medical group.
- Newly-eligible Medicare patients not eligible
Congress drafted the language in a way that makes the previous relationship with the patient a Medicare relationship. The eligibility for coverage of the visit is triggered by the patient having received care through the provider while the patient is on Medicare. So, if you were 64 years old last year with commercial insurance and you saw your doctor, that visit wouldn’t count toward the previous relationship requirement because it wasn’t covered by Medicare.
- Giving telehealth visits away for free to Medicare patients
If a hospital system finds the hurdles to billing Medicare for telehealth during this public health emergency too high, they cannot simply give the Medicare patient the visit for free. Hospitals around the country are contemplating providing Coronavirus-related care at no cost. However, hospitals cannot simply give the Medicare patient the visit for free. CMS could consider this an inducement under Medicare rules. Unless those rules are waived, the visit could be considered a violation of anti-kickback rules. We should commend the Administration on their work to reduce anti-kickback barriers to value-based care. Perhaps they can waive the rules during this crisis.
In sum, great effort by Congress to cover telehealth during this outbreak, but more needs to be done to ensure that it can practically be implemented.
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Press Release: Congress Acts to Make Telemedicine Available to Seniors During Coronavirus
Congress Acts to Make Telemedicine Available to Seniors During Coronavirus
March 5, 2020 – Today, Congress moved to help seniors access telehealth during the Coronavirus emergency without having to leave their homes.
Please find a statement from the Alliance for Connected Care below:
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Alliance Sends Letter to Congressional Leaders on Telehealth for COVID-19
The Alliance for Connected Care sent a letter to eight Congressional leaders to include a provision in the COVID-19 supplemental appropriation that will allow telehealth visits to be covered in traditional Medicare during the public health emergency.
Including this provision in the upcoming supplemental legislation will encourage health systems and others to leverage telehealth in their communities, allowing for critical care connections.
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