RSVP NEEDED – Using Telehealth to Address the Coronavirus (Alliance Virtual Hill Briefing)
View this past event at Recording Available: Virtual Hill Briefing – Using Telehealth to Address the Coronavirus Public Health Emergency
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Telehealth in the Third COVID Legislative Package
The President has signed the Coronavirus Aid, Relief, and Economic Security Act (H.R.748). The language is a significant advancement for the telehealth community. Here is a topline of the key telehealth provisions in the bill –
Sec. 3212. Telehealth network and telehealth resource centers grant programs.
- This section would amend the current Telehealth Network and Telehealth Resource Centers grant program to specify that it will support evidence-based projects, to extend grant period funding to five years, rather than four, and assuring that 50 percent of funds shall be for projects in rural areas. Provides $29M for each of FY21-25.
Sec. 3701. Exemption for telehealth services.
- This section would allow a health plan or employer to provide pre-deductible coverage of telehealth and other remote care for individuals with health savings account (HSA) eligible high-deductible health plans (HDHP) for plan years beginning on or before December 31, 2021. This could be either discounted or fully covered care.
Sec. 3703. Increasing Medicare telehealth flexibilities during emergency period.
- This section would eliminate the requirement in Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (Public Law 116-123) that limits Medicare telehealth expansion authority during the COVID-19 emergency to situations where the physician or other professional has treated the patient in the past three years. The “qualified provider” requirement would instead be replaced with a Secretarial ability to waive all requirements under 1834(m).
Sec. 3704. Enhancing Medicare telehealth services for Federally qualified health centers and rural health clinics during emergency period.
- This section would allow, during the COVID-19 emergency, Federally Qualified Health Centers and Rural Health Clinics to furnish telehealth services to beneficiaries in their home or other setting. Medicare would reimburse for these services at a composite rate similar to payment provided for comparable telehealth services under the Medicare Physician Fee Schedule.
Sec. 3705. Temporary waiver of requirement for face-to-face visits between home dialysis patients and physicians.
- This section would eliminate a requirement during the COVID-19 emergency that a nephrologist conduct some of the required periodic evaluations of a patient on home dialysis face-to-face., allowing these vulnerable beneficiaries to get more care in the safety of their home.
Sec. 3706. Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period.
- This section would allow hospice providers to conduct a face-to-face encounter required for recertification of eligibility via telehealth.
Sec. 3707. Encouraging use of telecommunications systems for home health services during emergency period.
- This section provides the HHS Secretary the flexibility to consider ways to encourage the use of telecommunications systems and other communications or monitoring services, consistent with the care plan for the individual, as appropriate.
Appropriations:
Federal Communications Commission
- $200 million to remain available until expended, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including to support efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services during an emergency period
Dept of Agriculture
- $100 million for the costs of construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas
- $25 million for the Distance Learning, Telemedicine, and Broadband Program (DLT) –The DLT grant program supports rural communities accessing telecommunications-enabled information, audio and video equipment, and related advanced technologies for students, teachers, and medical professionals
Indian Health Services
- $1,032,000,000 to prevent, prepare for, and respond to coronavirus, domestically or internationally, including, but not limited to, funding for surveillance, testing capacity, community health representatives, public health support, telehealth, Purchased/Referred Care, and other health service activities necessary to meet the increase in need of services and to protect the safety of patients and staff
- Up to $65,000,000 is for electronic health record stabilization and support
Public Health and Social Services Emergency Fund
- $27,014,500,000, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including the development of necessary countermeasures and vaccines, prioritizing platform-based technologies with U.S.-based manufacturing capabilities, the purchase of vaccines, therapeutics, diagnostics, necessary medical supplies, as well as medical surge capacity, and related administrative activities, addressing blood supply chain, workforce modernization, telehealth access and infrastructure, initial advanced manufacturing, novel dispensing, enhancements to the U.S. Commissioned Corps, and other preparedness and response activities
- $180,000,000 of the funds appropriated (under the Public Health and Social Services Emergency Fund) shall be transferred to ‘‘Health Resources and Services Administration—Rural Health’’ to remain available until September 30, 2022, to carry out telehealth and rural health activities under sections 330A and 330I of the PHS Act and sections 711 and 1820 of the Social Security Act to prevent, prepare for, and respond to coronavirus, domestically or internationally.
Health Resources & Services Administration (HRSA)
- $275 million to remain available until September 30, 2022 for Ryan White programs, rural health programs, and telehealth programs.
Department of Veterans Affairs
- $14.4 Billion to supports increased demand for healthcare services at VA facilities and through telehealth, including the purchase of medical equipment and supplies, testing kits, and personal protective equipment. Also enables VA to provide additional support for vulnerable veterans, including through programs to assist homeless or at-risk of becoming homeless veterans, as well as within VA-run nursing homes and community living centers.
- The Secretary of HHS may enter into contracts with telecommunications providers in order to provider mental health services to isolated veterans during the emergency
- Creates flexibility for telephone or telehealth renewals in the Veteran Directed Care program
- Secretary of VA shall ensure telehealth capabilities are available to homeless veterans participating in HUD-VA programs
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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