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COVID-19 Telehealth Policy Resources to Know About
 
With telehealth policy changing rapidly during the COVID-19 emergency, the Center for Connected Health Policy (CCHP) and the National Consortium of Telehealth Resource Centers (NCTRCs) have worked to develop some important resources to help guide providers and telehealth stakeholders through the swiftly changing landscape. 

Below are some resources that can be utilized, and are updated regularly:
Check back regularly - more videos on additional topics are on their way!
  • NCTRC COVID-19 Telehealth Resource Page:  This COVID-19 focused telehealth resource page developed by the NCTRC houses some useful tools on telehealth and provides links to the 12 regional, and 2 national telehealth resource centers and each center’s COVID-19 specific resources.  The page includes a NCTRC COVID-19 Telehealth Toolkit, designed to provide studies reflecting telehealth models that may apply to treating COVID-19, an overview of telehealth policy and additional resources. 
Other resources CCHP has found useful that have been developed by other entities, include the following:
CCHP’s Factsheet on California Telehealth Policy During COVID-19
The telehealth policy environment is evolving rapidly as governments face the increasing demands on our health system to combat COVID-19.  California has issued a series of waivers and guidance documents to help providers utilize telehealth and to provide Californians with greater access. 

CCHP has created a factsheet detailing COVID-19 California Medicaid (Medi-Cal) telehealth policy changes, as described in a March 24th guidance document, among other sources.  The most significant changes include allowing for the use of telephone to deliver services for specific service codes, and waiving the ‘new’ and ‘established patient’, ‘face-to-face/in-person’ and ‘four walls’ requirements for FQHCs, RHCs, and Tribal Clinics utilizing telehealth or telephone.  The policy changes in California are fluid, and the CA Department of Health Care Services (DHCS) may still submit another 1135 waiver or 1115 waiver to the federal government to further solidify the changes.  However, in the meantime the changes are moving forward and being implemented by DHCS.  For more information, see CCHP’s factsheet, and connect to the linked source material.

CCHP Releases Report Assessing Medicaid Coverage of Remote Communication Technology Codes

CCHP has released a new analysis, titled Remote Communication Technology Codes: An Analysis of State Medicaid Coverage, which examines state Medicaid reimbursement for certain technology-based service codes that utilize telehealth technologies, but are not considered to fall under the category of telehealth in Medicare. Examples include the virtual check-in codes G2010 and G2012.  Because these codes do not fall under the telehealth definition in Medicare, many states had not included them in their telehealth policy.  Note that the research for this report was conducted in January 2020 and does not account for expansions in telehealth policy due to COVID-19.

The analysis shows that many state Medicaid programs are reimbursing for remote communication technology-based services, and are not necessarily classifying these services as falling under the auspices of telehealth, which is a similar approach in Medicare. CCHP anticipates that increased reimbursement of these codes will continue, especially as more states utilize them to implement expansions in telehealth policy for the COVID-19 crisis.  To learn more, see the full report.

FCC COVID-19 Telehealth Program to Support Healthcare Providers

This week, the Federal Communications Commission (FCC) adopted a $200 million program, called the COVID-19 Telehealth Program that will assist eligible providers to purchase telecommunications services, information services and devices necessary to provide connected care services, both for the treatment of coronavirus as well as other conditions that occur over the course of the pandemic. The program will only fund monitoring device that are already connected and able to automatically share data, rather than unconnected devices that patients use at home and then share results with their medical professional remotely.  Funding for the program will come directly from the CARES Act.   The FCC began accepting applications for the COVID-19 Telehealth program on April 13.  The PDF application and instructions are via their website.

Additionally, the FCC also announced the establishment of the three-year Connected Care Pilot Program, to support the development of telehealth services and delivery for low-income Americans, especially among rural and veteran populations.  The pilot would direct $100 million towards supporting connected care services through the Universal Services Fund (USF).  The program would fund up to 20 projects, though all costs of a pilot would not be fully funded by this program.  The FCC had originally released a notice of proposed rulemaking on the Connected Care Pilot Program in July 2018, and a proposed rule in July 2019, where they asked for comments on various aspects of their proposal.  In the latest publication, the FCC announced establishment of the pilot program, as proposed, in order to explore whether and how USF can help defray health care costs of providing connected care services.  

For more information on both the COVID-19 Telehealth Program and Connected Care Pilot Program, read the full Report and Order from the FCC.

CMS Informational Bulletin on Telehealth Medicaid Flexibilities & Use for SUD Treatment
 
In early April, CMS released an Informational Bulletin to address two main topics: (1) Rural Health Care and Medicaid Telehealth Flexibilities; and (2) Medicaid Substance Use Disorder Treatment via Telehealth.  The guidance was required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act passed in 2018.  The introduction to the document notes that although the information in the report is focused on expanding access to telehealth generally and for substance use disorder treatment, it does include information that will be useful for states in light of the ongoing response to the COVID-19 pandemic.  The document includes a list of questions that are designed to help states assess which paths to pursue that aligns with telehealth coverage and reimbursement options for expansion of telehealth in their state or in an emergency situation.  For further information, read the full report
FEATURED FEDERAL LEGISLATION

The Coronavirus Aid Relief and Economic Security (CARES) Act  
HR 748 (Rep. Courtney) - The $2 trillion relief package included several telehealth items, including allowing FQHCs and RHCs in this emergency period to be a distant site provider for a telehealth service covered by Medicare. However, these services will be paid an amount calculated from the fee-for-service schedule, not the prospective payment system.  It also waived requirements for face-to-face encounters for dialysis patients and hospice care, and made modifications to the telehealth resource center grant program.  For more detailed information, see CCHP’s full write up on the bill. (Status: 3/27 – Became Law)

The Telehealth Expansion Act
S. 3539 (Sen. Daines) - Amends the Internal Revenue Code of 1986 to exempt telehealth services from certain high deductible health plan rules. (Status: 3/19 – Referred to Senate Committee on Finance)
 
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FEATURED STATE COVID-19 FOCUSED LEGISLATION

ALASKA
SB 241 – Sets parameters around when telehealth can be used during the public health disaster without first conducting an in-person examination.  (Status4/1 Transmitted to Governor)

PENNSYLVANIA
SB 841 – Requires a Disaster Emergency Report that would, among other elements, examine data points on increased costs related to provider and staff training, including training on pandemic preparedness and the use of telemedicine. (Status: 4/7 Referred to House Rules Committee)

MINNESOTA
SF 4334 – Requires a health carrier to not exclude or reduce coverage for a health care service or consultation solely because the service or consultation is provided via telemedicine directly to a patient at their residence. This is meant to cover the COVID-19 emergency and expires in Feb. 2021. (Status: 3/26 Enacted)   

OHIO
HB 580 – Requires that during a state of emergency, a health plan issuer must cover any health care service that is provided via telemedicine, if certain criteria are met. (Status: 3/23 Introduced in House)

NEW JERSEY
AB 3843 - Requires health insurance and Medicaid coverage for testing of COVID-19 and for the delivery of health care services provided through telemedicine and telehealth during the COVID-19 emergency. The coverage shall be provided to the same extent as for any other health care services, except that no cost-sharing shall be imposed on the coverage. (Status: 3/20 Enacted)

ILLINOIS
Executive Order 2009 – During the COVID-19 emergency, requires health insurers to cover the costs of telehealth services rendered by in-network providers that are clinically appropriate and medically necessary.  The insurance companies can establish reasonable requirement and parameters for telehealth services. (Status: 3/19 Filed with the Secretary of State

For more information on state legislation & regulations, visit CCHP's legislative tracking webpage.
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