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Telehealth Congressional Support Letter


The undersigned organizations represent millions of individuals facing serious, acute and chronic health
conditions across the country. Our organizations have a unique perspective on what individuals need to
prevent disease, cure illness and manage chronic health conditions. The diversity of our groups and…

December 9, 2020

Dear Majority Leader McConnell, Minority Leader Schumer, Speaker Pelosi, and Minority Leader
McCarthy:


The undersigned organizations represent millions of individuals facing serious, acute and chronic health
conditions across the country. Our organizations have a unique perspective on what individuals need to
prevent disease, cure illness and manage chronic health conditions. The diversity of our groups and…

Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 – December 2020

As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access the healthcare services they need in as safe a manner as possible. In order to provide our clients with quick and actionable guidance on the evolving telehealth landscape, Manatt Health has developed a federal and comprehensive…

Telehealth Practice Among Health Centers During the COVID-19 Pandemic — United States, July 11–17, 2020

Weekly / December 18, 2020 / 69(50);1902–1905

Hanna B. Demeke, PhD1; Leah Zilversmit Pao, PhD1; Hollie Clark, MPH1; Lisa Romero, DrPH1; Antonio Neri, MD1; Rhea Shah, MPH2; Kendra B. McDow, MD1; Erica Tindall, MSN1; Naureen J. Iqbal1; Kendra Hatfield-Timajchy, PhD1; Joshua Bolton, MS3; Xuan Le, AM3; Brionna Hair, PhD3; Stephanie Campbell, MPH3; Cuong Bui3; Paramjit Sandhu, MD1; Isaac Nwaise, PhD1; Paige A. Armstrong, MD1; Michelle A. Rose, PhD1 (View author…

Relief Bill Revamps COVID-19 Telehealth Program

The most recent COVID-19 relief bill that was signed into law in December includes $250 million in new funding for the federal COVID-19 Telehealth Program, previously discussed here. The program was originally established in March, at the beginning of the pandemic, to help expand connectivity among patients and providers across the country. Telehealth has played a vital role in fighting the COVID-19 pandemic by allowing patients to receive high-quality care from their homes or other remote locations and avoiding the risks of exposure to COVID-19…

HHS invests $8 million to address gaps in rural telehealth through the Telehealth Broadband Pilot Program

The program will be implemented in four state community locations, including in Alaska, Michigan, Texas and West Virginia.

Jeff Lagasse, Associate Editor

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, has awarded $8 million to fund the Telehealth Broadband Pilot program, which assesses the broadband capacity available to rural healthcare providers and patient communities to improve their access to telehealth.

Through the new program, $6.5 million was awarded to the National Telehealth Technology Assessment Resource…

Top 5 Telehealth Law Predictions for 2021

Tele-Med Act of 2015

With 2020 officially behind us, what does 2021 have in store for telemedicine and digital health policy? A year ago, our team predicted 2020 would bring “notable expansions in Medicare and Medicaid coverage” and “the reimbursement landscape looks promising for virtual care services.” Looking back, that was an understatement (if an easy one). Below are five new predictions for what legal changes telemedicine and digital health companies might expect to see this year.

1.  Licensing: More Efforts to Increase Reciprocity and Laws that Prioritize Quality of Care

In an effort to balance workload nationally and expand access to health care practitioners during the Public Health Emergency (PHE), many states temporarily suspended medical licensing requirements. As these temporary waivers begin to sunset, some state legislatures will seek to make the waivers permanent, allowing practitioners licensed in other states to deliver telehealth services across state lines, provided the out-of-state practitioner follows local state practice standards. While this may be a topic of discussion among policy shops, we expect few states will actually enact such changes in 2021.

Federally, the PREP Act allows practitioners to deliver telehealth services across state lines under a licensure exemption for COVID testing and certain limited “covered countermeasures” (e.g., treatment of COVID-19 infections). The PREP Act also grants certain immunities and protections, preempting state laws during the PHE. Given its Constitutional complexity and political nature, interstate licensing does not have a widely-accepted “solution,” nor does it have the bipartisan support seen in other areas of telehealth. Licensure will be a friction point between virtual care stakeholders and traditional practitioners invested in brick and mortar locations industry. The status quo (i.e., profession-specific interstate compacts and state-by-state patchwork legislative efforts) has left many digital health stakeholders unimpressed, frustrated, and increasingly searching for an alternate solution. Yet, a federal “top-down” preemption approach will be perceived as an unconstitutional encroachment on states’ rights under the 10th Amendment. Keep an eye out for a third channel to thread the needle, perhaps tying federal funds (e.g., Medicaid or COVID relief dollars) to state adoption of certain licensure waivers, enticing states to opt-in to interstate licensure reciprocity rather than federally compel it.

2.  Modalities: Technology-Neutral State Laws that Prioritize Quality of Care.

In 2020, many states enacted new telehealth laws and rules to change prior practice standards, allowable modalities, or prescribing requirements. Changes included eliminating face-to-face exams, practicing via telephone only, or waiving modality prescribing restrictions on telemedicine. Some of these changes were made by legislation while others by executive order or regulation. Many of the changes were on a temporary basis during the pandemic (with expiration dates that, confoundingly, often did not match the federally declared Public Health Emergency date). These waivers created a telehealth regulatory environment that focused less on technical modalities of care delivery (e.g., audio-video vs. asynchronous) and more on meeting the standard of medical care for a given patient. Aiding in this effort, the American Telemedicine Association (ATA) published model policy language for state telehealth rules, to serve as a reference tool for best practices. This trend towards technology-neutral telemedicine laws will continue in 2021, with stakeholders emphasizing the importance of medical standard of care and clinical quality of services, rather than proscriptive modality requirements.

3.  Privacy: Greater Sensitivity to Patient-as-Consumer in Digital Health

Telemedicine and digital health companies handling patient information on substance use disorder treatment can expect to see favorable changes to HIPAA laws, designed to encourage easier sharing of patient data, particularly for treatment purposes. Similar changes are anticipated to regulations under 42 C.F.R. Part 2 to ease payment and health care operations. Telehealth companies should also keep an eye on state data privacy laws. More states are expected to enact their own consumer laws to protect data privacy, as California did with its California Consumer Privacy Act. And the Federal Trade Commission (FTC)—the nation’s top federal privacy regulator—will continue enforcement investigations against organizations that violate consumer privacy rights. Given the proliferation of new telehealth services and startup companies launched in 2020, increased privacy regulation is likely to occur in 2021.

4.  Enforcement: OIG/DOJ Will Build on Prior Investigations

Building on its 2019 and 2020 criminal and civil investigations, HHS OIG and DOJ will continue its takedown of companies engaged in “telefraud“: scams that couple aggressive online marketing tactics with telemedicine services to serve as a conduit for illegal kickback arrangements with pharmacies, DME suppliers, and laboratories. Most telemedicine enforcement actions to date have involved kickback schemes and billing for medically unnecessary equipment and diagnostic tests, and few have centered on billing and coding of telehealth professional services. The ATA has commented how these companies do not represent the industry at large, and issued a letter articulating hallmarks of legitimate telemedicine providers.

With many traditional in-person providers having newly (and quickly) moved into telehealth in 2020, along with new temporary waivers of billing and coding rules and a relaxed regulatory environment, the future will likely see more Medicare audits and overpayment claims of telehealth professional services. Some niche areas of enforcement may be marketing/referral arrangements with pharmacies and laboratories, waivers of patient financial responsibility, ordering high-cost genetic tests, billing for practitioners located outside the United States, and arrangements seeking to take advantage of the global pandemic.

5.  Payment: Continued Expansion of Telehealth Reimbursement

The pandemic compelled health plans, both government and commercial, to remove prior restrictions on telehealth and expand coverage for virtual care at a rate previously unseen. The new policy changes on Medicare reimbursement followed the previously established pathway of coverage, but the pace at which they were made was stunning. CMS also introduced nearly 100 telehealth service codes covered on a temporary basis until the Public Health Emergency expires. Much of 2020’s reimbursement expansion will continue through 2021, as commercial payers follow CMS’ lead. Remote patient monitoring still has plenty of room to grow. Despite the recent payment expansions RPM has seen, it has yet to have its “breakout year” in widespread use and payment.

Employers will explore more telehealth services for employees to deal with the stress of the pandemic, focusing on tele-primary care, behavioral health, and specialty care like fertility. As more traditional providers offer telehealth services in addition to in-person care, we may see telehealth increasingly paid on a fee for service basis (rather than a PEPM enterprise model). At the same time, value based models focusing on or centered around virtual care, including bundled payments and shared savings, will grow beyond the pilot phase, as providers begin to “own” certain care pathways.

Time will tell how these five predictions will hold up over the next 12 months. What is certain, however, is that telemedicine and virtual care continues to be one of the fastest-growing areas in healthcare.

What’s next for telehealth under the Biden administration?

There’s lots of work to do expanding access for underserved patients, said experts at the American Telemedicine Association’s EDGE policy conference.

By Kat Jercich January 12, 2021 03:33 PM

The COVID-19 pandemic triggered a flurry of changes to regulations around telehealth and virtual care – the vast majority of which expire once the public health emergency ends.

The current presidential administration and 116th Congress have each signaled their support for virtual care to various degrees over the past year….

Lawmakers Face Pressure to Address Licensure Barriers for Telehealth Adoption

The Alliance for Connected Care has sent an open letter to federal and state policymakers urging them to develop licensure guidelines that would allow providers to treat patients in other states via telehealth.

By Eric Wicklund

January 14, 2021 – The Alliance for Connected Care is putting pressure on lawmakers at both the state and federal levels to relax licensing barriers that interfere with multi-state telehealth programs.

The alliance has sent an open letter to policymakers in a bid to create consensus principles for telehealth across state lines….

CMS Clarifies 2021 PFS Reimbursements for Remote Patient Monitoring

In an update posted this week in the Federal Register, the Centers for Medicare & Medicaid Services has amended the 2021 Physician Fee Schedule to clarify reimbursement for remote patient monitoring programs.

By Eric Wicklund

January 20, 2021 – The Centers for Medicare & Medicaid Services has made corrections to the 2021 Physician Fee Schedule, opening the door to improved reimbursement for remote patient monitoring.

In a January 19 update posted in the Federal Register, CMS amended a requirement for RPM coverage that had drawn criticism from telehealth…

Today’s Virtual Care Revolution: How Policy Has Shaped And Will Continue To Shape Telehealth

Some will say 2020 was the year that everything changed, but in reality, it will be 2021 that determines our new healthcare reality. Virtual care advanced quickly—and under duress—last year. How will we learn from the seismic shifts in care delivery we experienced thanks to COVID-19? How can we help providers and innovators embrace the transformation? How will we solidify these gains?

Dad’s Story: Telemedicine Pioneer

We think of telemedicine as a relatively recent invention—only made possible by the internet and smart phones—but I had my first taste of…

Staff Training, Education May be the Keys to Telehealth Sustainability

Dozens of health systems and organizations in New York are joining forces with the Northeast Telehealth Resource Center to launch a statewide telehealth training program.

By Eric Wicklund

January 22, 2021 – As healthcare providers look to launch or expand their telehealth networks, a key ingredient to success and sustainability is a staff that knows how to use the technology.

A telehealth bill introduced earlier this month by New York Governor Andrew Cuomo includes the launch of an open-access continuing professional education telehealth training program. The program,…

The “State” of Telehealth: New Jersey

Saturday, January 23, 2021

This article is the first post in our new “State” of Telehealth series in which we discuss innovation on a state level on the expansion of telehealth access, coverage and reimbursement.

On January 14, 2021, the New Jersey Senate Committee approved a proposed bill (Bill S-2559, the “Bill”) that, if signed into law, would amend New Jersey’s existing telehealth law and expand reimbursement for covered services provided via telehealth.

The Bill sponsored by Senators Vin Gopal and Nia Gill would…

OIG audits telehealth home services, studies HHAs’ pandemic strategies

The Department of Health and Human Services Office of Inspector General recently has disclosed it is conducting an audit of home health services that were provided as telehealth during COVID-19. In addition, it is studying the challenges home health agencies (HHAs) have faced in providing care during the pandemic.  

In recent months, the Centers for Medicare and Medicaid Services has waived certain requirements in an effort to extend Medicare telehealth benefits to healthcare professionals who had been ineligible before the COVID-19 pandemic. An audit will evaluate whether skilled services furnished…

Omnibus Appropriations Package – 15 Key Provisions for Healthcare Providers

The spending bill funds the federal government through the end of the fiscal year, Sept. 30, 2021, and provides a $300 per week federal unemployment supplement, $600 stimulus checks and $284 billion for a second round of Paycheck Protection Program loans discussed in a previous McGuireWoods alert, among other policies….

Passed by Congress Dec. 21, 2020, and signed by President Donald Trump Dec. 27, 2020, the $1.4 trillion omnibus Consolidated Appropriations Act, 2021 (H.R. 133), includes numerous statutory provisions that directly affect healthcare providers.

The spending bill funds the federal government through the end of the fiscal year, Sept. 30, 2021, and provides a $300 per week federal unemployment supplement, $600 stimulus checks and $284 billion for a second round of Paycheck Protection Program loans discussed in a previous McGuireWoods alert, among other policies….

‘Really difficult nut to crack’: MedPAC torn over telehealth regs post-COVID-19

Dive Brief:

  • Members of an influential congressional advisory committee on Medicare are torn on how best to regulate telehealth after the COVID-19 public health emergency, hinting at the difficulty Washington faces as it looks to impose guardrails on virtual care without restricting its use after the pandemic ends.
  • During a Thursday virtual meeting, the Medicare Payment Advisory Commission expressed its support of telehealth broadly, but many members noted snowballing use of the new modality could create more fraud and abuse in the system down the line.
  • Key questions of how much Medicare…
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