Senate Finance Committee Weighs Telehealth Solutions to Combat Fentanyl Crisis and Improve Behavioral Health Services
The Senate Committee on Finance recently convened a hearing to discuss measures to combat the fentanyl crisis, with a significant focus on the role of telehealth in behavioral health services. Committee members and witnesses emphasized the benefits of telehealth for addiction treatment and advocated for policies that support its integration into mainstream healthcare. Among the witnesses who spoke, Drs. Abigail Herron and Jeanmarie Perrone highlighted the importance of telehealth in reducing delays in care, improving patient-provider communication, and extending the availability of appointments. Both urged for payment parity in telehealth services to sustain the new models of addiction treatment that have emerged during the pandemic.
The Senate Finance Committee members, across party lines, showed strong support for the "Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act," which aims to enhance access to telehealth services for addiction treatment by allowing for the prescription of a controlled substance after one telehealth evaluation. Federal law requires an in-person visit (or meeting one of the narrow telehealth exceptions), although this requirement is currently not in effect due to extended COVID-19 temporary waivers. Additional witnesses, including Dr. Caleb Banta-Green and Tony Vezina, stressed the need for innovative care models and increased funding for recovery support (medication assisted treatment (MAT)), emphasizing telehealth's critical role in creating a comprehensive and accessible system for individuals battling substance use disorders. This hearing underscores the growing consensus on the pivotal role of telehealth in addressing behavioral health challenges and the ongoing fentanyl crisis. For more on the hearing, watch the full video and download each witnesses’ statement on the Committee on Finance Website. |
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HHS and CMS Finalize Rule to Ensure Non-Discrimination in Telehealth Services
The US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare and Medicaid Services (CMS) have jointly released a Final Rule updating non-discrimination regulations under Section 1557 of the Patient Protection and Affordable Care Act. The Final Rule, effective July 5, 2024, significantly impacts telehealth providers by prohibiting discrimination based on race, color, national origin, sex, age, or disability in the delivery of their health programs through telehealth services. Telehealth platforms must now be accessible to individuals with disabilities and those with limited English proficiency (LEP), ensuring effective communication and meaningful access for all patients. The rule finalizes a definition of telehealth that pulls directly from the Health Resources Services Administration’s Office for the Advancement of Telehealth which defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.” The OCR rule explicitly states that technologies included within the term includes videoconferencing, the internet, store-and-forward imaging, streaming media, terrestrial and wireless communications. Telehealth providers receiving Medicare payments must evaluate and update their programs to comply with these new requirements. The rule emphasizes that communications before, during, and after telehealth appointments must be accessible, and telehealth services may be used as reasonable accommodations for individuals with disabilities or those facing mobility challenges. The OCR also encourages telehealth providers to familiarize themselves with these regulations to avoid discriminatory practices and ensure equitable access to telehealth services, at several points directing covered entities to its previously released Guidance on Nondiscrimination in Telehealth for more details.
In response to concerns about inequities in telehealth reimbursement, the OCR stated that they will evaluate complaints regarding inadequate telehealth reimbursement or excessive requirements limiting access to telehealth on a case-by-case basis to determine if they are discriminatory under Section 1557. However, the regulation of reimbursement rates themselves falls outside the scope of this rule.
For more information, see the full text of the Final OCR Discrimination rule. |
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CMS Proposes TEAM Model to Enhance Care Coordination and Telehealth Access for Medicare Patients
Last month, the Centers for Medicare and Medicaid Services (CMS) released their proposed rule for Hospital Inpatient Prospective Payment System and for Acute Care Hospitals and Long-Term Care Hospital PPS for Fiscal Year 2025. Within the rule, CMS proposes establishing the Transforming Episode Accountability Model (TEAM), an episode-based alternative payment model aimed at improving care coordination and outcomes for Medicare patients undergoing specific surgical procedures. Under TEAM, selected acute care hospitals would oversee the cost and quality of care from surgery through the first 30 days post-discharge. The model includes a focus on connecting patients to primary care services to support long-term health outcomes. Key surgical procedures covered include lower extremity joint replacements and coronary artery bypass grafts.
Telehealth is emphasized within the proposed TEAM model with waivers for geographic and originating site requirements, and allowing beneficiaries to receive telehealth services from any location, including their homes. Note that the proposed telehealth waivers would not apply to the face-to-face encounter requirement for home health certification. Additionally, CMS proposes new telehealth-specific HCPCS G-codes to accurately report evaluation and management services provided to patients in their homes. While the waiver supports enhanced care coordination and timely access to care, it does not cover additional costs such as setup or training. CMS plans to monitor telehealth usage patterns under TEAM to prevent overutilization and ensure the quality of care remains high. CMS seeks comments on the proposed waivers with respect to telehealth services and creation of the new home visit telehealth G-codes.
The rule also recaps the Frontier Community Health Integration Project Demonstration (FCHIP) (originally established as a 3 year demonstration beginning in August 2016), which provides several waivers of Medicare telehealth requirements for critical access hospitals (CAHs) participating in the program. For example, CMS waives a section of statute that specifies that the payment for a telehealth service by a distant site practitioner is the same as it would be had the service been performed in person. CMS allows for modification of the payment amount for both services and the originating site facility fee in the demonstration to make reasonable cost-based reimbursement to participating CAHs. The FCHIP Demonstration was authorized for a five-year extension in 2021. The currently proposed rule estimates that the demonstration will be budget neutral, but acknowledges they may update or modify the budget methodology and analytical approach to ensure the full impact of the program is appropriately captured as time goes on. For more details on both the FCHIP demonstration and the new TEAM model, read the full text of the proposed rule. The comment deadline closed yesterday (June 10, 2024) and CMS will likely release a final rule before the end of the year. |
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VA Expands CHAMPVA: New Telehealth, Mental Health, and Contraceptive Services
In a new rule released in late April, the Department of Veterans Affairs (VA) has announced an expansion of medical services coverage for family members and primary family caregivers participating in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), effective May 30, 2024. These changes aim to ensure CHAMPVA beneficiaries, which include over 737,500 spouses, surviving spouses, children, and caregivers of eligible veterans, have access to high-quality care when needed. CHAMPVA covers a wide range of medical services, including mental health, prescriptions, surgeries, family planning, and more. Through the newly adopted rule, the VA is finalizing the removal of the exclusion of audio-only telehealth for CHAMVA beneficiaries for services provided on or after May 12, 2020. The amendment will apply retroactively and allow reimbursement of medically necessary audio-only telehealth services if claims are filed for reimbursement by Nov. 26, 2024. In addition to the audio-only allowance, the final rule removes limits for mental health and substance use services and specifies that pre-authorizations for outpatient mental health visits exceeding 23 per year or more than two sessions per week are no longer required. Finally, the rule also addresses contraceptive services, eliminating deductibles and cost-sharing for necessary contraceptive services approved by the FDA in the CHAMVA program. For more details, see the full text of the final rule. |
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Medicare SBIRT Services Includes Telehealth for Enhanced Accessibility Through Dec. 31, 2024
The Centers for Medicare and Medicaid Services has updated its Medicare Learning Network (MLN) booklet on Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services to include a section for telehealth services. SBIRT services encompass annual screenings and counseling for alcohol misuse, depression screenings in primary care settings, and wellness visits that include substance use disorder (SUD) screenings and mental health services. The new telehealth section specifies that Medicare covers interactive telecommunications, including 2-way interactive, audio-only technology to diagnose, evaluate or treat certain SUDs using telehealth services if the patient is in their home. It also states that providers can provide telehealth using 2-way interactive audio-only technology, and that they will pay telehealth services to patient’s homes at the non-facility physician service rate through Dec. 31, 2024. For more on SBIRT Services, see the entire MLN Guidance Booklet. |
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Evaluating Telemedicine Disparities for NHPI Medicaid Beneficiaries in Washington State
Recent policy changes have increased access to telemedicine services for Medicaid beneficiaries, addressing critical disparities for Native Hawaiian and Pacific Islander (NHPI) individuals who have faced disproportionate health care challenges, especially during COVID-19. A new study featured in Health Affairs Scholar using 2020–2021 Medicaid claims data from Washington State compared telemedicine usage between NHPI and non-Hispanic White individuals. The findings revealed that NHPI individuals were 38%-39% less likely to use telemedicine than their White counterparts, even after adjusting for various factors. The primary drivers of this disparity were differences in how characteristics like primary language and gender affected telemedicine use, rather than the characteristics themselves. For example, the authors found that varying levels of comfort with the English language could impact one's confidence in addressing a health concern via telemedicine as a digital modality rather than via in-person settings. These results highlight the need for healthcare leaders to work closely with NHPI communities to understand and address barriers, including potential discrimination in telemedicine access. For more details on the study’s design and results, see the full Health Affairs article. |
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Latest Policy Developments in CCHP’s Telehealth Policy Finder and Policy Trends Map
CCHP’s Telehealth Policy Finder look-up tool and Policy Trend Maps were updated throughout the past month based on the latest information from our ongoing state telehealth policy tracking. The latest states to be updated include Arizona, Arkansas, Georgia, Maine, Maryland, Michigan, Missouri, Pennsylvania, Rhode Island, West Virginia, and Wyoming.
Over the past month, multiple states made changes to their telehealth policies in an array of policy areas, including their Medicaid programs, professional regulations, and cross-state licensing. Highlighted changes from this group of states include:
- Arizona: Added new regulations to implement the state’s statutory required telehealth provider registration for out-of-state providers. It also provides practice standards for them to follow, including consent and requirements around liability insurance. Arizona also joined the Counseling Compact through passage of SB 1173.
- Arkansas: The Arkansas Medicaid Program updated their Transportation Manual to explicitly allow telemedicine to be used for ambulance services. Specifically, it states that an ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. The Arkansas Department of Health also revised their regulations to include telehealth practice standards for dietetics and speech language pathologists and audiologists.
- Georgia – In March, the Georgia Department of Health published a PowerPoint presentation to their website which indicates that telemedicine/telehealth practitioners are required to maintain professional liability insurance, including having a $1 million per occurrence and $3 million per aggregate in their policy. It also includes specific requirements for umbrella policies. Senate Bill 35 was also passed that amends Medicaid coverage requirements for continuous glucose monitoring.
- Maine: Passed LD 1956 which provides telehealth practice standards for optometrists, including that telehealth services are allowed as long as the licensee acts within the scope of practice of their license and standards of practice. Maine also joined the Physician Assistant Compact and Social Work Licensure Compact.
- Maryland: Passed House Bill 1078 which requires Medicaid to provide remote ultrasound procedures and remote fetal non stress tests in certain circumstances. House Bill 522/Senate Bill 492 was also passed which requires the State Department of Education and the Maryland Department of Health to jointly adopt guidelines for school health services regarding access to telehealth appointments. House Bill 1127/Senate Bill 950 was enacted to authorize the reimbursement of sexual assault forensic exams conducted through telehealth under certain circumstances, as well as requires a study on the feasibility of a telehealth program to conduct sexual assault forensic examinations. Additionally, two regulations were finalized. One regulation amends behavioral health crisis services regulations and references that mobile crisis follow-up outreach may be completed by means of telephone, telehealth or in person, and the second regulation relates to community based behavioral health services, and references the use of telehealth within mobile crisis teams.
- Michigan: Michigan Medicaid issued a new bulletin providing reimbursement clarification for out-of-state providers, including that they will reimburse out-of-state providers as long as they are enrolled in Michigan Medicaid and the patient is in the state where the provider is licensed. It also provides specific instructions for telemedicine providers licensed through the Interjurisdictional Telepsychology Compact. Additionally, the bulletin states that “virtual-only” providers not associated to a Michigan billing provider within the Community Health Automated Medicaid Processing System will be subject to out-of-state provider prior authorization requirements. See bulletin for additional billing instructions. Regulations governing telehealth practice for chiropractors were also adopted, including an informed consent requirement and practice standards.
- Missouri: Updated their telemedicine billing presentation to reflect continuation of telehealth after COVID-19, and provide billing clarifications, such as the correct place of service codes for health care providers delivering medical services and also those delivering behavioral health residential or inpatient services. It also clarifies the outpatient hospital facility fee and provides additional information for federally qualified health centers (FQHCs) and rural health clinics (RHCs). Specifically, it specifies the charges FQHCs can include on their cost report and which they cannot.
- Pennsylvania: Pennsylvania Medicaid updated their Federally Qualified Health Center/Rural Health Clinic Handbook, revising their definition for a FQHC/RHC encounter to include telehealth, telemedicine, or teledentistry between a beneficiary and the physician, dentist or licensed non-physician practitioner who exercises independent judgment in the provision of medically necessary health care services that are part of the FQHC’s/RHC’s approved scope of project.
- West Virginia: Passed Senate Bill 533 which requires that Medicaid and insurers that issue a policy on or after January 1, 2025, provide coverage for emergency medical services to (among other things) triage and transport a patient to an alternative destination within the state or treat in place if the ambulance service is coordinating the care of the patient through medical command or telehealth services. Senate Bill 300 was also passed which provides a definition of telehealth and allows for its use in the context of medication assisted treatment programs and treating patients with substance use disorder. Finally, House Bill 4110 was passed, which authorizes the West Virginia Board of Licensed Dietitians to promulgate a rule relating to telehealth practice, requirements and definitions. Additionally, a number of new regulations pertaining to telehealth were adopted including:
- A rule that establishes requirement for treatment of sexual assault victims at a health care facility, and addresses access to telehealth technology for teleSANE (sexual assault nurse examiners)
- A rule that establishes general standards and procedures for behavioral health services and support, including that a provider must have a policy regarding face to face or telemedicine availability of medical staff to directly observe the patient after hours.
- A rule establishing standards and procedures for licensure and regulation of medication assisted treatment (MAT) in office-based MAT programs, and includes that counseling sessions may be completed via telehealth.
- 4 professional boards adopted regulations addressing the use of telehealth within their profession, including: the Massage Therapy Licensure Board, the Board of Acupuncture, the Medical Imaging and Radiation Therapy Technology Board of Examiners and the Board of Licensed Dietitians. With the exception of the Dietitian regulations, the other board rules clarify that the professions are in-person and hands on, therefore those boards will not issue a license for the practice of telehealth in those particular professions.
Given the nuanced and varied approaches states are taking with their telehealth policies, please reference CCHP’s telehealth Policy Finder to link to additional details and access each states’ policies in their entirety. |
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