20/20 Vision: Legislative Foresight

We are already almost a month into 2020, and with the new year comes new opportunities for growth and advancement of virtual care delivery. Some of those advancements have already been in the works, and here we give you a summary of the things to keep an eye on in 2020.

Medicare

From Medicare comes a fresh Physician Fee Schedule for the new year, and with it, more coverage for telehealth.

While there were no submissions for new telehealth codes submitted for consideration by the medical community this year, in a surprise move, CMS itself suggested and finalized 3 new codes for telehealth treatment of Opioid Use Disorder: HCPCS codes G2086, G2087, and G2088. These codes describe “office-based treatment for opioid use disorder” at varying stages of treatment and increments of time.

CMS also clarified that telehealth services furnished by Opioid Treatment Programs, as established by the SUPPORT Act, are not being delivered by Medicare’s established eligible telehealth providers and therefore the telehealth services rendered by them are not restricted by the same restrictions to those eligible providers (i.e., geographic and originating site requirements). This raises an interesting question about other such entities that furnish these types of services, such as FQHCs and RHCs, and whether they too are exempt from those restrictions.

There were a few other mentions of services delivered via telecommunication technology in this year’s Physician Fee Schedule, mostly surrounding Transitional Care Management, Chronic Care Management, and a new subcategory of Principle Care Management. 

Check out the Center for Connected Health Policy’s fact sheet for an in-depth analysis of the new PFS.

Proposed Legislation

As we are starting a new year, we wanted to take a moment to review some of the larger pieces of legislation that are currently before Congress in regards to telehealth.

The CONNECT for Health Act

Truly a bipartisan bill, this is sponsored by an equal number of Democrat and Republican politicians in both the House and the Senate. The sweeping piece of legislation proposes a comprehensive overhaul to Medicare telehealth reimbursement policies. Most notably, Section 3 states that “the Secretary would be allowed to waive any restrictions applicable to telehealth services” given a handful of considerations on how the waiver effects utilization and budgetary and physician shortage needs.

The subsequent sections propose changes to how Medicare covers telehealth in a variety of settings and situations: mental health services, emergency medical care, federally qualified health centers and rural health clinics, native american health service facilities, and hospice care. It also addresses policies and procedures surrounding how new telehealth services are added, telehealth use in a national emergency, and fraud and abuse laws for services and technology. Lastly, it proposes a number of studies and models to explore how telehealth is used in the home, how the telehealth waiver functions in alternative payment models, and new models to look at adding other eligible health professionals and other measures of telehealth utilization. 

For more information, read CCHP’s initial analysis of the bill with a complete sectional breakdown and impact assessment.

STAR Act of 2019

The need for specialty care providers in rural areas and underserved communities is becoming a topic of high interest for many in the telehealth arena. Recently there have been a variety of studies done on the role that lack of medical specialists plays in mortality and population health care in those areas. 

• In the December 2019 issue of Health Affairs, researchers from Saint Louis University found that for rural patients, “having one or more annual visits with both a specialist and a primary care provider was associated with a 15.9 percent lower preventable hospitalization rate and a 16.6 percent lower mortality rate, relative to having only one or more visits with a primary care provider.”

   

• The University of Minnesota’s Rural Health Research Center cited similar numbers in their December 2019 Policy Brief: “Specialty care services were necessary for more than one in five (22%) of all Medicare beneficiary appointments in RHCs surveyed, but nearly two-thirds (64%) of all RHC respondents noted that they had difficulties finding specialists to whom they can refer their patients.”

   

• Mental health providers are particularly affected. The American Hospital Association put out a 2019 Rural Report, and in it they state that, “among rural Medicare beneficiaries, the number of telehealth visits increased from 7,015 in 2004 to 107,955 in 2013 and continues to rise […] In a recent analysis of rural Medicare beneficiaries, researchers found that nearly 80 percent of telehealth visits were related to mental health conditions, underscoring both the need and opportunity for this type of care in rural America.”

   

• The number of Americans affected was summed up nicely in the August 29, 2019 issue of Medical Economics Magazine: “According to the Centers for Disease Control and Prevention (CDC), more than 46 million Americans, about 15 percent of the entire U.S. population, live in sparsely populated areas with low housing density, often hours from urban centers. […] The Health Resources and Services Administration has designated 7,200 regions across the country as Health Professional Shortage Areas. Nearly 60 percent of those shortage areas are located in rural regions.”

The University of New Mexico’s Project ECHO, the MAVEN Project, and the VA Healthcare System have done an admirable job of directing the potential power of telehealth towards specialty care provider disparities between urban and rural areas. The next distinctly bipartisan bill worth highlighting, Specialty Treatment to Access and Referrals Act of 2019 (STAR Act), would make it the federal government’s turn.

The STAR Act focuses solely on medically underserved and rural areas and has a narrow and specific focus, in contrast to the sweeping CONNECT for Health Act. 

 Most recently OCHIN, “a nonprofit health care innovation center designed to provide knowledge solutions that promote quality, affordable health care to all”, has thrown its considerable weight behind the bill. In a press release on November 21, 2019, Abby Sears, the CEO of OCHIN said, “The STAR Act’s investments in telehealth expansion would help solve today’s problem of patients wasting precious time and money and give them access to specialists they may not otherwise see.”

The STAR Act would give the Secretary to grant up to $12,000,000 to eligible rural healthcare entities to implement and conduct pilot projects testing eConsult and related telehealth service efficacy between the years 2021 and 2025.

To review CCHP’s in-depth analysis of this bill, go here. 

Telehealth Across State Lines Act of 2019

Sen. Blackburn from Tennessee introduced a series of three bills aimed at reducing the shortage of physicians in rural America, the Telehealth Across State Lines Act, the Rural America Health Corps Act, and the Rural Health Innovation Act.

The Telehealth Across State Lines Act is of particular interest – as its title would suggest, it aims to create a national telehealth program. The bill is complete with reporting and study guidelines and a generous $20,000,000 cap per year to help establish this pilot between the years of 2020 and 2024.

For further information, the text of the bill can be found here. Here is an article from mHealthIntelligence on the bill, and here is an article summarizing all three bills in the Senator’s Rural Health Agenda.

MOMMIES Act

Another bill to keep an eye on is the The Healthy MOMMIES Act of 2019. While not specifically about telehealth, the bill is geared towards decreasing the maternal mortality rate in America. However, the author of the bill, Congresswoman Ayanna Pressley, clearly understands the role telemedicine can play in this case and includes “Studying telemedicine as a mechanism for increasing access to maternity care” as one of the main purposes of the bill. 

To read her summary, go here; to read the fill text of the bill, go here.

Moving Forward

Here is a list of some additional bills to keep an eye on in 2020:

• Lower Health Care Costs Act (S 1895)
• Enhance Access to Support Essential (EASE) Behavioral Health Services Act (HR 5473)
• Teleabortion Prevention Act of 2019 (HR 4935)
• Telehealth Expansion Act of 2019 (HR 5257)

2019 was a great year for telehealth. As the new year commences, we champions of telehealth need to keep up the momentum. If there is an open comment period for a new regulation, add your voice and expertise. If there is a bill supporting telehealth that is being championed by your local congressperson, reach out to them and offer your support and knowledge. Follow the SimpleVisit blog and other news sources to stay up-to-date on the progress our country is making towards a full realization at a policy level of what this technology is capable of. 

Keep a look out for Part 2 of our 20/20 Vision series next week, “Presidential Panorama”. We will examine the single biggest event of this coming year, the 2020 presidential election, and discuss how telehealth factors in to the campaigns of the candidates left in the race.