Alabama Partnership for Telehealth Summit: U.S. Telemedicine Policy Update

Latoya S. ThomasOctober 16, 2014Birmingham, AL

Public Policy Goals

Knock down government barriers

Promote “value” innovative payment and service models

Address care delivery problems• Cost, access, outcome,

productivity

Major Government Roles Rendering

Reimbursement

Regulation

Research

Resources

Readiness and recovery

Federal Overview

Medicare FFS BarriersLimited live video

Only rural counties (20% of beneficiaries) Limited originating sitesLimited providersOnly specific procedures

No store & forward

No remote patient monitoring

Medicare BillsTelehealth Enhancement Act of 2013

• HR 3306 – Gregg Harper (R-MS)

• S 2662 – Thad Cochran (R-MS)

Medicare Telehealth Parity Act• HR 5380 – Mike Thompson (D-

CA)

Side-by-Side: Rural  Telehealth Enhancement

Act, Cochran (S. 2662) / Harper (H.R. 3306)

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3

Store-and-forward for—    

Critical access hospitals ♦  

Sole community hospitals ♦  

Federally-qualified health centers   ♦

Rural clinics   ♦

Into homes for--    

Kidney dialysis (video and RPM) ♦  

Hospice patients ♦  

“Homebound” patients ♦  

Physician recertifications for home health care

♦  

Side-by-Side: MetroTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306) 

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3 

All critical access hospitals ♦  

All sole community hospitals ♦  

Restore coverage for 104 counties that lost it in 2013

♦  

Video for metro counties with < 25,000 population

♦  

Video and store-and-forward for metro counties with < 50,000 population

  ♦

Side-by-Side: All BeneficiariesTelehealth Enhancement

Act, Cochran (S. 2662) / Harper (H.R. 3306)

Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3

Hospital readmissions: shared savings for a hospital beating its reduction benchmark

♦  

For accountable care organizations ♦  

For bundled payments ♦  

For medical homes    

Medicare counterpart for Medicaid “health homes” for chronic care

♦  

Authorize specialty care oriented ♦  

Stroke diagnosis ♦  

Federally-qualified health centers – video and store-and-forward

  ♦

Remote patient monitoring for--    

Congestive heart failure   ♦

Chronic obstructive pulmonary disease   ♦

Diabetes by federally-qualified health centers   ♦

More covered providers    

Diabetes educators   ♦

Therapies – PT, OT, RT, speech & hearing   ♦

Coming Down The Pike…ACO New Proposed Regs

2015 Medicare Physician Fee Schedule • New CMS Code for Chronic Care Management

(GXXX1)• Other proposed service codes

FCC on universal services and net neutrality

HIPAA privacy and security

Internet Prescribing for Controlled Substances• Ryan Haight Online Pharmacy Consumer

Protection Act of 2008

State Overview

50 State PatchworkMedicaid47 states cover something

46 telemental health (AL)21 home telehealth (AL)14 remote patient monitoring (AL)11 store-and-forward

Private Insurance19 states + DC w/full parity laws2 states w/partial parity lawsWho’s next?

State Employee Plans11 states cover something

ATA State Telemedicine Gaps Analyses

State Composite Ratings for Coverage & Reimbursements Analyses

Alabama ProgressPARITYMedicaid C

MEDICAID COVERAGE & CONDITIONS OF PAYMENTDistance or Geography Restrictions APhysician-provided Services BMental/behavioral Health Services BPatient Setting CEligible Technologies BTelepresenter B

INNOVATIVE PAYMENT OR SERVICE MODELSHealth Home ✔ Corrections ✔

Chronic Disease Management ✔

Alabama OpportunitiesPARITYPrivate Insurance FState Employee-based Plan F

MEDICAID COVERAGE & PAYMENTEligible Providers FHome Health FRehabilitation N/AInformed Consent F

INNOVATIVE PAYMENT OR SERVICE MODELSMedicaid Managed Care  Medicare-Medicaid Dual Eligibles  State-wide Network  HCBS Waiver  

State Composite Ratings for Physician Practice Standards & Licensure

Alabama – Physician Standards

Coming Down The Pike…Convening State Legislature Sessions

• Parity• Improving coverage under Medicaid

and State employee health plans• Innovative payment/delivery models

State Licensing Boards • Scope of Practice• Practice Rules• Licensure Models

• Compact vs. Expedited Licensure

ATA Free, Public Resources

• 2014 ATA Policy Priorities

• State Policy Toolkit• State Gaps Analyses• State Legislative

Matrix• (Members Only)

– State Legislative and Regulatory Trackers

– Monthly State Call

• State Policy Checklist• ATA Wiki

• State Medicaid Best PracticesTelemental and BehavioralRemote Patient Monitoring and Home Video VisitsStore-and-forwardSchool-basedManaged CareTelestrokeHigh-risk PregnanciesTelerehabilitation

AmericanTelemed.orgATAwiki.org

Latoya S. ThomasDirector, State Telehealth PolicyLThomas@AmericanTelemed.org

202-223-3333