On July 7, 2016, the Centers for Medicare and Medicaid Services released their proposed Medicare Physican Fee Schedule for CY 2017. This year, CMS proposed expanding eligible telehealth services by adding the following 6 new telehealth codes for reimbursement:
- End-Stage Renal Disease Codes 90967, 90968, 90969, and 90970
- Advance Care Planning Codes 99497 and 99498
CMS also proposed to create two new G-codes to reflect the resource costs of providing critical care consultation services remotely to critically ill patients. The codes, GTTT1 and GTTT2, would be used for initial and subsequent services to describe critical care consultations delivered via telehealth.
For more information, read the CCHP July Newsletter, HERE.
To read the full Proposed Rule in its entirety, please click HERE
Photo (L-R): Senator Rosalyn Baker, Hawai‘i State Legislature; Christina Higa, Co-Program Director, PBTRC; Governor David Ige, State of Hawai‘i; Deborah Birkmire-Peters, Co-Program Director, PBTRC
On July 7, 2016, Governor David Ige of the State of Hawaii signed into law Senate Bill 2395: Relating to Telehealth as Act 226 (16). This Act:
- Requires the State’s Medicaid Managed Care and Fee-for-Service programs to cover services provided through telehealth;
- Specifies that any telehealth services provided shall be consistent with all federal and state privacy, security, and confidentiality laws;
- Specifies medical professional liability insurance policy requirements with regard to telehealth coverage;
- Clarifies that reimbursement for services provided through telehealth shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient;
- Requires written disclosure of coverages and benefits associated with telehealth services;
- Ensures that telehealth encompasses store and forward technologies, remote monitoring, live consultation, and mobile health;
- Ensures that telehealth is covered when originating in a patient’s home and other non-medical environments;
- Clarifies requirements for physicians and out-of-state physicians to establish a physician-patient relationship via telehealth;
- Ensures that reimbursement requirements for telehealth services apply to all health benefits plans under chapter 87A, Hawaii Revised Statutes; and
- Makes other conforming amendments related to telehealth for clarity.
To view the Act in its entirety: http://www.capitol.hawaii.gov/session2016/bills/GM1328_.PDF
To watch the signing ceremony: https://youtu.be/ZUufRdqIy4Q
The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health & Human Services (HHS) released a Technical Brief titled, “Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews.” The brief provides an overview of the body of evidence about telehealth for use by decisionmakers.
To view the brief, click HERE.
The fourth edition of CCHP’s State Telehealth Laws and Reimbursement Policies Report is now available! CCHP’s report is the most comprehensive report on state telehealth laws, regulations and Medicaid policies available and contains the most current and up to date information for all 50 states and the District of Columbia. The report found that as many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth delivered services. Live video Medicaid reimbursement continues to far exceed reimbursement for store-and-forward and remote patient monitoring (RPM). In fact, the number of states offering any form of reimbursement for live video, store-and-forward or RPM services has remained stagnant since July 2015 (although there has been a shift in the particular states offering reimbursement for these modalities). These diverging policy directions are indicative of the vast difference in telehealth policies throughout the nation.
Significant findings for this April 2016 update include:
- Just as last year, forty-seven states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. While Iowa’s Medicaid program clarified that they do provide reimbursement for live video, Utah’s telemedicine policy cannot be found, eliminating the state from those that provide reimbursement and keeping the number of states that provide telemedicine reimbursement consistent with last year.
- Oklahoma’s Medicaid program no longer provides reimbursement for store and forward delivered services, while Washington’s Medicaid program now does. Therefore, states reimbursing for store and forward remains at nine states. States that only provide reimbursement for teleradiology were not counted in this number.
- There has been no change since July 2015 in state Medicaid programs offering reimbursement for RPM, continuing at sixteen states.
- Although the practice of restricting reimbursable telehealth services to rural or underserved areas, as is done in the Medicare program, is decreasing, some states continue to maintain this policy. For example, Idaho eliminated such a policy since our July 2015 update of this report, however New Hampshire added this restriction.
- The practice of limiting the type of facility that can serve as an originating site is becoming more common with eight states adding specific facility lists for originating sites since July 2015, making a total of 23 states with this restriction.
- Thirty state Medicaid programs offer a transmission or facility fee when telehealth is used (an increase of one state from July 2015).
- Thirty-three jurisdictions have laws that govern private payer telehealth reimbursement policies (an increase of four states from July 2015).
Visit CCHP’s website to download a copy of the infograph
or a full PDF version of State Telehealth Laws and Reimbursement Policies Report. Or use CCHP’s interactive state policy map
to conduct specific searches. All of these materials can be located on CCHP’s website
View the updated report here!
On March 14, 2016, Christina Higa, Co-Program Director of the Pacific Basin Telehealth Resource Center gave a presentation on Telehealth and Telemedicine to the Pre-Medical Association of the University of Hawai‘i at Mānoa. During the presentation, students were asked if they were aware of telehealth and telemedicine. Unfortunately, out of the 28+ students who came, few raised their hands in acknowledgement. Ms. Higa spoke on the topics of telehealth and telemedicine that are very exciting, yet very complex. Telehealth and telemedicine are growing topics that will be increasingly important for future physicians and other healthcare workers. Ms. Higa reiterated that our future physicians need to become aware of the different aspects of healthcare (including telehealth and telemedicine) that will ultimately impact future physicians and their patients.
The Pre-Medical Association (PMA) is the largest pre-health organization at the University of Hawai‘i at Mānoa. The mission of PMA is to strive to provide students with a holistic perspective of the field of healthcare, help members to develop academically and professionally through service and leadership opportunities, as well as foster collegiality among peers with similar goals and interests. The goals of the Pre-Medical Association are to provide its members with events and activities relevant to the field of healthcare, such as community service and medical education opportunities. PMA also connects its members with professionals in the healthcare community, expose members to under-served areas, academic institutions, and organizations related to healthcare.