Palmetto Care Connections: National Telehealth Policy Update Latoya S. Thomas August 23, 2017

About ATA The American Telemedicine Association (ATA) is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and our members work to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Established in 1993 Over 8,000 members world-wide

21st Century Landscape

Challenges & Opportunities Coverage & Payment Clinical Practice & Licensure Portability Provider & Care Networks Knock down government barriers Identify innovative elements Promote value Fully support innovative payment and service models that address care delivery problems: Cost, access, convenience, choice, outcomes, and productivity

States with Parity Laws for Private Insurance Coverage of Telemedicine (2017) WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH* ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ* AL AK* Telemedicine Parity Law Partial Parity Law Proposed Parity Bill No Parity Legislative Activity States with the year of enactment: Alaska (2016)*, Arizona (2013)*, Arkansas (2015), California (1996), Colorado (2001), Connecticut (2015), Delaware (2015), Georgia (2006), Hawaii (1999), Indiana (2015), Kentucky (2000), Louisiana (1995), Maine (2009), Maryland (2012), Michigan (2012), Minnesota (2015), Mississippi (2013), Missouri (2013), Montana (2013), Nebraska (2017), Nevada (2015), New Hampshire (2009), New Jersey (2017), New Mexico (2013), New York (2014), North Dakota (2017), Oklahoma (1997), Oregon (2009), Rhode Island (2016), Tennessee (2014), Texas (1997), Vermont (2012), Virginia (2010), Washington (2015) and the District of Columbia (2013) States with proposed legislation: In 2017, Idaho, Iowa, Kansas, Massachusetts, North Carolina, Ohio, Pennsylvania, and West Virginia *Coverage applies to certain health services.

50 State Medicaid Models Today All cover imaging All states cover something 49 telemental health 40 home telehealth 21 remote patient monitoring 16 store-and-forward WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AL Medicaid Telehealth Coverage No Coverage

Interstate Licensure Models National Reciprocity No bills pending Expedited Federation of State Medical Boards (Interstate Medical Licensure Compact) – 22 states joined Pending: D.C., Georgia, Maine, Michigan, and Texas Mutual Recognition National Council for State Boards of Nursing (Enhanced NLC) – 26 states joined Pending: Massachusetts, New Jersey Pending: None (APRN Compact) – 2 states joined (Needs 10 states) Association for State and Provincial Psychology Boards (PSYPACT) – 3 states joined (Needs 7 states) Pending: Illinois Federation of State Boards of Physical Therapy – 14 states joined Proposed: New Jersey

Nationwide Areas for Improvement Telehealth Business Registries Alaska and New Jersey Accommodate patient and provider settings Parity for all state-regulated health plans Network Adequacy Facility credentialing and privileging by proxy Cross-state practice Interagency collaboration Modality-neutral e.g. asynchronous, synchronous, remote patient monitoring, online adaptive interviews Hold telemedicine to the same standard as in-person care Tech-enabled remote supervision and collaborative agreements Establishing a provider-patient relationship Initial and follow-up visits Prescribing and Dispensing Technology allowed Telepresenter/facilitator Additional patient informed consent Provider and patient location

Medicare Telehealth Updates CY 2018 Proposed Physician Fee Schedule CPT codes 90839 and 90840 (Psychotherapy for crisis; first 60 minutes) and (Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) HCPCS code G0296 (Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)) CPT code 90785 (Interactive complexity (List separately in addition to the code for primary procedure)) CPT codes 96160 and 96161 (Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument) and (Administration of caregiver-focused health risk assessment instrument (eg,depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument)) HCPCS code G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)) Eliminate the required use of the GT modifier on professional claims. This does not apply to institutions or asynchronous demonstrations in Alaska and Hawaii. CMS is also soliciting public comment on 2 areas: Ways that it might further expand access to telehealth services within the current statutory authority and pay appropriately for services that take full advantage of communication technologies. Regarding remote patient monitoring, other existing codes that describe extensive use of communications technology for consideration for future rulemaking, including CPT code 99090 (Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)).  CPT code 99090 is also assigned a procedure status of B (bundled). Medicare Telehealth Audits OIG reviewing Medicare claims paid for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements. Proposed Comprehensive Care for Joint Replacement Model Waives 1834(m) for appropriate HCPCS codes Allows telehealth in the home

Urge Congressional Support to remove Medicare telehealth barriers. CBO Score! CHRONIC CARE Act - S. 870: Sen. Hatch (R-UT) Medicare Advantage ACOs Stroke diagnosis and treatment Home RPM for dialysis therapy CONNECT for Health Act – S. 1016/H.R. 2556: Sen. Schatz (D-HI) & Rep. Black (R-TN-6) Telehealth provisions from S. 870 Bundled payments FQHCs, IHS sites Allows administrative order to expand coverage

Other Key Federal Policy Reforms Medicare Telehealth Parity Act H.R. 2550: Rep. Mike Thompson (D-CA-5) Helping Expand Access to Rural Telehealth (HEART) Act H.R. 2291: Rep Sean Duffy (R-WI-7) CMMI Mtg – Sept. 8 Behavioral health payment models Ryan Haight Act Outstanding response from DEA on internet prescribing

ATA State Policy Resources http://www.americantelemed.org/policy-page/state-policy-resource-center ATA Policy Priorities State Policy Toolkits State Gaps Analyses State Legislative Matrix (Members Only) State Legislative and Regulatory Trackers Monthly State Webinar State Policy Checklist ATA Wiki Telemedicine Practice Guidelines State Medicaid Best Practices Telemental and Behavioral Remote Patient Monitoring and Home Video Visits Store-and-forward School-based Managed Care Telestroke High-risk Pregnancies Telerehabilitation

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Director, State Policy Resource Center AmericanTelemed.org ATAwiki.org Latoya S. Thomas Director, State Policy Resource Center LThomas@AmericanTelemed.org 202-223-3333