Leveraging the Utilization of Telemedicine to Improve Access to Care Richard Elliott Network Manager

MHS & Telehealth Our partnership efforts include: Within MHS’ School-Based Division, collaboration with providers, schools, and community partners has led to the implementation of school-based telehealth clinics. Elwood School-Based Telehealth Clinic (Elwood, IN) The Healthy Vikes School-Based Telehealth Clinic (Valparaiso, IN) Our partnership efforts include: Facilitation of work plan Technical assistance Funding Marketing Elwood provides both physical and behavioral health services. Open M-F school hours (when school is in session) Sees ONLY students Diagnose and treat acute illnesses and minor injuries such as strep throat, ear infections, rash, and influenza. (St. Vincent Medical Group- Dr. Zentz) Limited lab testing (rapid strep, rapid flu, urine dips/cultures) (St. Vincent Medical Group- Dr. Zentz: gives verbal order over virtual visit for nurse to conduct lab; lab resources provided by St. V) Behavioral health services and referrals (Aspire Indiana) Health Vikes provides physical health services. Open M-F 6:30am-11:30am (when school is in session) Sees students AND staff Diagnose and treat acute illnesses and minor injuries such as strep throat, ear infections, rash, and influenza. Limited lab testing (rapid strep, rapid flu, urine dips/cultures) HealthLinc has a MA onsite at the school to act as the ‘presenter’ Do we share the other clinics launched? IRHA’s initiatives Brief mention of the 9 that have launched or will launch this school year with their HRSA funding…. Partnership efforts: Facilitation of work plan: hosting work group and sub committee work groups, following up with ‘next steps’, take aways, assignments, etc.; mitigating gaps and barriers Technical assistance: providing TA and SME to initiative based on lessons learned, best practices from other clinics and clinic models within IN and across the US Funding: MHS has provided funding for telehealth equipment, marketing materials, printings and mailings Marketing: marketing support to the initiative as well as specific marketing to our members on the sponsoring agency’s panel

Operational Models Physical Health- St. Vincent Medical Group Billing- GT Modifier, Spoke and Hub site billing The clinic can: Diagnose and treat acute illnesses and minor injuries Conduct limited laboratory testing (strep, flu, urine) Provide behavioral health services and referrals ROI for MHS Increase access to care for our members (both physical and behavioral health) Decrease in inappropriate ER use Increase in continuity of care Potential ROI if other uses: ROI for provider Increase in continuity of care for current patients Increase in access to care Increase in patient load Embed Aspire video Physical Health- St. Vincent Medical Group Behavioral Health- Aspire Indiana

Opportunities for Additional Use 7 day follow up/30 day follow up HEDIS 2018 changes Prescribing of a partial agonist to treat or manage an opioid dependence. (House Bill 1337) Billing for Telemedicine Services: Hub Site: Professional Service Code with the GT Modifier Spoke Site: Telemedicine Originating Site Facility Fee – Q3014 with GT Modifier Store and Forward not reimbursed, NCQA HEDIS change A telehealth encounter can satisfy both the 7-day and 30-day follow-up visit measures. No in-person office visit is required. If both follow-up visits are conducted via telehealth, the two encounters can be conducted by two different mental health professionals. It is not required that they be conducted by the same professional. The professional qualifications are the same for the mental health professionals conducting in-person and telehealth follow-up visits House Bill 1337 Requires the office of Medicaid policy and planning office to reimburse a Medicaid provider, determined by the office to be eligible, for covered telemedicine services. Prohibits the office from setting any distance restrictions under Medicaid on telehealth services and telemedicine services. Requires a telemedicine services prescriber to contact the patient’s PCP if the telemedicine services prescriber has provided care to the patient at least two consecutive times through the use of telemedicine services. Removes a limitation on prescribing controlled substances EXCEPT for opioids through the use of telemedicine if: 1. The prescriber maintains a controlled substance registration; 2. the prescriber meets federal requirements concerning the prescribing of the controlled substance; 3. The patient has been examined in person by a licensed Indiana healthcare provider that has established a treatment plan to assist the prescriber in the diagnosis of the patient; 4. The prescriber has reviewed and approved the treatment plan and is prescribing for the patient pursuant to the treatment plan; and 5. The prescriber complies with the requirements of the INSPECT program. Allows for the prescribing of an opioid using telemedicine services IF the opioid being prescribed is a partial agonist being prescribed to treat or manage an opioid dependence. Hub Site Services and Billing Requirements Office or other outpatient visits- 99201-99205 and 99211-99215 Individual psychotherapy- 90832-90834, 90836-90840, 90846, 90847, and 90853 Psychiatric diagnostic interviews- 90791 and 90792