Lloyd Sirmons – Director www.setrc.us – 888.738.7210

On August 20, 2010, Georgia Partnership for TeleHealth (GPT) was awarded a HRSA grant from the Office for the Advancement of TeleHealth: Southeastern TeleHealth Resource Center. Grant Re-Awarded 2013 & 2016 (Grant #: G22RH30350)

Neufeld - Telehealth for Ohio Mental Health & Addiction Services Providers October 4, 2013

SETRC provides an applied approach to telehealth education and technical assistance services in order to streamline implementation and better utilize telehealth applications and technology in the region. Workgroups Provide insight and direction regarding the advancement of telehealth and encourage collaboration among existing telehealth networks and programs. Education Online education through the National School of Applied Telehealth (www.nsat.us) Awareness Present and Exhibit at State, Regional & National Events & Meetings

SETRC Advisory Committee Dr. Anne Burdick – FL – U of M Mike Smith – FL – FSU Ron Sparks – AL Dr. Eric Wallace – AL - UAB Jeff Robbins – GA – Tift Regional Jill Davis – GA – Collaborative Telehealth Consulting Kathy Schwarting – SC – Palmetto Care Conn Dr. Katie Cristaldi – SC Center of Excellence

Telemedicine Billing No reimbursement mandate – Payment Parity Bill Insurance Modifiers CMS & Medicaid (POS 02) GT – Live video GQ – Store and forward Contract with Providers Direct-to-Consumer FL Medicaid MCO – MCO required to pay for telemed & teledentistry CMS (Medicare) Private Payers

FL Medicaid AHCA Contract – Attachment II – Scope of Service – Effective 2/1/2019 Section VI. Coverage and Authorization of Services – P 63-63 The Managed Care Plan shall provide coverage for services provided through telemedicine, when appropriate, for services covered under this Contract, to the same extent the services would be covered if provided through a face-to-face (in-person) encounter with a practitioner. The Managed Care Plan agrees to not be more restrictive in the coverage requirements for services provided through telemedicine than those established for services provided in-person.

FL Medicaid The Managed Care Plan shall ensure the enrollee has a choice of whether to access services through a face-to-face or telemedicine encounter. The Managed Care Plan shall ensure that the enrollee record includes documentation, as applicable, when telemedicine services are provided.

FL Medicaid When providing services through telemedicine, the Managed Care Plan shall ensure: (1) The telecommunication equipment and telemedicine operations meet the technical safeguards required by 45 CFR 164.312, where applicable; (2) The Managed Care Plan’s providers using telemedicine comply with Health Insurance Portability and Accountability Act and other State and federal laws pertaining to patient privacy; (3) The Managed Care Plan’s telemedicine procedures comply with the requirements in this Contract; and (4) The Managed Care Plan provides training to providers regarding the telemedicine requirements in this Contract.

FL Medicaid The Managed Care Plan shall cover the following additional telemedicine modalities: store-and-forward and remote patient monitoring services, when appropriate, as a part of its Quality Enhancement programs, in accordance with the requirements specified in Attachment II, Section VI.F., Quality Enhancements, of the Contract. Failure to use telemedicine coverage provisions as described in Section VI.D.4. of this contract - $1,000 per occurrence (p. 183)

MEDICARE – Telehealth Only Live Video reimbursed Store & Forward (Asynchronous) only for Alaska & Hawaii demonstration pilots Specific list of providers eligible for reimbursement Limited to rural HPSA, non-MSA, or telehealth demonstration projects Limited types of facilities eligible Limited list of reimbursable services, but CMS decides what can be delivered via telehealth and reimbursed

MEDICARE – Telehealth (Beginning 1/1/19) Expanded to add Renal Dialysis Facilities & the home for ESRD-services ONLY. Rural limitation not apply for ESRD services in hospital-based or CAH-based renal dialysis centers, renal dialysis facilities or home. Acute stroke service via telehealth may take place in currently eligible originating sites and mobile stroke unit or any location deemed appropriate by Secretary. Renal Dialysis Facilities & home are excluded.

MEDICARE – Telehealth (Beginning 1/1/19) For acute stroke diagnosis, evaluation and treatment of symptoms, originating site limitations not apply. Facility fee not given to home originating sites or in the case of acute stroke services, those sites exempted from the geographic limitations. A new modifier will be created for acute stroke Types of services and providers eligible to be reimbursed if providing telehealth services did NOT change

MEDICARE – Telehealth (Beginning 1/1/19) Telehealth Technologies used to deliver care, but not called a telehealth service Added codes for remote physiological monitoring: CPT code 99453 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. CPT code 99454- Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. CPT code 99457- Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

Opioids & SUD The SUPPORT for Patient and Communities Act required CMS to adjust their reimbursement policy of telehealth for treating individuals with SUDs or a co- occurring mental health disorder. Removed the originating site geographic requirements for telehealth services on or after July 1, 2019 for any existing Medicare telehealth originating site (except for a renal dialysis facility). Home was made an eligible originating site for purposes of treating these individuals, however the home would not qualify for the facility fee. Within 5 years a report of the impact of telehealth services on SUD must be submitted by the Secretary

Opioids & SUD Guidance by CMS given to states regarding options for receipt of federal funds for Medicaid covered treatment of SUD through telehealth Guidance by CMS on availability of federal funding in Medicaid coverage for SUD treatment services using telehealth through managed care and school-based health centers Within one year the DEA must have final regulations for a special registration to remotely prescribe Suboxone/Buprenorphine through telehealth

Florida HB23 Practice Standards Standard of Care. The new law makes it clear that a telehealth provider has the duty to practice in a manner consistent with his or her scope of practice and the prevailing professional standard of practice for a health care professional who provides in-person health care services to Florida patients. Telehealth Exams. A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination before using telehealth to provide health care services.

Florida HB23 Practice Standards Telemedicine Prescribing A telehealth provider may only use telehealth to prescribe a controlled substance if the controlled substance is prescribed for: (1) the treatment of a psychiatric disorder; (2) inpatient treatment at a hospital; (3) the treatment of a patient receiving hospice services; or (4) the treatment of a nursing home resident.

Florida HB23 Practice Standards Telemedicine Prescribing This change expands telemedicine controlled substance prescribing in Florida to hospice and nursing home patients. Prior to this law, controlled substances could only be prescribed via telemedicine for the treatment of psychiatric disorders or for patients in a hospital. The Florida Board of Medicine may need to update its regulations to reflect this expansion. Telemedicine prescribers should continue to be mindful of prescribing requirements under federal laws, as remote prescribing of controlled substances is governed by the Ryan Haight Act.

Florida HB23 Practice Standards Patient Medical Records. Telehealth providers must maintain a complete record of the patient’s care according to the same standard as used for in-person services and comply with applicable Florida law for confidentiality and disclosure of the patient’s medical record.

Resources https://www.setrc.us/learn/ https://www.telehealthresourcecenter.org/ https://www.cchpca.org/