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

2. 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

3. 21st Century Landscape

4. 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

5. 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.

6. 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

7. 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

8. 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

9. Medicare Telehealth Updates
CY 2018 Proposed Physician Fee Schedule
CPT codes and (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 (Interactive complexity (List separately in addition to the code for primary procedure))
CPT codes and (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 (Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)).  CPT code 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

10. 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

11. 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

12. ATA State Policy Resources
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

13. Join Us in Washington, DC!
Register Today
ATA Lobby Day
Networking Opportunities
Engaging Discussions

14. Director, State Policy Resource Center
AmericanTelemed.org
ATAwiki.org
Latoya S. Thomas
Director, State Policy Resource Center