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 States Take Steps to Make Telehealth a Viable Option for Rural Populations

A new analysis by Avalere Health, a consultancy in Washington, D.C., examines how states are increasingly turning to telehealth options as they look for avenues to improve access and health outcomes for their underserved, rural, or homebound populations.

The study comes at a time more long term and post-acute care facilities, notably in rural areas, are also having conversations about telehealth and its uses in the clinical care of residents.

Avalere said even as the Centers for Medicare & Medicaid Services has made regulatory efforts to expand access to telehealth, like through its final rule in April to increase telehealth benefits for Medicare Advantage plans, it is the states that are playing a critical role in the coverage and reimbursement environment for telehealth services.

“Many state legislatures view telehealth as an opportunity to alleviate strains on physician shortages and overburdened health systems by increasing remote accessibility to care,” the report said. “Since 2017, over 40 states and D.C. have passed legislation expanding various types of telehealth coverage, parity, and reimbursement in both the individual and group markets and Medicaid programs.”

Most recently, in the 2019 legislative sessions, state legislators introduced more than 80 bills that would increase cross-state licensing for telehealth providers, an important development that could spur additional access to clinical care.

Avalere said the actions by the states are in line with the Interstate Medical Licensure Compact (IMLC), which is an agreement between 29 states, D.C., and the territory of Guam, permitting physicians to practice medicine across state lines and increasing access to telehealth services.

When discussing telehealth, the study said definitions are important as there are various technologies in play. At its core, telehealth leverages health communication technologies, including direct, electronic, and patient-to-provider interactions that collect and transmit health information to facilitate care without the need for a face-to-face health care encounter, the study said.

Technological innovation even allows direct consultations between providers and patients via video platforms such as Skype. Other innovative methods to access telehealth include:

-          Live Video: Using audiovisual telecommunication technology, doctors can have a live, two-way interaction with patients, caregivers, or providers.

-          Store-and-forward: Transmitting videos and images through a secure electronic communication system to the necessary health professional.

-          Remote Patient Monitoring (RPM): Collecting personal health and medical data in one location and transmitting it to a provider in a different location.

-          Mobile Health: Tracking personal health aimed at encouraging health behaviors using smartphone applications and other devices such as wearables.

Avalere said the current policy for telehealth at the federal level includes the fact traditional, fee-for-service Medicare covers real-time audio and video, and reimburses only for services with eligible providers (for example, doctor’s offices, hospitals, critical access hospitals, rural health clinics). Starting in 2020, Medicare Advantage plans can include additional telehealth benefits outside of supplemental benefits.

The study said states regulate telehealth services through licensure of the health professions and coverage and benefit requirements in the individual and group markets, as well as Medicaid programs.

“As such, reimbursement varies by state, modality, and state licensure laws,” Avalere said.

And, as of August 2019, some 80 percent of physicians meet the criteria for licensure across state lines and provide telehealth services through the IMLC; 36 states and D.C. have coverage parity policies for private-payer coverage, meaning that coverage for telehealth services must be delivered equivalent to an in-person service; and 21 states and D.C. have coverage parity policies in their Medicaid programs.

In addition, 28 states have Medicaid payment parity policies, meaning that health plans must pay providers the same rates for telehealth service that it pays for an equivalent in-person service.

Also, Medicaid programs in 12 states and D.C. reimburse for store-and-forward, and Medicaid programs in 21 states and D.C. include RPM, but most states have limits on information collection, restrictions on monitoring for specific clinical conditions, and include reimbursement only for home health agencies for Medicare-Medicaid dual-eligible beneficiaries.

“Access to telehealth services remains a legislative priority in many states, but adoption of new technologies by patients and providers has encountered challenges, including reimbursement variability across states and relative to in-person patient visits and privacy and patient safety concerns, especially related to data sharing and populations with complex health needs,” the study said.

Read the full report at https://tinyurl.com/yxqwqnj7.

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