Ramona Midkiff

Source: The National Law Review

There have been several significant developments with regard to Federal government telehealth policy. These include the recently enacted appropriations bill funding the Federal government for the balance of the fiscal year, a Department of Health and Human Services Office of Inspector General data brief, the MedPAC annual report to Congress and statements by the Secretary of Health and Human Services.

Appropriations Law

On March 15, 2022, President Biden signed H.R. 2471, the “Consolidated Appropriations Act, 2022” [Public Law 117-103].  The new law authorizes the Telehealth Network Grant Program at the Health Resources and Services Administration (HRSA) to include providers of prenatal, labor care, birthing, and postpartum care services.

• H.R. 2471 contains provisions dealing with telehealth flexibility extensions.
• Removes geographic requirements and expands origination sites for telehealth services.
• Expands practitioners eligible to furnish telehealth services.
• Extends telehealth services for Federally Qualified Health Centers and rural health clinics.
• Delays the in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
• Allows for furnishing of audio-only telehealth services.
• Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during the PHE.
• Extends the flexibility allowing a high deductible health plan to cover telehealth benefit (for months beginning after March 31, 2022, through the end of 2022) pre-deductible and still qualify as a HDHP with a Health Savings Account.

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Source: CMS

Updated 01/05/2022

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth.

List of Telehealth Services for Calendar Year 2022 (ZIP)

Source: Center for Connected Health Policy

On March 15th President Biden signed the Consolidated Appropriations Act of 2022.  This bill will extend federal telehealth flexibilities for 151 days post-public health emergency (PHE), including PHE location, provider, and audio-only expansions, and includes new report requirements. A delay to the new in-person telemental health visit requirement in Medicare was also included for the same period of time.

The telehealth components in the legislation include:

• Telehealth Flexibility Location – Geographic & rural exceptions to allow for any site including the home to continue for 151 days after the PHE ends – no facility fee for these sites
• Telehealth Flexibility Provider Type – Adds occupational therapists, physical therapists, speech-language pathologists, audiologists, and federally qualified health centers (FQHCs) and rural health clinics (RHCs) to eligible provider list for 151 days
• Audio-Only – Continue to allow for the 151-day extension period
• In-person visit requirement for telemental health – Delay requirement until after the 151 days extension
• Use of telehealth for recertification of eligibility for hospice care – Continue to allow for the 151-day extension period
• New Reports
  • MedPAC report due June 15, 2023 to Congress, includes looking at payment policy for telehealth for FQHC and RHC’s
  • Beginning July 1, 2022, Secretary of Health and Human Services must publicly publish on quarterly basis data on Medicare claims on telehealth services including utilization and beneficiary characteristics
  • By June 15, 2023, Office of Inspector General to submit to Congress fraud, waste, and abuse report on program integrity

Funding opportunities that could be put toward telehealth are also included in the legislation, including funding for rural hospital programs and telehealth networks, in addition to grants that will establish or sustain mobile teams or enhance access through telehealth.

While the resources and extensions in the agreement are promising, they signify that conversation around permanent telehealth policies are far from over. For more information, please review the Consolidated Appropriations Act of 2022 in its entirety. For a helpful breakdown of the bill and its telehealth components, access CCHP’s Consolidated Appropriations Act of 2022 Chart.

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MedPAC Report Recommendations Related to Telehealth Data

Last week the Medicare Payment Advisory Commission (MedPAC) released its March 2022 Report to Congress: Medicare Payment Policy. The report covers a variety of Medicare payment issues and recommendations, including suggestions related to gathering more information regarding the delivery of care via telehealth from providers. In particular, MedPAC recommends the Centers for Medicare & Medicaid Services (CMS) require clinicians to use an audio-only claims modifier in order to track modality specific information, and that home health agencies (HHAs) and hospice providers be required to report the provision of telehealth on Medicare claims. The rationale behind the recommendations is that more data is needed to truly understand the impact of telehealth on quality, cost, and access to determine the accuracy of payments. The amount of time necessary and sufficient to collect and complete such evaluations is unaddressed in the report. As the federal government postpones permanent policy changes in exchange for limited extensions, it is important that policymakers consider the time it will take to effectively assess the delivery of care via telehealth using additional data.

The main telehealth issues of focus within the MedPAC report include that currently, there is a lack of consistency restricting the ability to track audio-only and telehealth visits by certain providers. For instance, some telehealth expansions have been made permanent for HHAs, which MedPAC suggests significantly expanded their telehealth programs during the pandemic. While the HHAs were supposed to report the costs of telehealth services on their Medicare cost report, there was no requirement to report any other information about telehealth use related to frequency, duration, modality, or which beneficiaries received such services. The same limited information applies to hospice providers.  MedPAC offered that operationalization of this data reporting component could be achieved through the use of a claims modifier as long as CMS permits the use of telehealth services in the hospice setting.

Other telehealth findings provided in the report include:

• Beneficiaries’ access to care is comparable to privately insured individuals and that during the past year, half of beneficiaries accessed clinicians via telehealth
• Nearly half of Medicare beneficiaries used telehealth at least once in the past year
• Audio-only telephone visits were most common – 37% of elderly Medicare beneficiaries used audio-only
• Interactive video visits were used by 23% of Medicare beneficiaries
• 86% of beneficiaries were satisfied with their telehealth visits and around half wanted to continue using telehealth post-pandemic

MedPAC states that their recommendations related to telehealth data collection should apply regardless of whether Medicare covers these services temporarily or permanently. However, it will be difficult to collect helpful data on telehealth without maintaining coverage and access for telehealth. As MedPAC notes, without more information their ability to understand the role that telehealth has played during the public health emergency (PHE) is limited, as is the ability of policymakers in determining post-PHE policy changes. The report also reiterates a policy option they provided to Congress in their March 2021 report, in which they suggested CMS continue to cover telehealth after the PHE for a “limited period” such as one to two years after the PHE ends to allow for gathering of additional evidence on the impact of telehealth to determine permanent telehealth payment policies. Meanwhile, President Biden signed the Consolidated Appropriations Act of 2022 last week which extended telehealth expansions for just five months after the end of the PHE, raising questions related to how that timeline was determined and if it will be sufficient to address remaining concerns and questions related to long-term telehealth policies.

Please review the MedPAC report for additional details on their findings and recommendations.

Source: Channel 7 WSPA

SPARTANBURG COUNTY, S.C. (WSPA) – Internet access may improve soon in rural areas of Spartanburg County. The County Council voted Monday to spend $4 million in American Rescue Plan funding to expand broadband access in rural areas.

“We learned, during the pandemic, how lacking we were in broadband when you get outside the municipalities,” said Councilman David Britt.

The county will now select a broadband carrier to work with, which will put up an additional $10 million to make this project happen. The carrier will then survey the areas and decide how to install the technology.

“This infrastructure is almost comparative to electricity in the 1920s,” said Councilman Justin McCorkle.

“There are lot of people spending a lot of time at home who need this service that we don’t provide in these rural areas, and they can’t afford to do it,” added Councilman Bob Walker.

The county estimates this project will provide internet access to more than 3,500 homes.

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Source:  Bluffton Today

By:  Michael M. DeWitt, Jr.

From recreation to education, from community centers to international commerce hubs, South Carolina Representative Shedron Williams is seeking millions in state funding for the people he represents in Hampton and Jasper counties.

 Ahead of the S.C. House of Representatives debate on the state budget later this month, Rep. Williams (D-Hampton) has made several budget requests totaling more than $59.1 million. The largest of those request include a $37 million investment in facilities in the newly consolidated Hampton County School District and $7 million for the Jasper port.

“With the influx of federal funds coming to our state on top of a surplus, this year’s budget presents an opportunity to make historic investments in education and other neglected projects in our state,” Williams said.

“All I can do is ask and be at the table,” Williams stated in an email to The Hampton County Guardian, but added that “We are expecting the majority of the items.”

While Williams priorities include a countywide recreation/health and wellness center in Hampton County as well as improvements to Lake Warren State Park, here is a full breakdown of all of Williams’ requests:

Southern Carolina Alliance

$700,000 for a rail crossing at the Southern Carolina Industrial Park. This item is a must for the full development of the new agribusiness that is promising 1,500 jobs, said Williams.

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By: Kathy Rhoad, Director of Public Relations & Program Development at Palmetto Care Connections

BAMBERG, SC—Palmetto Care Connections (PCC) Chief Executive Officer Kathy Schwarting announced that Matthew Bartels, M.D., F.A.A.P., C.P.E., chief medical officer for BlueCross Blue Shield of South Carolina and Christian L. Soura, executive vice president of the South Carolina Hospital Association (SCHA) have joined the PCC Board of Directors.

“Palmetto Care Connections is extremely fortunate to have the expertise of Dr. Matt Bartels and Christian Soura as new members of our board of directors as we work to assist health care providers in keeping health care local and connecting rural and underserved South Carolinians to quality services through broadband, technology and telehealth,” said Kathy Schwarting.

Dr. Matt Bartels has served as vice president, chief medical officer for BlueCross BlueShield of South Carolina since 2017. He is responsible for oversight of the clinical content of commercial insurance programs and initiatives, and he plays a key role in driving health and outcome measurement requirements and program evolution.

Board-certified in pediatric medicine, Dr. Bartels practiced for over 20 years and has worked in health plan administration for the last 17 years. Prior to coming to S.C. in July 2017, Dr. Bartels was in a leadership role at Excellus BlueCross BlueShield in New York where he was a chief medical officer with a focus on quality program development, population health, analytics and reporting, provider partnership collaborations, and innovative health care improvement activities.

He received his bachelor’s degree from Fordham University and graduated from the University of Buffalo School of Medicine and Biomedical Sciences. He completed his residency training at the University of Virginia Medical Center in Charlottesville, Virginia. Dr. Bartels is a member of the American Medical Association and is a fellow of the American Academy of Pediatrics. He is a Certified Physician Executive as well as a member of the American Association for Physician Leadership.

The PCC Board of Directors also welcomes Executive Vice President of the South Carolina Hospital Association Christian Soura. He previously led the South Carolina Department of Health and Human Services and was president of the National Association of Medicaid Directors. Earlier, he was deputy chief of staff for Governor Nikki Haley, with responsibility for the state’s executive budget and the administration’s policy initiatives.

Soura is a former secretary of administration for the Commonwealth of Pennsylvania and was chairman of the Pennsylvania Employee Benefits Trust Fund Board, Pennsylvania’s largest group purchaser of health insurance.

He holds graduate degrees from Penn State and the University of Illinois. Christian is the chairman of the Nurse-Family Partnership’s Board of Directors and has held leadership positions in professional associations including the National Association of Medicaid Directors, National Association of State Chief Administrators, and the American Society for Public Administration. He also served on South Carolina’s Commission on National and Community Service.

About PCC

Established in 2010, Palmetto Care Connections (PCC) is a non-profit organization that brings technology, broadband, and telehealth solutions to health care providers in rural and underserved areas in South Carolina. PCC hosts the Annual Telehealth Summit of South Carolina presenting state and national best practices and trends, as well as providing networking connections for health care, technology and broadband professionals.

The leader of the South Carolina broadband consortium, PCC assists health care providers in receiving broadband savings through the Federal Communication Commission’s Healthcare Connect Fund program. Since 2013, PCC has helped providers save more than $30 million in broadband costs.

PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, serving as an advocate for rural providers and partnering with organizations to improve health care access and delivery for all South Carolinians.

The National Cooperative of Health Networks Association named Palmetto Care Connections as the 2021 Outstanding Health Network of the Year. In recognition of her devotion to improving health care in rural areas, PCC Chief Executive Officer Kathy Schwarting received South Carolina’s 2021 Community Star award presented by the National Organization of State Offices of Rural Health.

Source: Index-Journal

By: Robert Preidt

THURSDAY, March 3, 2022 (HealthDay News) — Telemedicine was widely used by Americans with multiple sclerosis (MS) during the pandemic, and many were happy with the results, a new study finds.

“The findings suggest that telehealth services were well liked during the pandemic. Because many individuals with MS have physical disability that may make travel more difficult, temporary expansions of telehealth coverage should be made permanent after the pandemic in order to expand access and reduce health care disparities,” said lead author Michelle Chen. She is a core member of Rutgers Institute for Health, Health Care Policy and Aging Research, and neurology instructor at the Robert Wood Johnson Medical School in New Jersey.

MS is a chronic and progressive neurological disorder and the leading cause of non-injury-related disability among young and middle-aged adults.

People with MS require regular medical care, so health care providers were concerned about how medical facility closures and social distancing measures during the early stages of the pandemic would affect the health of their MS patients.

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Source: Index-Journal

By: Physician’s Briefing Staff

TUESDAY, March 1, 2022 (HealthDay News) — Alexa may soon be able to help patients contact a doctor. The service from Amazon and telemedicine provider Teladoc Health will be available around the clock on Amazon Echo devices, the Associated Press reported.

After telling Alexa they want to talk to a doctor, customers will get a call back from a Teladoc physician. In some cases, doctors will be able to prescribe medications, according to details announced Monday. Whether patients get a call back on the same day they make their request to Alexa may depend on the availability of doctors, Teladoc spokesman Chris Savarese told the AP.

Amazon will not be able to access, record, or store the content of the ensuing call, he noted. The cost will depend on the patient’s insurance. Without coverage, the fee will be $75. The service will be audio-only to start, but the companies said they expect to soon add video, the AP reported.

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