Telehealth waivers take critical step in extending to 2024 in House bill now passed

August 3, 2022 | by | 2 Comments

In a 406-12 vote last week, the US House of Representatives passed HR 4040, the Advancing Telehealth Beyond COVID–19 Act of 2021. The bill, which now goes to the Senate after the August recess, extends key Medicare telehealth waiver provisions to the end of 2024.

The key provisions extended are:

  • Permitting Federally Qualified Health Centers (FQHCs) and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner)
  • Medicare beneficiaries to receive telehealth services at any site, regardless of type or location
  • Any type of practitioner to furnish telehealth services, subject to approval by the Centers for Medicare & Medicaid Services
  • Audio-only evaluation and management and behavioral health services
  • Delay of in-person requirements for behavioral health telehealth
  • Use of telehealth to satisfy Medicare face-to-face telehealth requirements for hospice care

The current emergency telehealth extension expires five months after the end of the Covid-19 public health emergency (PHE). As of today, that ends in October 2022. For any further extensions or permanent changes, the Centers for Medicare and Medicaid Services (CMS) is required to seek them from Congressional legislation. FierceHealthcare, ATA releases 25 July, 27 July 

Wisconsin’s $5M for child psychiatry, community telehealth; FQHC patients prefer audio-only telehealth–Rand

April 5, 2022 | by

The state of Wisconsin is granting $5 million to telehealth vendors, equally split between child telemental health and community telehealth delivery. Governor Tony Evers announced the grant series which was funded by the American Rescue Plan, the third COVID stimulus round of 2021 as part of the State and Local Fiscal Recovery Fund to bolster rural telehealth plus mental health. With COVID fading, the funds are being redeployed by states for related health initiatives.

Applications are due 6 May for:

  • Up to five one-year grants of approximately $500,000 will be provided to Wisconsin hospitals and health systems to expand and improve child psychiatry telehealth services
  • Between 25 and 50 providers to partner with community organizations to establish neighborhood telehealth access points at food pantries, homeless shelters, libraries, long-term care facilities, community centers, and schools. These are targeted to reach people with limited access to technology and reliable internet service. These are also one-year grants of up to $100,000 each.

While big telehealth funding for mental health grabs the headlines, at the local level, it is these state initiatives that often keep both providers and smaller telehealth companies going. State of Wisconsin release, mHealth Intelligence

RAND Corporation’s study of telehealth in Federally Qualified Health Centers (FQHCs) found that audio-only telehealth was used more frequently during the pandemic, and continued to be used by patients for behavioral health even when primary care shifted back to in-person visits. The study group was the California Health Care Foundation (CHCF)’s 45-center Connected Care Accelerator (CCA) program started in July 2020. These centers serve rural, low-income, and underserved populations, common in places like Wisconsin (this Editor worked with a successful FQHC ACO there) and in California.

Audio and video telehealth was problematic for both the patient population and the clinics. Those with limited English proficiency participated in a significantly lower percentage of video visits. Behavioral health centers also had difficulties. Centers that coordinated efforts to replace audio-only with video visits had specific promising practices.

According to the RAND study, “key facilitators of telehealth implementation were leadership support, patient willingness to use the technology, platforms that were easy to use and access, a sense of urgency within clinics, changes in reimbursement policy, and training opportunities for staff.” Another recommendation was to retain centers to serve as distant telehealth sites (and to be reimbursed). Also mHealth Intelligence

The difficulty in bringing telehealth to those needing it most

September 23, 2015 | by

California’s Center for Connected Health Policy, which is the National Telehealth Policy Resource Center, has published a study which concludes that community health centers (CHC)–a general term covering Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC)–have difficulty sustaining telehealth programs to support the underserved and ill with chronic conditions including mental health without grants or other subsidies. Consultant Milliman studied five California CHCs and determined that other than financial, major impediments to successful implementation were structural: complex billing and reimbursement rules, and difficulty tracking telehealth visits through multiple EHRs that weren’t necessarily compatible with each other or with billing systems. Many of these CHCs cannot financially provide telehealth without grants or other subsidies. This study holds lessons for telehealth companies which are working with ACOs, hospital discharge programs and practices in rural areas, as well as the Indian Health Service. Study (link to PDF), Healthcare Informatics, California Healthline  Hat tip to Elizabeth Olis of Viterion Digital Health