TTAC

Telehealth Policy and Regulatory Considerations During a Pandemic

The following information is provided strictly for educational and informational purposes. It is not intended to and should not be relied upon or construed as a legal opinion or the official position of any government agency, or the sponsoring organization, the Alaska Native Tribal Health Consortium (ANTHC). These materials are made possible by Grant # GA5RH37463 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, the U.S. Department of Health and Human Services. The information provided does not reflect nor represent the official views of the Office for the Advancement of Telehealth, Health Resources and Services Administration or the U.S. Department of Health and Human Services, the Telehealth Resource Centers or any other grant funded entity. It is comprised of suggestions and opinions of experts in the fields of telehealth, information technology, epidemiology, public health, nursing, hospital administration and policy/regulatory who worked together to comprise this document in response to the current Covid-19 Pandemic.

Introduction

Reports, studies and surveys have demonstrated telehealth provides opportunities to make healthcare more efficient, better coordinated, convenient and affordable. Telehealth can also help address health income and access disparities in underserved communities by removing location and transportation barriers, unproductive time away from work, childcare expenses, etc.[1],[2],[3],[4] In spite of evidence showing high-quality outcomes, satisfaction, and success rates (e.g., 95% patient satisfaction rate, 84% success rate in which patients were able to completely resolve their medical concerns during a telehealth visit),[5] nationwide adoption of telehealth has been quite low due to policy and regulatory barriers, constraints, and complexities.

Healthcare services delivered via telehealth and other communications technologies are regulated at both the federal and state levels. Coverage and reimbursement policies vary among the different payers/plans (e.g. Medicare, Medicaid and private insurers) and may be defined by state telehealth parity laws. Restrictions placed on provider reimbursement have been cited as the number one barrier to adoption.[6][7] Licensure, privacy and security, remote prescribing of controlled substances, and other related policy, legal and regulatory matters are subject to myriad rules and guidelines promulgated by various regulatory bodies (see details below). However, with the arrival of the COVID-19 pandemic, the crisis triggered rapid federal and state-level temporary policy changes that lifted many of the legacy coverage and payment barriers and accelerated adoption during the outbreak. With relaxed regulations, the number of Medicare beneficiaries using telehealth skyrocketed in the early weeks of the pandemic. According to Medicare claims data, CMS reported an increase in utilization of approximately 12,000% in just a month and a half between early March and mid-April 2020.[8] As the pandemic took hold, many states also took action to expand broad coverage and payment of telehealth services under Medicaid and allow out-of-state providers to treat their residents using telehealth.[9],[10] Approximately 34.5 million telehealth services were delivered to Medicaid and CHIP beneficiaries from March through June 2020 which represents an increase of 2,632% compared to March through June 2019.[11] Commercial plans expanded their policies which also resulted in increased utilization with some plans implementing payment parity, removing copays and offering telehealth services for free.[12] CMS also allowed Medicare Advantage plans to add more telehealth benefits during the crisis without going through the normal application review process.

Removing long-standing regulatory constraints on payment for telehealth services resulted in high adoption rates across the nation during the COVID-19 pandemic. Yet, in order to be prepared for any future pandemic, sustained adoption of telehealth is needed. Therefore, it is the opinion of the members of this Think Tank that permanent policy changes that allow broad coverage and payment of telehealth services, as well as, cross-state licensing reforms are essential to incentivize providers to continue to invest in national telehealth and telecommunications infrastructure. Policies that enable coverage and payment parity for telehealth services should be implemented in the short term beyond the public health emergency to allow time for adoption of telehealth services to become sustainable. Furthermore, the COVID-19 pandemic presents an exceptional opportunity for data collection and analysis since it is the first broad implementation of telemedicine in the United States. For the first time, providers, patients, and policymakers can see and measure the impact of telemedicine on care delivery, healthcare access disparities, and cost.  Keeping the current relaxation of restrictions and payment parity for the short term (2-3 years) will allow time to gather appropriate data to drive appropriate policy development.

Building national infrastructure for providers to deliver telehealth services will also provide the necessary framework to keep businesses in operation, provide distance education, and for other purposes during any future pandemic. Additionally, a national infrastructure will foster health and digital equity and transformation of the healthcare system from fee-for-service to value-based care.

Toolkit Outline: