latoya thomas american telemedicine association
DESCRIPTION
APT Conference 2014TRANSCRIPT
Alabama Partnership for Telehealth Summit: U.S. Telemedicine Policy Update
Latoya S. ThomasOctober 16, 2014Birmingham, AL
Public Policy Goals
Knock down government barriers
Promote “value” innovative payment and service models
Address care delivery problems• Cost, access, outcome,
productivity
Major Government Roles Rendering
Reimbursement
Regulation
Research
Resources
Readiness and recovery
Federal Overview
Medicare FFS BarriersLimited live video
Only rural counties (20% of beneficiaries) Limited originating sitesLimited providersOnly specific procedures
No store & forward
No remote patient monitoring
Medicare BillsTelehealth Enhancement Act of 2013
• HR 3306 – Gregg Harper (R-MS)
• S 2662 – Thad Cochran (R-MS)
Medicare Telehealth Parity Act• HR 5380 – Mike Thompson (D-
CA)
Side-by-Side: Rural Telehealth Enhancement
Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
Store-and-forward for—
Critical access hospitals ♦
Sole community hospitals ♦
Federally-qualified health centers ♦
Rural clinics ♦
Into homes for--
Kidney dialysis (video and RPM) ♦
Hospice patients ♦
“Homebound” patients ♦
Physician recertifications for home health care
♦
Side-by-Side: MetroTelehealth Enhancement Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
All critical access hospitals ♦
All sole community hospitals ♦
Restore coverage for 104 counties that lost it in 2013
♦
Video for metro counties with < 25,000 population
♦
Video and store-and-forward for metro counties with < 50,000 population
♦
Side-by-Side: All BeneficiariesTelehealth Enhancement
Act, Cochran (S. 2662) / Harper (H.R. 3306)
Medicare Telehealth Parity Act, Mike Thompson (H.R. 5380), Phase 1 of 3
Hospital readmissions: shared savings for a hospital beating its reduction benchmark
♦
For accountable care organizations ♦
For bundled payments ♦
For medical homes
Medicare counterpart for Medicaid “health homes” for chronic care
♦
Authorize specialty care oriented ♦
Stroke diagnosis ♦
Federally-qualified health centers – video and store-and-forward
♦
Remote patient monitoring for--
Congestive heart failure ♦
Chronic obstructive pulmonary disease ♦
Diabetes by federally-qualified health centers ♦
More covered providers
Diabetes educators ♦
Therapies – PT, OT, RT, speech & hearing ♦
Coming Down The Pike…ACO New Proposed Regs
2015 Medicare Physician Fee Schedule • New CMS Code for Chronic Care Management
(GXXX1)• Other proposed service codes
FCC on universal services and net neutrality
HIPAA privacy and security
Internet Prescribing for Controlled Substances• Ryan Haight Online Pharmacy Consumer
Protection Act of 2008
State Overview
50 State PatchworkMedicaid47 states cover something
46 telemental health (AL)21 home telehealth (AL)14 remote patient monitoring (AL)11 store-and-forward
Private Insurance19 states + DC w/full parity laws2 states w/partial parity lawsWho’s next?
State Employee Plans11 states cover something
ATA State Telemedicine Gaps Analyses
State Composite Ratings for Coverage & Reimbursements Analyses
Alabama ProgressPARITYMedicaid C
MEDICAID COVERAGE & CONDITIONS OF PAYMENTDistance or Geography Restrictions APhysician-provided Services BMental/behavioral Health Services BPatient Setting CEligible Technologies BTelepresenter B
INNOVATIVE PAYMENT OR SERVICE MODELSHealth Home ✔ Corrections ✔
Chronic Disease Management ✔
Alabama OpportunitiesPARITYPrivate Insurance FState Employee-based Plan F
MEDICAID COVERAGE & PAYMENTEligible Providers FHome Health FRehabilitation N/AInformed Consent F
INNOVATIVE PAYMENT OR SERVICE MODELSMedicaid Managed Care Medicare-Medicaid Dual Eligibles State-wide Network HCBS Waiver
State Composite Ratings for Physician Practice Standards & Licensure
Alabama – Physician Standards
Coming Down The Pike…Convening State Legislature Sessions
• Parity• Improving coverage under Medicaid
and State employee health plans• Innovative payment/delivery models
State Licensing Boards • Scope of Practice• Practice Rules• Licensure Models
• Compact vs. Expedited Licensure
ATA Free, Public Resources
• 2014 ATA Policy Priorities
• State Policy Toolkit• State Gaps Analyses• State Legislative
Matrix• (Members Only)
– State Legislative and Regulatory Trackers
– Monthly State Call
• State Policy Checklist• ATA Wiki
• State Medicaid Best PracticesTelemental and BehavioralRemote Patient Monitoring and Home Video VisitsStore-and-forwardSchool-basedManaged CareTelestrokeHigh-risk PregnanciesTelerehabilitation
AmericanTelemed.orgATAwiki.org
Latoya S. ThomasDirector, State Telehealth [email protected]
202-223-3333