However, during a state of national emergency, there are exceptions to this rule. However, taking important vital signs like a temperature and oxygen saturation proves challenging, particularly if the patient does not have a thermometer or pulse oximeter at home. Changes to Medicare Advantage: Medicare Advantage plans have been able to offer additional telehealth benefits not covered by traditional Medicare and have flexibility to waive certain requirements with regard to coverage and cost sharing in cases of disaster or emergency, such as the COVID-19 outbreak. During the COVID-19 outbreak, there are many clinicians who are first-time users of telemedicine, who must ensure they are covered before providing services. 2021 - First Choice Health FCH Providers portal provides access to benefits and eligibility, status of claims and payments, payor search, provider update form, and more. Policy Changes in Response to COVID-19: In response to the COVID-19 outbreak, CMS issued guidance reiterating states can use existing flexibility to provide coverage for telehealth services: “States have broad flexibility to cover telehealth through Medicaid, including the methods of communication (such as telephonic, video technology commonly available on smart phones and other devices) to use.” They clarify, “No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.” The FAQ guidance also discusses how telehealth and telephonic services can be covered for FQHCs and rural health centers (RHCs) and under managed care contracts, if states choose to do so. To make an appointment to virtually see one of our providers using the app, call: 860-528-1359. For the duration of the COVID-19 public health emergency, DEA-registered providers can now use telemedicine to issue prescriptions for controlled substances to patients without an in-person evaluation, if they meet certain conditions. For some plans this applies only to telehealth visits related to COVID-19, while for others this applies to any health indication. Telemedicine, what was once a niche model of health care delivery, is now breaking into the mainstream in response to the COVID-19 crisis. During the current outbreak, many telemedicine platforms are experiencing high volumes of patients trying to access care online which has resulted in IT crashes and long wait times to obtain a virtual appointment in some systems. For example, at least 16 states are requiring payment parity for telehealth during the public health emergency. Historically, states have had broad flexibility to determine whether to cover telehealth/telemedicine, which services to cover, geographic regions telehealth may be used, and how to reimburse providers for these services. For example, providers can now use phone calls, or affordable technologies like Facetime and Zoom, for many patient encounters, at least for the time being. Additionally, a study by the Harvard School of Public Health showed that 21% of rural Americans reported access to high-speed internet is a problem for them or their family. Three notes: 1. Based on the results of a March 2020 KFF Health Tracking Poll, nearly seven in 10 adults 65 and older (68%) say they have a computer, smart phone or tablet with internet access at home (compared to virtually all adults ages 30-49 and 85% of adults ages 50-64). A KFF study showed that in 2017, sizable shares of non-elderly adults with Medicaid reported they had never used a computer (26%), did not use the internet (25%) and did not use email (40%). HHS has waived enforcement of HIPAA for telemedicine, while the DEA has loosened requirements on e-prescribing of controlled substances. Telemedicine growth has been limited by lack of uniform coverage policies across insurers and states, and hurdles to establishing telemedicine in health systems (e.g. About First Choice Telehealth; Meet Our Team; Contact Us; Media; First Choice Blog; The Details. To combat the growing financial responsibility on employers, companies are increasingly turning to self-insured healthcare models to lower costs. With new telehealth flexibility and relaxation of privacy laws in response to COVID-19, some of these financial hurdles may be lessened. Almost all states are moving to temporarily waive out of state licensing requirements, so that providers with equivalent licenses in other states can practice via telehealth. Alina Salganicoff Follow @a_salganicoff on Twitter The federal government regulates reimbursement and coverage of telemedicine for Medicare and self-insured plans, while Medicaid and fully-insured private plans are largely regulated on a state-by-state basis (Figure 3). Telehealth virtual visits available for CA, FL, GA, ME, NM, PA, TN, WA . While studies show some interest in telehealth among older individuals, concerns include perceived poorer quality of care, privacy issues and difficulty using technology. Filling the need for trusted information on national health issues, Gabriela Weigel, Because older patients are at higher risk for severe symptoms of coronavirus and in general require more frequent primary care, they may benefit greatly from telehealth to reduce in-person risk of exposure. January 12, 2021 – The growth of telehealth has exploded since the COVID-19 pandemic began, and there are no signs of it slowing down anytime soon, panelists agreed at CES 2021. For example, First Choice Health will waive cost-sharing for telehealth if care is delivered via the 98point6 platform, and Oscar will do so if delivered by the Doctor on Call service. These plans may cover telemedicine, but each plan can choose to cover these services or not. In the months leading up to quarantine, First Choice partnered with companies like 98point6 — an on-demand primary care service — and Rightway Health, a service that advises consumers on the best place to seek medical attention. First Choice will cover all medically necessary services required to facilitate testing and treatment of COVID-19 for its eligible members, in accordance with federal and state guidance. Your PCP should always be your first choice for care (both in-person and virtual visits). CA, ME, MD, NM, ND, UT) have issued guidance to relax state-specific privacy standards for telehealth during the state of emergency. “Tighter relationships between providers and employers reduce costs and improve outcomes, and as we transition from 2020 into 2021, FCH is developing new partnerships and products built around this concept.”. With growing demand for telemedicine, several changes have been made to telehealth policy, coverage and implementation, in order to make telemedicine more widely accessible during this state of emergency. Figure 5: Key Changes to Coverage Restrictions for Medicare Fee-for-Service During the COVID-19 Emergency. Clinicians must ensure their malpractice or liability insurance covers telemedicine, and if needed, that it covers services provided across state lines. Published: May 11, 2020. For example, if a clinician is located in California, but is providing services remotely to a patient in Oregon via telemedicine, the provider must be licensed in Oregon, the state where the patient is located. In China, telemedicine platform JD Health saw a tenfold increase in their services during the outbreak and is now providing nearly 2 million online visits per month. The most commonly covered modality of telehealth was live video. Many hospitals have instructed patients with suspected coronavirus symptoms or exposure to call their doctors or turn to telemedicine first, before showing up to the emergency room or urgent care visit. A separate provision in the CARES Act allows federally qualified health centers (FQHCs) and rural health clinics (RHCs) to serve as “distant site” providers, and provide telehealth services to Medicare beneficiaries during the COVID-19 emergency period (Figure 5). YES, THERE’S AN APP FOR THAT…to lessen the risk of exposure to coronavirus (COVID-19) while continuing to provide you with quality health care, First Choice is offering virtual visits. The deal makes 98point6’s telehealth platform available to self-funded employers utilizing First Choice’s health network, allowing covered employees to access on-demand primary care services ― such as consultation, diagnosis and treatment ― via their phones. Importantly, these expanded telehealth services under Medicare are not limited to COVID-19 related services, rather they are available to patients regardless of diagnosis and can be used for regular office visits, mental health counseling, and preventive health screenings. This requires they be licensed to practice across state lines. 2. Depending on the insurer, some patients may be able to engage in telemedicine visits with their usual providers, while some may have to see providers from specific telemedicine vendors, outside of their usual source of care. Whether it be doctors, advance practice clinicians like nurse practitioners and physicians’ assistants, or registered nurses who facilitate telemedicine interactions, all will need to be trained on telemedicine technologies, requiring additional time and resources. Serving local communities since 2015. FCPP is a non-profit medical foundation committed to serving the health care needs of … Many states have relaxed telemedicine written consent, licensing, and online prescribing laws, while expanding coverage in Medicaid and fully-insured private plans. This brief presents some of the many policy changes that have taken place in the field of telehealth by the federal government, state governments, commercial insurers and health systems in just the few short weeks since the COVID-19 outbreak hit the U.S. We highlight key considerations in achieving widespread implementation of telemedicine services during this pandemic and beyond, including easing of telemedicine regulations, broadening insurance coverage, strengthening telecommunications infrastructure, and patient facing issues like connectivity and quality of care. Toggle navigation Visit First Stop Health for information on how telemedicine can help improve your health. This means some telemedicine platforms may need to hire more clinicians in order to keep up with demand. CMS has also expanded access to the types of services that made be provided via audio-only telephones. A recent poll found 23% of adults have used telehealth services in light of the COVID-19 pandemic. Our Rising Star Awards nomination deadline has been extended. If a patient needed to buy home monitoring equipment like a blood pressure cuff or a glucose monitor, it remains unclear if this would be paid for by the patient out of pocket, or by the health system. U0001:CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel. For example, if a pregnant person wishes to use telemedicine for a prenatal care visit to reduce their virus exposure, monitoring routine measurements like blood pressure, weight and fetal heart rate will prove challenging if not already set up to do so at home. Share on Facebook. In approximately half of states, if telemedicine services are shown to be medically necessary and meet the same standards of care as in-person services, state-regulated private plans must cover telemedicine services if they would normally cover the service in-person, called “service parity.” However, fewer states require “payment parity,” meaning telemedicine services to be reimbursed at the same rate as equivalent in-person services. Organizations. Corporate Address. For patients with possible coronavirus infection, taking a thorough history via telemedicine is relatively straightforward, including reviewing symptoms, travel history and exposure history. Dr. Abarbanell MD Primary Care is a family-owned primary care clinic with excellent facility and physician. Telemedicine can enable providers to deliver health services to patients at remote locations, by conducting “virtual visits” via videoconference or phone (Figure 1). This is in line with the Centers for Disease Control and Prevention (CDC) encouragement that those who are mildly ill should call their doctors before seeking in-person care. The cost of providing employer-sponsored healthcare in 2019 was around $15,000 per employee, and it’s not expected to decrease in following years — especially with the COVID-19 pandemic taking up so many resources. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. Urgent Care Center Network Get the care you need when you need it at an urgent care center in our network–no appointment needed. Gaps in technology access and use among some groups of patients may also be a concern. Similarly, utilization of telemedicine by traditional Medicare and Medicaid and beneficiaries enrolled in managed care plans had been trending upward, but remained low. Since they already know your medical history, they’re a great first choice. A study of Medicaid claims data showed beneficiaries enrolled in Medicaid managed care plans were more likely than those in FFS programs to use telemedicine. Figure 2: Telemedicine Is Being Used in Many Scenarios during the COVID-19 Pandemic. Due to advances in technology, telemedicine has emerged as a critical health care component that can help improve your patients’ access to timely and cost-effective care. Other modifications to telehealth availability in response to the COVID-19 emergency include allowing both home health agencies and hospice providers to provide some services via telehealth, and allowing certain required face-to-face visits between providers and home dialysis and hospice patients to be conducted via telehealth. However, on March 17, 2020 the U.S. Department of Health and Human Services (HHS) issued an announcement stating that, “Effective immediately… [HHS] will exercise enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies during the COVID-19 nationwide public health emergency.” This now allows widely accessible services like FaceTime or Skype to be used to telemedicine purposes, even if the service is not related to COVID-19. Partner with First Choice Telehealth Solutions and watch your providers quickly transform patient care to a new level of performance. “We’ve made important strides in the past year through strategic partnerships that rethink what digital care means.”. To make these services more readily accessible to patients, some insurers are working to increase their numbers of in-network telehealth providers within their existing networks of care, while others are contracting with specific telehealth vendors to provide these services. They also offer telemedicine programs that address behavioral health, weight loss and substance abuse. Fertility and family planning services have seen a surge during COVID, says Peter Nieves, chief operating officer of WINFertility. Telemedicine Capability. “We challenged ourselves to reduce our annual increases to somewhere around 4-6%, and we definitely beat it.”. * Telemedicine isn’t a replacement for your Primary Care Provider (PCP). In the remaining states, telemedicine is typically reimbursed at lower rates than equivalent in-person care. In 2020, the company expanded coverage to include more than 55,000 new members across the country. In 2019, large employers projected that healthcare costs were going to rise by 5% for the sixth year in a row, according to a survey by the Business Group on Health. Normally, clinicians must be licensed to practice in states where they offer telemedicine services, and states regulate which health professionals are credentialed to practice in their state. Medicare is also temporarily expanding the types of providers who may provide telehealth services. home was not an eligible “originating site”), limiting telemedicine’s reach for many low income people. The federal government has focused on broadening telemedicine access for Medicare beneficiaries, and waiving enforcement of HIPAA to enable use of video platforms like Facetime and Skype. This complexity in the regulatory framework for telemedicine creates challenges for patients in knowing what services are covered, and for providers in knowing what regulations to abide by. Florida Blue and Prominence Health Plan will waive copays for telehealth if using the Teladoc platform (Appendix). Many insurers are reducing or eliminating cost sharing for telemedicine, for a limited period of time. For patients who are having more severe symptoms (e.g. The federal government, some states, and some health insurance carriers are trying to enable more telemedicine visits to be permitted and paid for. Additionally, expanding coverage of telemedicine may result in increasing health spending, if patients use telehealth in addition to in-person care, rather than as a substitute. One survey projects a possible 5.3% increase in health plan costs for large employers in 2021. Prior to COVID-19, all states and DC provided some coverage of telehealth in Medicaid FFS but the definition and scope of coverage varied from state to state. Additionally, Medicaid programs in 46 states and DC have issued guidance to expand coverage or access to telehealth during this crisis, while 38 states and DC have granted payment parity for at least some telehealth services as of May 5, 2020. Others participate in “compacts” that allow providers in participating states an expedited process to practice in other compact states. U0002:Coronavirus (COVID-19) for non-CDC laboratory tests for SARS-CoV-2/2019. While these unprecedented and swift measures have been taken to broaden telemedicine access during this pandemic, gaps in coverage and access to telemedicine remain. phone) to qualify for coverage. While use of telehealth has opened the door for patients to maintain access to care during this public health crisis, ensuring quality of care of telehealth visits is still important. Of note, state telehealth policies may differ between Medicaid FFS and managed care, an important distinction given most Medicaid beneficiaries are now in managed care plans. The waiver does the following: lifts the requirement that beneficiaries must live in rural areas in order to receive telehealth services, meaning beneficiaries in any geographic area could receive telehealth services; allows the patient’s home to qualify as an “originating site” from which they can access telehealth visits; allows telehealth visits to be delivered via smartphone with real-time audio/video interactive capabilities in lieu of other equipment; and removes the requirement that providers of telehealth services have treated the beneficiary in the last three years. One concern is that resource limited health organizations may not have sufficient bandwidth to achieve this. However, many seniors may not feel comfortable or be able to use these technologies. 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