Pamela King. MBAHIE Outreach CoordinatorAgency for Health Care Administration

Example Telehealth Programs

Telehealth Research Studies

Cobble Hill Health Center - 360 bed Skilled Nursing Facility in New York, participated in one year study:

• Impact of using “virtual physicians”(video conferencing) outside of regular primary care physician hours

• The contracted telehealth provider’s physician staff assessed 313 residents over the course of 1 year due to changes in the resident’s medical condition

• A total of 105 residents (33.5%) from this total were identified as “avoiding” admission as a direct result of the telehealth intervention

• The charts from these same residents were reviewed by Cobble Hill’s Medical Director, and 91 (29%) were confirmed as “absolute” admissions had the telehealth encounter not occurred

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Whitman, John, MBA, NHA; Donny Tuchman, NHA. “Reducing Avoidable SNF to Hospital Admissions and Readmissions by Implement a Virtual Physician Service, Enabled through Technology” The TRECS Institute Presentation. July 2016.

TTelehealth Civil Money Penalty Grant Project

• Project Amount: $275,000• Telemedicine Providers:

TripleCareDocsConnect

• Telemedicine services:Provided at four Florida nursing homes Utilized from 6:00 p.m. to 7:00 a.m. EST, Monday through Friday, all day Saturday, Sunday and national holidays

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TelehealthHB 7087 (2016) / 2016-240 L.O.F.

1. Telehealth Advisory Council: 15 members including the Secretary of AHCA (Chair) and the Surgeon General (member)

2. Survey for current capabilities, utilization and coverage levels:

• AHCA to survey licensed health care facilities

• DOH to survey licensed health care practitioners

• OIR to survey health plans and HMOs 3. AHCA to submit a report of survey findings

to the Governor, Senate President, and Speaker of the House by 12/31/2016

4. Final Advisory Council report of recommendations to increase the use and accessibility of telehealth services by 10/31/2017

Telehealth Advisory Council Recommendations

• Definition• Health Insurance

• Coverage• Reimbursement

• Licensure• Interstate Licensure• Standards of Care

• Patient Safety• Patient-Practitioner

Relationship• Consent• Prescribing

• Technology8

Defining Telehealth

Six Key Components:1.Telehealth can be used for providing health care and public health services2.Telehealth includes synchronous and asynchronous transmission modalities3.Practitioners treating Florida patients must be appropriately licensed in

Florida or appropriately supervised by a licensed Florida health care practitioner as prescribed by law or rule

4.Health care practitioners must act within the scope of their practice5.Telehealth can be between health care practitioners or health care

practitioners and patients6.There must be no limitations on geographic location or place of service

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Health Insurance & Telehealth

• Coverage Parity• Reimbursement Parity• Medicare • Medicaid

• Fee-for-service Rules• Insurance Network Adequacy

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Resource: AmericaTelemedicineAssociation.org. Retreived 10/26/17

Health Insurance & Telehealth

CCoverage Parity

Suggested Language for Future Legislation:

A health insurance policy issued, amended, or renewed on or after July 1, 2018, shall provide coverage for services (excluding Medicare plans) provided via telehealth to the same extent the services are covered if provided in-person. An insurer shall not impose any additional conditions for coverage of services provided via telehealth.*

* The intent of this recommendation is to ensure appropriate insurance coverage for the use of telehealth in treating patients. Any legislative language developed should not require insurers to add additional service lines or specialties, mandate a fee-for-service arrangement, inhibit value-based payment programs, or limit health care insurers and practitioners from negotiating contractual coverage terms.

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Health Insurance & TelehealthReimbursement Parity

Recommended Legislative Language:

For the purposes of health insurance payment (excluding Medicare plans), payment rates for services provided via telehealth shall be equivalent to the rates for comparable services provided via in-person consultation or contact contained in the participation agreement between the insurer and the health care practitioner.*

*The intent of this recommendation is to ensure appropriate insurance reimbursement for the use of telehealth in treating patients. Any legislative language developed should not require insurers to add additional service lines or specialties, mandate fee-for-service arrangements, inhibit value-based payment programs, limit health care insurers and practitioners from negotiating contractual coverage terms, or require insurers to pay for facsimiles or audio only communication.

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Health Insurance & Telehealth

MedicaidRecommendations:• The Agency modify the Medicaid

telehealth fee-for-service rule to include coverage of store-and-forward and remote patient monitoring modalities in addition to the currently reimbursed live video conferencing modality

• The Council recommends the Agency develop a model that would allow Medicaid Managed Care plans to utilize telehealth for the purpose of meeting network adequacy

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Resource: AmericaTelemedicineAssociation.org. Retrieved 10/26/17

Health Insurance & Telehealth

Medicare

Recommendation:• The State of Florida support

modifications to Medicare telehealth laws that would expand coverage to include store-and-forward modalities as well as remote patient monitoring, expand the types of health care practitioners covered, and revise or eliminate the existing geographic and place of service requirements

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Resource: AmericaTelemedicineAssociation.org. Retrieved 10/26/17

Health Practitioner Licensure & TelehealthInterstate Licensure

Recommendations:• Maintain the requirement of Florida

licensure for health practitioners providing patient care in Florida via telehealth. This recommendation requires no change to current regulations and does not inhibit the use of telehealth to treat patients

• The legislature adopt laws allowing participation in health care practitioner licensure compacts that have licensure requirements that are equivalent to or more stringent than Florida

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Health Practitioner Licensure & TelehealthStandards of Care

Recommendations:• The Council acknowledges Florida’s current standards

of care as sufficient for general regulatory oversight of patient care; and recognizes that each health care regulatory board, and the Department when there is no board, has direct authority for establishing appropriate standards based on knowledge and insight for their respective practitioners

• To ensure clarity for Florida licensed health care practitioners and stakeholders regarding the ability to use telehealth as a modality of care, the Council recommends the Department, healthcare regulatory boards and councils continue to educate and raise awareness among licensees that they may use telehealth modalities to serve patients

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Patient/Consumer ProtectionPatient-Practitioner Relationship

Recommendation:• The Council recommends the Florida

legislature recognize the ability for practitioners and patients to establish a relationship through telehealth in addition to encourage efforts for ensuring patient care coordination among treating practitioners

Recommended Legislative Language:• A health care practitioner-patient

relationship may be established through telehealth.

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Patient/Consumer Protection

Telehealth & Prescribing

Recommendation:The Council recommends the Florida legislature recognize the establishment of practitioner-patient relationships through telehealth as appropriate for treating patients, including the prescribing of medications, with limited exceptions for prescribing of controlled substances

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Telehealth and PrescribingRecommended Legislative Language:• Health care practitioners, authorized by law, may prescribe medications

via telehealth to treat a patient as is deemed appropriate to meet the standard of care established by his or her respective health care regulatory board or council. The prescribing of controlled substancesthrough telehealth should be limited to the treatment of psychiatric disorders and emergency medical services. This should not prohibit an authorized, health care practitioner from ordering a controlled substance for an inpatient at a facility licensed under chapter 395, Florida Statute or a patient of a hospice licensed under chapter 400, Florida Statute.

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Patient/Consumer Protection

Patient ConsentRecommendation:The Council recommends maintaining current consent laws in Florida. The Council notes that additional consent requirements will add unnecessary barriers for both practitioners and patients attempting to utilize telehealth services

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TechnologyRecommendations:• The Agency identify existing resources for

health information exchange to expand interoperability between telehealth technologies and integration into electronic health record (EHR) platforms

• The Agency continue promotion of existing programs and services available to increase access to technology, access to broadband networks, and improved interoperability

• Medical schools, schools of allied health practitioners, and health care associations provide information and educational opportunities related to the utilization to telehealth for serving patients

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• Legislation• Senate Bill 280• House Bill 793

• Policy Changes• Medicaid Fee for Service Rules• Network Adequacy• Regulatory Board Rules

• Education• Medical & Allied Health Schools• Health Care Practitioners• Health Care Facilities

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• Built on the nationwide eHealth Exchange platform• Allows providers to query for patient clinical records• Federated network with no centralized data repository• Common data standards, legal agreement, and governance• Covers 100M patients nationwide

• Assists in meeting the health information exchange requirements of Meaningful Use, which includes

• Electronically exchanging summary of care records• Incorporating electronic summary of care records into an EHR• Performing clinical reconciliation using received summary of care records

• For more information, visit• https://www.florida-hie.net/plu/• http://sequoiaproject.org/ehealth-exchange/about/

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Secure Messaging• Affordable, secure, HIPAA-compliant exchange

• Push model of exchange• Uses industry-developed Direct standards• Strict identity verification standards for users• Supports transport of documents of any format

• DirectTrust accreditation means that users can exchange with a trusted nationwide network of over 1.3 million users.

• Florida HIE DMS address book includes over 50,000 addresses in Florida, Georgia, and Alabama.

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• Offers timely notice of patient hospital encounters to health care providers and health plans.

• Patient-authorized exchange• Improves care coordination and transitions of care• Reduces hospital admissions and readmissions• Supports value-based payment reform models like ACOs

• Participation• 215 hospitals covering over 95% of all acute care hospital

beds in Florida• 40 subscribers receiving alerts on 5 million Florida residents• Over 5 million hospital encounter alerts delivered since 2015

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QUESTIONS?

Fall 2017

CContacts and Resources

www.ahca.myflorida.com/medicaid/ehrMedicaidHIT@AHCA.MyFlorida.com

www.Florida-HIE.netFLHII@ahca.myflorida.com

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http://www.floridahealthfinder.gov/index.html

http://www.ahca.myflorida.com/SCHS/telehealth/h // h fl id