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A new study conducted by researchers from the University of Minnesota School of Public Health, Harvard Medical School and the university’s T.H. Chan School of Public Health and athenahealth found that telehealth visits may provide better infection control than in-person visits. The study found that people who visited their doctor’s office after someone infected with the flu had visited were much more likely to come down with the flu themselves, a factor that would not be an issue with telemedicine visits.

Telehealth provider SOC Telemed is expanding its partnership with Iowa-based health system UnityPoint Health by broadening its telepsychiatry services from three hospitals to an additional four hospitals. SOC Telemed and UnityPoint first implemented SOC Telemed’s Telemed IQ platform and telepsychiatry solution three years ago, and in that time decreased the average length of a mental health visit by 11.87 hours and saved over $1.7 million in annual boarding costs.

As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Manatt Health has developed a federal and comprehensive 50-state tracker for policy, regulatory and legal changes related to telehealth during the COVID-19 pandemic. Linked here is the executive summary, which outlines federal developments from the past two weeks, new state-level developments, and older federal developments.

During the COVID-19 pandemic, a high proportion of FQHCs’ telehealth visits were conducted via audio-only. This article discusses measures that providers can take to ensure that audio-only visits are safe, secure, and HIPAA-compliant.

Lawmakers in North Dakota are beginning to look into determining a consistent payment model for telemedicine services across the state. This will create clarity for insurers, allow telehealth to become more commonplace, and ultimately create greater access to telehealth care for rural residents.

Recent research conducted by Zoom found that 72% of survey respondents want to attend healthcare appointments both virtually and in-person post-pandemic. In an interview with Heidi West, head of healthcare at Zoom, West discussed the results of this survey and what a hybrid approach to health care might look like in the future. West maintains that telehealth is a necessary care option to improve accessibility to care, though she acknowledges that issues facing universal telehealth access include broadband accessibility and reimbursement policies.

Members of the Pro-Choice Caucus introduced a resolution asking for a reconsideration of policies governing access to abortion-inducing drug mifepristone. The FDA Commissioner stated that the agency would look into permanently lifting restrictions on telehealth abortions. The proposed resolution aims to ensure that any policy changes regarding tele-abortions are “equitable and based on science.”

Rep. Cindy Axne (IA-03) announced her support for two bipartisan bills—the Telehealth Modernization Act and the CONNECT for Health Act—to preserve telehealth options for Iowans beyond COVID-19. The bills would remove geographic site requirements, allow beneficiaries to use telehealth from their own homes, ensure reimbursement for telehealth services provided by health centers and rural health clinics, and improve the process for covering additional telehealth services.

US Reps. Dean Phillips (D-MN) and Steve Chabot (R-OH) reintroduced The Telehealth Coverage and Payment Parity Act (HR 4480) after it failed in 2020. The bill would require payers to cover telehealth services, including cost-sharing requirements such as deductibles, at the same as in-person services; prohibit restrictions on which conditions can be managed virtually; eliminate location-based restrictions on providers and guarantee that all medically necessary benefits in ERISA plans are covered by telehealth. It would also expand the definition of a “qualifying telecommunications system,” or telehealth platform, to include the telephone, internet communications, streaming media communications “and such other systems as specified by the Secretary of Health and Human Services.”

The Biden-Harris Administration announced on Thursday, Aug. 12 that it will make up to $500 million available in grants to help rural healthcare facilities, tribes and communities expand access to COVID-19 vaccines, healthcare services and nutrition assistance. Applicants can apply for two types of assistance: Recovery Grants and Impact Grants. Recovery Grants are available to help public bodies, nonprofit organizations and tribes provide immediate COVID relief to support rural hospitals, healthcare clinics and local communities. Applications will be accepted until funds run out. Impact Grants are meant to help regional partnerships, public bodies, nonprofits and tribes solve regional rural healthcare issues and build stronger and more sustainable systems in response to the pandemic. Impact Grant applications are required to be submitted to local USDA Rural Development State Offices by 4 p.m. on Oct. 12, 2021.

Though telemedicine has been beneficial for connecting remote patients to care, however, not all patients and providers in rural parts of the state may be able to take advantage of telehealth technologies. For instance, Dr. Amy Slagle, a family physician at the Menominee Tribal Clinic in Keshena, shared they don’t typically use telehealth because their service in Northeast Wisconsin is inconsistent and because many patients do not own smartphones.

Though telehealth claims have been declining in recent months, telehealth visits increased drastically across all U.S. states during the pandemic. California experienced a 1,860% percent growth in telehealth utilization, followed by Massachusetts, Oregon, Hawaii and Vermont. Even states with the least growth still more than doubled their use, with North Dakota bringing up the rear at 218%. Wyoming, Mississippi, Iowa and Arizona were also on the low end of the range.

The University of Iowa Hospitals and Clinics saw the number of telemedicine visits increase from 726 during January through March of 2020 to 63,066 from mid-March through the end of May. However, patients still face the barrier of broadband internet access. Read the entire article about telemedicine in Iowa here.

This analysis discusses the benefits of audio-only telehealth during COVID-19 and its potential after the pandemic. During the pandemic, CMS found that an estimated one in three telehealth encounters were conducted by phone. Supporters argue that allowing audio-only telehealth will increase access to care, especially for underserved populations. However, adding audio-only telehealth to the list of covered services requires lawmakers to determine how and how much it will be reimbursed.

An omnibus Health and Human Services bill recently passed in Minnesota will allow nearly all Medicaid clinical services to be delivered via two-way interactive telehealth. Services can be delivered through audio-only telehealth through June 30, 2023, during which time the state will be evaluating the benefit of making this addition permanent. The bill also permanently adds mental health and substance use disorder to the list of eligible services.

Four hundred and thirty leading health care organizations wrote a letter to congressional officials asking them to create permanent Medicare telehealth expansions, including removing limitations on telemental health services, authorizing the Secretary of Health and Human Services to allow additional telehealth "practitioners, services and modalities," and helping ensure that federally qualified health centers, critical access hospitals, rural health centers and providers like them can furnish telehealth services.

Warren Phillips, the clinical director at Central Iowa Psychological services developed an eConsult service called Psychiatric and Behavior Health Consultation (PBHC) that medical providers can enroll in to help Iowans access these much-needed services. The program allows Iowa providers to consult with the PBHC provider team about behavioral and psychiatric issues.

Proposed rules for telehealth would include expanding the list of Medicare-eligible telehealth services, adding codes for Remote Therapeutic Monitoring (RTM), removing geographic location requirements for mental health services, require an in-person visit every 6 months for mental health services, permitting Medicare to pay for mental health visits furnished via telehealth by Rural Health Clinics and Federally Qualified Health Centers, allow payment for behavioral health visits furnished via audio-only phone call, including for counseling and therapy services provided through Opioid Treatment Program.

ForwardHealth released an update in July of 2021 (2021-21), titled "Transition From Temporary to Permanent Synchronous Telehealth Coverage Policy and Billing Guidelines.” For complete policies and procedures, please see the Online Handbook on the ForwardHealth Portal. Providers are reminded that they are responsible for all information in the Updates.

A recent study aimed to examine the impact of accessibility to a provider via telemedicine on emergency department visit rates in adults who were on home hospice and palliative care. Among the intervention group, the number of emergency department visits and the number of 911 calls decreased from 12 (54.5%) to one (4.5%) post intervention.

Hawai’i UTelehealth, a service run out of the University of Hawaiʻi at Mānoa John A. Burns School of Medicine, was funded by the Federal Communications Commission Connected Care Pilot Program to provide mental health service to rural populations who might experience time constraints, financial burdens and transportation barriers when trying to access services. The online telepsychiatry and telepsychology platform allows individuals to talk to a licensed professional about worries, stress, anxiety, substance use or other concerns at no charge.

A recent study found several barriers to utilizing telehealth for African Americans that were not related to access to technology. While over 90% of participants had the technology to use or access telehealth services, participants had less trust in doctors’ ability to diagnose COVID and less trust in doctor’s ability to treat them using telehealth. The authors summarize that having more Black doctors is key to increasing trust in different forms of health care delivery.

Many legislators in California want the state’s Medicaid program (Medi-Cal) to continue paying for audio-only telehealth appointments at the same rate as for video and in-person visits, a policy that began during the pandemic. From March 1, 2020 to April 30, 2021, Medi-Cal paid for 2.4 million phone appointments. A meta-analysis from the California Health Benefits Review Program reported that telephone visits are generally as effective as in-person visits.

The Federal Communications Commission is providing $57 million in funding for a total of 59 telehealth pilot project sites across the country. Included in these sites are those operated by Catholic Health Initiatives’ pilot project that seeks to expand broadband access to patients in 36 rural sites across Arkansas, Kentucky, Nebraska, Iowa, North Dakota and Minnesota. The aim of the project is to improve connectivity and strengthen chronic care management.

Telehealth visits make up between 60 and 70% of all healthcare services in U.S. tribal communities. However, as many tribal communities are in rural and isolated locations, they face challenges in telehealth delivery. For instance, less than 1% of Apache County, AZ, which is mostly located in the Navajo Nation territory, has access to high-speed internet.

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