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The national Public Health Emergency was renewed April 16, 2022, with an approximate expiry date of July 16, 2022.

One of the biggest barriers to offering telehealth or virtual care service in North Dakota is unsustainable reimbursement rates to health care providers, according to Andrew Askew, vice president of public policy for Essentia Health. During the COVID-19 pandemic, telehealth offerings exploded. However, debate persists in North Dakota about whether or not the state should implement a blanket parity law to cover telehealth services.

The Office of Inspector General (OIG) recently created a new webpage related to telehealth. The purpose of the webpage is to summarize the OIG’s telehealth oversight work to provide a summary of its findings and recommendations that can be used by policymakers and other stakeholders to evaluate potential changes to federal telehealth policies.

The AMA published an issue brief entitled Equity in Telehealth: Taking Key Steps Forward. The issue brief highlights steps that the AMA sees as necessary to promoting telehealth equity, including funding broadband expansion programs, more accessible technology designs, programs to increase digital literacy, and telehealth programs developed with historically marginalized communities in mind, among other things.

Governor Evers will utilize a $5 million investment to make children’s tele-mental health services more accessible by bolstering child psychiatry telehealth services and establishing neighborhood telehealth access points. The program builds on the Get Kids Ahead Initiative which will provide $15 million for schools to invest in school-based mental health services for kids. Up to five one-year grants of approximately $500,000 will be awarded to hospitals and health systems across the state. Applications are due by 3 pm on Friday, May 6.

According to new evidence from private insurance claims data, social workers were the top specialty providing telehealth services nationally this past January. Because the most common telehealth service social workers provide is psychotherapy, this is just one sign of how prevalent the provision of mental health services through telehealth has been. Further, throughout 2021 and into January 2022, mental health conditions constituted the top telehealth diagnostic category nationally and in every region.

Appleton Area Health in Minnesota will be receiving a $174,300 grant from this round of funding from the American Rescue Plan Act. The hospital will use a portion of its funding to upgrade its telemedicine capabilities and replace hospital equipment. It also plans to install 28 flat-panel television monitors with cameras in clinic exam rooms and patient rooms.

The Nebraska Public Service Commission’s Nebraska Telehealth Program will allocate $1.5 million per fiscal year from the Nebraska Universal Service Fund to health care providers. Nebraska’s health care providers have until June 23 to apply to receive FY2022 support.

Prior to the pandemic, the University of Michigan Hospital in Ann Arbor, Michigan, implemented a patient monitoring at home program using fully managed device kits. Studies show great benefits for patients, as well as hospitals, when patients are monitored in the 30-day post-discharge period. Preliminary findings demonstrate a decrease in readmission rates and ED utilization after the program was implemented. Most of the patients engaged in the program were 60 and older, and reported generally high satisfaction with the program.

A recent study evaluated over 2,000 COVID-19 watch patients enrolled between Nov. 29, 2020, and Feb. 5, 2021 to compare those that received standard care or care that included the pulse oximeter device. Researchers found little difference in the number of days spent out of the hospital following enrollment between each group, suggesting that “a low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices.”

A recent University of Iowa study found that an at-home telemonitoring program was an effective and sustainable way to manage COVID-19 for patients. High-risk COVID-19 patients who were at University of Iowa Hospitals and Clinics were given monitoring kits that included a pulse oximeter, an automated blood pressure cuff, vital signs and symptoms log sheet, contact information to report worsening symptoms, and instructions in English, Spanish and French. Researchers found that most patients did well with the setup: only 6.2% required hospitalization and 1.2% a stay in the intensive care unit from the time of HMP enrollment.

A recent survey conducted by the American Medical Association polled 2,232 physicians between Nov. 1 and Dec. 31, 2021. Of physicians surveyed, 52% said their telehealth use has decreased since they first started offering telehealth services. Audio-visual telehealth is the most popular modality (used by 93% of physicians), followed by audio-only (used by 69% of physicians).

Sue Gehling, a psychiatric nurse practitioner in Iowa, developed Classroom Clinic after realizing how frequently she would get questions from patients and their families in Carroll, where she works, about mental health. Four districts are trying out the platform, which provides psychiatric evaluations and diagnosis, medication management and therapy. The program has allowed more students from towns without available providers to access mental health services from their own schools via telehealth.

A new study researchers identified several factors that helped facilitate telehealth visits. Through interviews with healthcare workers and patients at two federally qualified health centers that primarily serve Chinese and Latino immigrants, researchers discovered that one of these factors was having bilingual personnel.

Dr. Andy Burchett, Avera's chief medical information officer and chair of family medicine, presented at the HIMSS22 conference about Avera’s remote patient monitoring program launched during COVID-19. In his session "Remote Patient Monitoring: Reaching Out and Breaking Through,” Burchett said that after tweaking the payment model, absorbing some of the cost and picking a platform, Avera committed to bridging the hospital-to-home gap. Patients were given a thermometer and pulse oximeter, which were connected digitally to Avera's data-monitoring center, where the data could be watched and patients triaged appropriately. This not only saved patients and staff from unnecessary exposure to the virus, but helped preserve much-needed personal protective equipment, which was in short supply at the beginning of the pandemic.

Within the AMA Telehealth Clinical Education Playbook, a new educator-directed guide focused on embedding educational interactions within a telehealth patient encounter, the authors list 12 keys to creating a high-quality telehealth encounter, that focus on “replicating in-person clinical encounters as closely as possible.”

Telehealth services from doctors, nurses and other health professionals were utilized by 22% of Americans in a recent month-long period, according to an analysis of U.S. Census Bureau Household Pulse Survey data. North Dakota residents were least likely to use telehealth services. Just 11% of residents here reported recently utilizing telehealth services. Iowa joined at the bottom at 12%, with another three states at 13%.

Although Iowa’s emergency proclamation expired February 15, 2022, the Board of Medicine authorized a grace period that will give physicians 90 days (until May 17, 2022) to obtain licensure in Iowa to comply with the Board’s normal licensure requirements. The end of the statewide emergency will not impact Medicaid flexibilities currently in place for telehealth.

CCHP’s 2022 billing guide is now available: Billing for Telehealth Encounters: An Introductory Guide on Medicare Fee-For-Service. The guide reviews Medicare rules for originating and distant sites, PHE and post-PHE rules, provides an explanation of telehealth billing terminology, and offers an overview of Communication Technology Based Services (CTBS), among other topics.

CCHP reviewed both changes wrought by the Consolidated Appropriations Act of 2022 and MedPAC’s March 2022 Report to Congress: Medicare Payment Policy. The Consolidated Appropriations Act will extend federal telehealth flexibilities for 151 days post-public health emergency (PHE), including PHE location, provider, and audio-only expansions, and includes new report requirements. The MedPAC report covers a variety of Medicare payment issues and recommendations, including suggestions related to gathering more information regarding the delivery of care via telehealth from providers.

The 2022 gpTRAC regional telehealth conference will again be held at the Radisson Blu - Mall of America, May 23-25, in Bloomington, MN. Early-bird registration is available now through February 14th. If interested in presenting at this year’s event, the deadline to submit a proposal for consideration is Feb. 28th. Check out the conference website for registration and additional information for potential presenters and exhibitors.

Wisconsin ratified the occupational therapy licensure compact through signing into law 2021 Wisconsin Act 123. As Wisconsin was the 10th state to ratify and enter into this compact, the compact is now active and may begin to establish rules.

If passed, this bill would:
Add CAHs as a distant site provider of telehealth services.
Require that the ordering clinician conduct an in-person exam of the patient no earlier than 12 months prior to ordering certain high-cost lab tests and high-cost DME products via telehealth.
Require HHS to study the impact of the pandemic telehealth flexibilities and deliver a report to Congress no later than 18 months after the end of the public health emergency.

And for another two years after the federal PHE ends, it would:
Extend certain Medicare telehealth payment waivers on originating site and geographic location limitations, expand the list of permissible telehealth providers, and broaden the availability of audio-only telehealth services for Medicare beneficiaries for two years after the public health emergency ends
Allowed DEA-registered practitioners to prescribe controlled substances without a prior in-person medical evaluation of the patient, provided the telemedicine technology uses interactive audio-visual communications and complies with state law
Extend flexibilities put into place by the CARES Act, allowing FQHCs and RHCs to serve as distant sites (the location of the practitioner) for an additional two years after the expiration of the public health emergency.
Payment may not be made for telehealth services furnished by a physician or practitioner unless such physician or practitioner submits a claim for payment under the national provider identification number assigned to such physician or practitioner

The Public Service Commission of Wisconsin funded 16 grants, totaling around $1 million, that aim to help grow telemedicine services in Wisconsin. The three largest grants went to ThedaCare, Children’s Hospital and Health System, and Hospital Sisters Health System Wisconsin. Among the items that will be paid for by the funding will be telemedicine carts, iPads, webcams, as well as equipment capable of transmitting x-ray images to radiologists off-site to ease accessibility for patients in Edgerton.

Senate Bill 309, co-authored by Rep. Amy Loudenbeck (R-Clinton) and Sen. Dale Kooyenga (R-Brookfield) became 2021 Wisconsin Act 121. Act 121 is a technical fix that was needed to provide clarity and uniformity to the definitions of “Free and Charitable Clinics” and “Telehealth” in Wisconsin Statutes. Senate Bill 491, co-authored by Rep. Amy Loudenbeck (R-Clinton) and Sen. Kathy Bernier (R-Lake Hallie), became 2021 Wisconsin Act 132. Act 132 changes the payment structure for subsidized guardianship placements by having the state pay for the program instead of the individual counties.

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