Pamela King. MBA HIE Outreach Coordinator Agency for Health Care Administration

Pamela King. MBA HIE Outreach Coordinator Agency 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 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. 5

Telehealth Civil Money Penalty Grant Project Project Amount: $275,000 Telemedicine Providers: TripleCare DocsConnect 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 6

Telehealth HB 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 Technology 8

Defining Telehealth Six Key Components: 1.Telehealth can be used for providing health care and public health services 2.Telehealth includes synchronous and asynchronous transmission modalities 3.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 practice 5.Telehealth can be between health care practitioners or health care practitioners and patients 6.There must be no limitations on geographic location or place of service 9

Health Insurance & Telehealth Coverage Parity Reimbursement Parity Medicare Medicaid Fee-for-service Rules Insurance Network Adequacy Resource: AmericaTelemedicineAssociation.org. Retreived 10/26/17 10

Health Insurance & Telehealth Suggested Language for Future Legislation: Coverage Parity 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. 11

Health Insurance & Telehealth Reimbursement 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-forservice 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. 12

Health Insurance & Telehealth Medicaid Recommendations: 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 Resource: AmericaTelemedicineAssociation.org. Retrieved 10/26/17 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 13

Health Insurance & Telehealth Medicare Resource: AmericaTelemedicineAssociation.org. Retrieved 10/26/17 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 14

Health Practitioner Licensure & Telehealth Interstate 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 15

Health Practitioner Licensure & Telehealth Standards 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 16

Patient/Consumer Protection Patient-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. 17

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 18

Telehealth and Prescribing Recommended 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 substances through 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. 19

Patient/Consumer Protection Patient Consent Recommendation: 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 20

Technology Recommendations: 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 21

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 22

Powered by 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/

Secure Messaging Powered by 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.

powered by 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

QUESTIONS? 27

2 8 Contacts and Resources www.ahca.myflorida.com/medicaid/ehr MedicaidHIT@AHCA.MyFlorida.com www.florida-hie.net FLHII@ahca.myflorida.com http://www.floridahealthfinder.gov/index.html http://www.ahca.myflorida.com/schs/telehealth/ h Fall 2017