By Alana Lerer, MPH, CAHIMS, Manager, Government Relations, HIMSS
As the number of confirmed cases of coronavirus (COVID-19) continues to grow, state policymakers in the United States are taking extensive actions to manage the spread through information and technology. These actions focus on increasing access to telehealth to connect patients and providers virtually throughout the duration of the declared public health emergency, supporting public health surveillance and electronic case reporting to improve disease tracking and management, and coordinating with state health information exchanges (HIEs).
The federal government is also taking important actions on telehealth. Read more: Telehealth in the COVID-19 Spotlight.
HIMSS is continuing to monitor state and federal actions, since policy changes are occurring daily. As of March 27, states have taken the following actions on telehealth.
Centers for Medicare and Medicaid Services (CMS) is offering states Section 1135 waivers and relevant checklists and tools. These waivers give states flexibilities to focus their resources on COVID-19 response. As of March 27, CMS has approved 34 states. Flexibilities include temporarily reducing delays on enrolling new and out-of-state providers, which has implications for telehealth.
Overall, Medicaid provides states with a great deal of flexibility to use telehealth services in their programs, including various methods of communication such as telephonic or video technology commonly available on smart phones and other devices. Ultimately, 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.
In response to COVID-19, CMS issued a FAQ on March 24 on how states and health insurance carriers can leverage telehealth. The majority of actions states have taken fall into the following three categories:
Thirty-two states are temporarily waiving in-state licensing requirements for qualified medical personnel overall and specifically for delivering telehealth for providers outside of state lines. The Federation of State Medical Boards issued recommendations for states licenses during pandemics. Typically, in most states, healthcare providers need to maintain a license for each state in which they serve. Now, to expand the workforce during this public health emergency, many states are removing that restriction and allowing providers to practice across state lines. For example, in Florida, with approval, out-of-state providers may temporarily deliver telehealth services to Floridians without attaining a license. Some states, like Alabama, have adopted emergency licensing procedures and expedited the process to offer temporary licenses to qualified medical personnel during the declared emergency.
Twenty-eight states are expanding access to telehealth for Medicaid recipients. These policies include one or more of the following rules: allowing the patient’s home to be the originating site (i.e. location of patient during service), requiring that provider reimbursement for telehealth be equal to that of a traditional in-person visit, covering telehealth for specified services (e.g. physical therapy, occupational therapy), allowing for multiple methods of telehealth, such as telephone without the requirement of video, and removing the requirement of a face to face initial appointment.
Nineteen states are mandating that commercial insurance carriers cover telehealth throughout the duration of the declared public health emergency. This may include waiving all copays, coinsurance, and deductibles for patients relating to COVID-19 diagnostic testing and requiring provider reimbursement for telehealth be the same as reimbursement for a traditional in-person visit.
Besides telehealth, states are beginning to appropriate funds for surveillance to detect and manage the outbreak and require electronic case reporting to public health entities.
Several state and regional HIEs and health information networks are leading efforts to respond to COVID-19, since they have the capability to share valuable patient data. The level of infrastructure of each HIE varies by state. Here are a few examples:
To effectively respond to the spread of COVID-19 through the support of information and technology, HIMSS recommends that states consider the following:
1. Scale-up telehealth to reduce the number of people using healthcare facilities while at the same time preserving and improving health. The Administration has issued flexible and constructive guidelines for Medicaid, but much more is needed. States can help to account for the uninsured population or those outside of the safety net.
2. Encourage routine public health data submission and query and, wherever possible require by law or policy, to enable a health IT infrastructure to be built and maintained, including in an emergency. Investments should continue in key initiatives, such as electronic case reporting, to enable cross-jurisdiction sharing of notifiable condition reports.
3. Leverage HIEs to facilitate cross-sector health data platforms or open health data portals to collect data across sectors including emergency management encounters, EMS data, and public health surveillance data. This approach can create targeted interventions, emergency response plans relating to communicable diseases and other non-health data such as transportation to support health impact assessments for policymakers to leverage and make informed decisions during all public health emergencies.
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In the CARES Act passed on March 27th, Congress included $500 million for CDC to modernize data infrastructure to support data surveillance for COVID-19 and future public health needs. Thank Congress for including these funds using our simple and quick form.
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