Technology and Telehealth

Part of: 2022 Policy Platform

LEADINGAGE ADVOCACY GOALS

Telehealth:

  • Advocate for permanent changes to Medicare, Medicaid, and commercial payer telehealth policy based on lessons learned from the coronavirus pandemic.
  • Ensure all aging services providers are included in future permanent telehealth expansions.
  • Remove Medicare’s restrictions of patients’ homes as an originating site for audio-only, synchronous audio-only, and asynchronous biometric remote patient monitoring (RPM) and for individuals with chronic conditions living independently, and for individuals with chronic conditions living independently but helped by home health clinicians. Also, promote the use of synchronous audio-video telehealth in skilled nursing homes and assisted living communities.
  • Create an equitable payment policy for the post-pandemic era that balances providers’ costs with patient protections.
  • Promote the adoption of interoperable electronic health records, including funding and technical support.
  • Promote the use of standards-based health information exchange between aging services providers and their partners including primary/acute care providers and payers.
  • Ensure equitable internet connectivity for all aging services providers and older adults, including in affordable housing where Wi-Fi access should be federally funded.
  • Promote policies that support the use of technology to support a reduction in social isolation.
  • Promote the LeadingAge proposed “Telehealth Demonstrations” to expand professionals eligible for certain telehealth interventions, such as Chronic Disease Management and Complex Chronic Conditions to include home health nurses, care managers, and clinical social workers at home health agencies that use RPM technologies to manage chronically ill populations, under the supervision of a physician. Such codes are under-utilized by physicians. Similarly, there are opportunities for therapists, pharmacists, and staff at other types of home-based care providers etc. to provide appropriate interventions using the appropriate modalities of telehealth.

Health IT Incentives:

  • Secure government funding for the Office of National Coordinator (ONC) at the U.S. Department of Health and Human Services (HHS) to:
  • Establish electronic health record (EHR) Interoperability Certification Criteria/Program relevant to LTPAC, but aligned, where possible with the acute care certification program.
  • Establish health IT education and training for staff in LTPAC providers, similar to the Regional Extension Centers (RECs) that supported small physician practices.
  • Fund technical assistance resource centers to provide technical assistance for LTPAC providers, similar to the RECs that supported small physician practices.
  • Direct financial incentives for LTPAC Providers (SNFs/NFs, Home Health, Hospice, Long-Term Acute Care Hospitals (LTACHs), In-patient Rehabilitation Facilities (IRFs) to:
  • Upgrade to interoperable EHR technology;
  • Upgrade their infrastructure and broadband connectivity;
  • Subscribe and connect to health information exchange entities or networks, and add technically competent staff to support the use;
  • Conditional Sustainable Use financial incentives/payment modifiers that, tied to quality measures, would be impacted by effective exchange of health information with partners for the next 5 years.

Broadband:

  • Extend the subsidized broadband connectivity rates for health care providers in rural areas to additional aging services providers by amending the Social Security Act (as was done in the 2015 Rural Connectivity Act, which added nursing homes to the definition of healthcare providers).
  • Create funding opportunities for congregate affordable low-income housing providers to collectively apply for and receive broadband internet connectivity to the building and to their residents’ units, to ensure equitable access to services.

THE ISSUE

Massively increased flexibilities, particularly in the Medicare program, to utilize technology to deliver all types of care became an essential lifeline for our health care system during a time of unparalleled challenges and strains. If there is any “silver lining” to the coronavirus pandemic, it has been an increase in the use of technology to deliver appropriate and timely care to keep people safe, healthy, and well-connected.

The ability to use telehealth during this emergency was vitally important to protect staff and patients’ health, but also to expand the reach of overextended health care personnel. Waivers in Medicare rules that allow the home to be an originating site of care, expand the types of technology that can be used for telehealth visits (e.g., Facetime and even audio-only in some cases), and expand the types of providers that can bill for telehealth services, are all massive changes from the pre-pandemic state of play.

The question now is how to capitalize on the progress made during the pandemic, which in many ways has served as the “demo” of telehealth that many have asked for in the past. Concerns for the future including how to make sure that telehealth is incorporated into practice in an equitable, cost-effective (for both the government and providers), and accessible way. What is clear is that we need to continue moving forward.

In addition to making permanent many of the pandemic flexibilities, aging services providers need to adequately pay their appropriate trained staff, like therapists and nurses. These staff can either deliver interventions, including therapy via telehealth (both synchronous virtual visits as well as asynchronous RPM) under a physician-approved care plan, or can assist a remote physician during an asynchronous telemedicine visit. Moreover, providers need support to maintain and upgrade technology. Hence, they need adequate reimbursement from all payer sources to sustain and maintain the investments they already made in delivering care via telehealth.

Broadband investment, especially in rural and underserved areas, is critical to making sure telehealth is an accessible service nationwide – including in affordable senior housing communities, many of which lack connectivity and where federal investment in wireless internet capability is imperative. Continued investment in broader health IT to support information management and the secure exchange of health information are also critically important and need to be inclusive of aging services providers. Finally, those providers who treat patients in their own home – like home health and hospice as well as PACE – who have not been able to take full advantage of the affordable internet connectivity like their other healthcare peers in rural areas, or telehealth in the past, or even the expanded telehealth flexibilities, need to be included.

ADVOCACY ACTION 2022

117th Congress

Click here to see the full list of technology/telehealth legislation LeadingAge is following in the 117th Congress.

  • Keeping key pandemic flexibilities:
    • We support keeping the following pandemic flexibilities in place permanently
    • Permanently removing the geographic restrictions on telehealth;
    • Allowing the home to be an originating site of care beyond the public health emergency,
    • Permanent expansion of the providers who can furnish telehealth services in both the physical and mental health arenas.
    •  Continued flexibility in the type of modality allowable for video-audio connections (e.g. allowing the use of FaceTime or other smartphone technology) to utilize all tools available, including audio-only, to deliver telehealth services as appropriate and look to work with Congress on the intersection of accessibility and privacy (e.g., HIPAA concerns).
  • Hospice face-to-face recertification. We support allowing the hospice face-to-face recertification to take place via telehealth on a permanent basis.
  • Prevent a telehealth “cliff” after the end of the PHE. While we support the expansion of telehealth based on the experience of providers and patients during the pandemic, it is critically important that there not be a “cliff” where the flexibilities suddenly end, potentially cutting off access. We support policies that would extend the public health emergency flexibilities for two years after the end of the PHE – though we would want to be sure it was inclusive of both legislative and regulatory flexibilities.
  • Reimbursement for home health telehealth visits: We support legislative efforts that allow virtual visits to be reimbursed under the Medicare home health benefit with appropriate guardrails..
  • PACE and Telehealth: We support legislation that would allow audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustment to payments for PACE and Medicare Advantage programs.
  • Housing and Technology. We support federal funding for the installation and service fees for wireless broadband internet in all HUD-assisted senior housing communities units.
  • Meaningful Use. Aging services providers were not included in previous funding efforts that supported health care providers’ transition to electronic health records (EHR) systems that contain the medical and treatment histories of patients. We will continue to advocate for funding and payment incentives, including incentives tied to quality, to assist aging services providers in accessing EHR technology that is interoperable with that of their physician and hospital partners and peers, and encourage the bi-directional exchange of information.
  • Nursing Homes and Telehealth: We support legislation that allows all nursing homes to use telehealth models to improve care.
  • Affordable Rural Internet Connectivity for Aging Services Providers: We support legislative action aimed at expanding the scope of the 2015 Rural Healthcare Connectivity Act, to include home health, hospice, and other aging services providers in the home and community Such action would allow all aging services providers to take advantage of lower internet connectivity costs offered to acute care, and nursing homes.
  • Executive Branch

  • CMS Commissioned Study on Telehealth Services. HHS announced in a December 2021 research report massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic. The report also provides insights into telehealth visits conducted in 2020 increased 63-fold from approximately 840,000 in 2019 to 52.7 million. Additionally, the report found: specialists like behavioral health providers saw the highest utilization relative to other providers; telehealth services were accessed more in urban areas than rural communities; and Black Medicare beneficiaries were less likely than White beneficiaries to utilize telehealth. In light of this report, LeadingAge encourages CMS to improve health equity in telehealth services as highlighted by the COVID-19 PHE and to expand access among underserved populations.
  • CMS 1135 waivers: LeadingAge will continue to advocate for a review of telehealth and technology 1135 waivers to see which can be made permanent without Congress, including utilization of telehealth for hospice routine home care visits and flexibility in licensure requirements in the Medicare and Medicaid program.
  • Remote patient monitoring: LeadingAge will work to ensure that all appropriate aging services providers can utilize and bill for asynchronous remote patient monitoring, which is critical for individuals with chronic conditions that our providers serve, to enhance their service.
  • Telehealth codes for home health and hospice: We will advocate for the creation of claims codes or modifiers to document home health and hospice virtual visits. Hospice providers are utilizing telehealth for routine home care during the pandemic and home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the creation of claims codes or modifiers that will allow for analysis of these encounters for a variety of purposes including quality measurement. MedPAC recommended the creation of a claims code for hospice telehealth visits in their December 2021 and January 2022 meetings and we anticipate it will be in the March 2022 report.
  • Advocate for allowing home health nurses to bill for services: Therapists and other appropriately licensed professionals are allowed to use telehealth and home health agencies to bill for such services beyond the pandemic. Remote patient and medication adherence monitoring improve chronic care management, reduce hospitalizations, hospital stay, and readmissions, and consequently cost. Chronic care management reimbursement codes currently exist for physicians, physician assistants , and nurse practitioners, but are woefully underutilized. We will advocate for the creation of claims codes or modifiers that will allow the appropriate staff at home health agencies to perform, and for agencies to bill for, a variety of appropriate chronic care management and therapy interventions approved by a physician’s plan of care using telehealth, including remote patient and medication adherence monitoring technologies.
  • Make demonstrations inclusive of telehealth: New and current CMS Innovation Center (or Innovation Center) demonstrations should include waivers to allow for the broad utilization of telehealth and technology. We will advocate for the Innovation Center to continue to build the evidence for the role these areas will continue to play in healthcare delivery.

ACTIONS YOU CAN TAKE NOW

  • Visit the Advocacy Action Center to let your representative and senators know your views on eliminating barriers for the expansion of telehealth services in the Medicare program.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies related to technology and not incorporating telehealth models in Medicare affect older adults.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know your views on technology and telehealth for older adults.

Resources