With Congress delaying the “telehealth cliff” by two years by adding a telehealth exemption as part of its omnibus spending bill in late 2022, HIMSS says it is now ready to make the case for permanent reimbursement for virtual care.
Also on its policy agenda for the year ahead: advocating for data standardization, providing input into interoperability rulemaking, and working with agencies and states to increase telehealth access. We spoke to the HIMSS Government Relations team to get their perspective on these priorities and more for 2023 and beyond.
Reasons to Make Telemedicine a Cost Control
Telemedicine, which has been proven to reduce the burden on health care providers and improve access, has been a priority for HIMSS for years, but the Congressional Budget Office has long complained that all the data is for non-Medicare patients, said Tom Leary, senior vice president. Explains President and Head of Government Relations at HIMSS, parent company of HIMSS Healthcare IT News.
The budget chief asked, “How do you know what the impact is on the Medicare population and the Medicare trust fund? We now have three years of data on the impact on the Medicare trust fund,” he said.
While a pandemic-era telehealth exemption answers many questions at the federal level, a two-year extension to offering telehealth among high-deductible health plans that include health savings accounts in the final legislative package in 2022 is a pursuit to make the change permanent.
HIMSS will “gather additional data over the next two years to inform Congress and the CBO on cost avoidance or cost containment,” Leary said.
In addition to making telehealth coverage permanent, simplifying patient access is another goal of the mission-driven nonprofit that aims to revolutionize the global health ecosystem through the power of information and technology.
HIMSS government relations manager Amanda Krzepicki said HIMSS is also actively supporting the Connect for Health Act and a bill that is expected to be reintroduced this year.
By 2023, HIMSS will not only further support telehealth with really strong data on how these services can help patients achieve broader reform, but will also work with licensing boards at the state level to discuss how telehealth can benefit more patients.
HIMSS members will communicate the long-term implications of multiple provider types and care settings related to reimbursement.
An example is audio telephony and how reimbursement rates are determined based on the care needed and appropriateness of care provided through that channel.
Audio reimbursement may be helpful, especially in areas with unreliable internet connections.
By July 2022, all state Medicaid programs will provide at least some audio-only coverage for behavioral health, according to a recent Kaiser Family Foundation report.
Most state Medicaid plans want to keep telemedicine expanding and have broad authority to do so without federal approval, the report said.
Krzepicki said that while we need to continue to focus on bad actors in the field, the data “doesn’t really show that costs are going up due to usage in the telehealth space.”
“For HIMSS, it really comes down to making sure we’re using the technology in at least one way that improves patient access to care,” Leary added.
Driving Broadband Adoption
HIMSS works with the Senate Broadband Caucus to continue expanding broadband.
“Broadband access is definitely an issue that we’re going to continue to push,” Leary said.
He said the Infrastructure Improvement Act put billions of dollars into it, and HIMSS will work with the FCC over the next year on last-mile connectivity.
The agency has rolled out more broadband expansion programs to increase connectivity to more communities, such as the Affordable Connectivity Outreach Grant Program, which will announce recipients on or before March 10.
The program provides funding to eligible state, local and tribal housing agencies, as well as nonprofit and community-based organizations and others, to conduct outreach to raise awareness and encourage participation in the ACP for families receiving federal housing assistance.
The FCC will also provide outreach grants to “trusted, neutral third-party entities, such as schools and school districts, or other local or state government entities.”
“Signing up for the ACP is free, but many don’t want to,” wrote Craig Settles for Healthcare IT News in November, how telemedicine’s efficacy depends on meeting broadband needs.
“Telehealth can win over the bystanders. The universal need for health care can make ACP combined with telehealth a win-win for everyone,” said Settles, a telehealth and broadband advocate.
Getting health care from home or from a clinic is just as important as getting an education, echoed Leary.
He noted that previous legislation funding broadband, such as the American Recovery and Resilience Act of 2009, defined what needed to be done to get the money.
What’s less clear this time around, Leary said, is how communities in need will get the money.
“How do you use that in health care, and how does health care fit into these discussions?” Leary said.
Creating Standards Synergies for “Interoperability 3.0”
HIMSS government relations specialists say there has been back and forth over the years about how to handle provider burden.
The Centers for Medicare and Medicaid Services has released a proposed rulemaking to improve the electronic exchange of healthcare data and streamline processes related to prior authorization to further enhance interoperability.
HIMSS members are interested in information transfer standards common to most health and pharmacy data used in rulemaking.
“I think CMS saw the writing on the wall and really capitalized on the fact that it was part of the public discourse,” Leary said.
Comments will be submitted in early March. In his comments, Leary said he expects HIMSS to emphasize leveraging the latest information-sharing standard HL7, integrating use cases from the healthcare enterprise, and aligning it with the National Prescription Drug Program Board standards.
“So we’re creating some synergy rather than creating something that burdens suppliers,” he said.
Another priority for members is to see CMSs increasingly aligned with the Trusted Exchange Framework and Common Agreement (TEFCA) and Qualified Health Information Network.
“Let’s determine what [Office of the National Coordinator for Health IT] Proposed, CMS builds on interoperability, but doesn’t take us in a different direction,” Leary said.
Striving for a more seamless patient record
Part of the Substance Abuse Confidentiality Act restricts the sharing of mental health records with providers — even when patients provide access.
The U.S. Department of Health and Human Services issued a notice of proposed rulemaking on December 2 calling for significant changes to better align the substance use secrecy statute (42 CFR Part 2) with HIPAA. The deadline for submissions is 31 January.
HIMSS, a founding member of the Patient ID Now Coalition, has long called for a national patient identifier for patient safety, Krzepicki said, explaining that lack of access to substance abuse records can hinder care and even lead to death.
Changes to the rules could make it easier for providers to share patient records and help keep the data cleaner.
“We don’t lose information from patient to patient, and patients don’t have to sign waivers that allow certain doctors to see different input from other providers,” she said.
Andrea Fox is Senior Editor for Healthcare IT News.
Healthcare IT News is a publication of HIMSS.