Leaders at Nemours Children’s Health Support New TIKES Act for Pediatric Telehealth Enhancement

Oct. 9, 2020
Nemours Children’s Health System are supporting legislation introduced in Congress on Oct. 1 that would help state governments to effectively integrate telehealth into their Medicaid and CHIP programs

On October 1, Representatives Lisa Blunt Rochester (D-Delaware) and Michael C. Burgess, M.D. (R-Texas) introduced legislation intended to enhance the support for telehealth-based care delivery for the nation’s children. A press release published on that day by Rep. Blunt Rochester’s office stated that:

“Today, Congresswoman Lisa Blunt Rochester (D-Del.) and Congressman Michael C. Burgess, M.D. (R-Texas), introduced the Telehealth Improvement for Kids’ Essential Services (TIKES) Act of 2020. The bill would provide guidance and strategies to states on effectively integrating telehealth into their Medicaid program and Children’s Health Insurance Program (CHIP), review the impact of telehealth on patient health and encourage better collaboration.”

And it quoted Rep. Blunt Rochester as stating that “The COVID-19 pandemic has allowed for us to make rapid progress on expanding access to telehealth so children and families across the country, especially those in rural and underserved communities, face fewer barriers to accessing medical care. With the introduction of the TIKES Act, we can continue that progress by bringing better alignment and clarity to Medicaid telehealth policies, as well as provide guidance to state Medicaid programs on the opportunities telehealth services can have for children. I’d like to thank my colleague, Congressman Burgess, for joining me in this critical effort.”

The press release also quoted Rep. Burgess, who stated that, “Amidst the pain and suffering that our nation has endured throughout the COVID-19 pandemic, a major takeaway has been the advantage of telehealth. There is a convenience factor to not having to take time to physically transport yourself to the doctor’s office and have your child sit in a waiting room with other potentially sick patients. This bipartisan legislation will improve utilization of telehealth by requiring the Centers for Medicare and Medicaid Services (CMS) to provide guidance to states on how to make the most of telehealth options in their Medicaid and CHIP programs. Additionally, it directs studies to gather data that can help inform future telehealth policy. I urge my fellow members to support this legislation that will help build upon the telehealth foundation that we have built this year.”

The press release also included a statement made by R. Lawrence Moss, M.D., president and CEO of the Wilmington, Delaware-based Nemours Children’s Health System. Dr. Moss stated, “I commend the leadership of Congresswoman Blunt Rochester and Congressman Burgess in responding to issues raised by health systems like Nemours by introducing this important legislation. Telehealth has facilitated the delivery of high-quality, efficient care to millions of American children. The public health challenge of COVID-19 highlighted its effectiveness and proved its value as a permanent part of the US healthcare system.”

According to the press release, “The TIKES Act of 2020 would:

Ø Provide states with guidance and strategies to increase telehealth access for Medicaid and Children’s Health Insurance Program (CHIP) populations

Ø  Require a Medicaid and CHIP Payment and Access Commission (MACPAC) study examining data and information on the impact of telehealth on the Medicaid population

Ø  Require a Government Accountability Office (GAO) study reviewing coordination among federal agency telehealth policies and examine opportunities for better collaboration, as well as opportunities for telehealth expansion into early care and education settings.

Nemours Children’s Health System also published its own press release on Oct. 1, which began by stating that “Nemours Children’s Health System applauds Congresswoman Lisa Blunt Rochester (D-Del.) and Congressman Michael C. Burgess (R-Texas) for their leadership in introducing the Telehealth Improvement for Kids’ Essential Services (TIKES) Act of 2020. Nemours has been a vocal advocate for policies, like the TIKES Act, that remove barriers to covering care provided via telehealth for families receiving Medicaid or Children’s Health Insurance Program (CHIP) benefits. During the COVID-19 public health emergency, telehealth became crucial for countless families abiding by public health recommendations to temporarily avoid in-person medical visits. Government policy waivers were highly effective in unleashing the power and potential of telehealth to provide safe care to children and families. At Nemours, in the early days of the pandemic response, telehealth visits increased 2,400 percent and expanded coverage allowed the health system to be reimbursed fairly for the services provided.” Dr. Moss said in a statement in the press release that “The emergency-driven easing of state and federal regulatory barriers to telehealth demonstrated how quickly policy makers, payers, and providers can work together on behalf of patients and families. I commend the leadership of Congresswoman Blunt Rochester and Congressman Burgess in responding to issues raised by health systems like Nemours by introducing this important legislation.”

The Nemours press release also noted that, “Currently, there is wide variation in telehealth policies among state Medicaid programs. This legislation creates an opportunity for the federal government to provide more clarity to states as they consider how to expand coverage of telehealth services. The TIKES Act would require the Centers for Medicare and Medicaid Services to provide states with guidance and strategies to increase telehealth access for children covered under Medicaid and CHIP, which cover care for those who can least afford it. The legislation would also promote greater coordination among federal agencies regarding their telehealth programs and policies and recommend a long-term evaluation of the impact of telehealth use across Medicaid programs.”

The week after the legislation was introduced, Dr. Moss sat down to speak with Healthcare Innovation Editor-in-Chief Mark Hagland about the TIKES Act. Below are excerpts from that interview.

How did you get involved in the TIKES Act?

The credit goes to Lisa Blunt-Rochester and Michael Burgess. It is challenging to get traction around kids and to get the broader healthcare community, whether the legislative or executive branch. We saw first-hand the immense value of telehealth during the COVID pandemic. We knew that earlier, but the pandemic shone a really bright light on the issue. We went from 1,000 to 28,000 visits a week, and an immense leap in terms of the number of providers trained in telehealth-based care delivery. And how that relates to the TIKES Act, through our national advocacy office in DC and our state advocacy in the five or six states in which we operate, we moved forward with this. What’s special about the act is that it directs CMS to provide clear and unambiguous guidance to states to provide equal access to care, and to eliminate some of the barriers to telehealth-based care. It’s a comprehensive act, and a huge step forward.

So this is a fertile time for the introduction of such legislation, because so many have interacted with telehealth, correct?

I’m cautiously optimistic. COVID shone a very bright light on what we can do and haven’t been doing, and showed us that many barriers to access to care are actually self-imposed barriers. The loss of life and illness have been terrible, but there have been true gains because of telehealth.

Pediatric care inherently involves the family, obviously, so telehealth is one of those areas in which interaction with it really impacts everyone, correct?

Yes. It’s a good lesson for all of us.

Is there anything else you’d like to add?

A couple of other aspects of the bill: the bill directs MACPAC, the Medicaid and CHIP Payment and Access Commission, to study the impact and potential impact of TH with an eye towards improving patient experience, cost and efficiency, and quality. That’s a big step forward. And it directs the Comptroller General and GAO [the U.S. Governmental Accountability Office] to look at cooperative actions among federal agencies. And that matches Nemours’ view around pairing Medicaid dollars with social-determinants-of-health dollars around poverty, safety, housing, and education, and so I take it as a big step forward in multiple areas.

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