New York Gov. Andrew M. Cuomo proposed sweeping legislation earlier this week that would expand access to and accelerate adoption of telehealth services for all state residents.
Noting in an announcement that the COVID-19 pandemic “laid bare the inequities in our healthcare system and showed that telehealth is a critical tool to expand access and lower costs for low-income communities, especially for behavioral health support, during the crisis, the governor took executive action to expand access to remote care, and these proposals codify and build on those successful reforms.”
In partnership with the Reimagine New York Commission—a state government-created group that will look to leverage advanced technology tools to help rebuild New York—the governor, via his 2021 State of the State, is proposing to enact comprehensive telehealth reform to help residents take advantage of telehealth tools and address existing roadblocks. These reforms will address key issues like adjusting reimbursement incentives to encourage telehealth, eliminating outdated regulatory prohibitions on the delivery of telehealth, removing outdated location requirements, addressing technical unease among both patients and providers through training programs, and establishing other programs to incentivize innovative uses of telehealth, according to the proposal.
"While New York State has been on the cutting edge of promoting telehealth for its residents, the adoption of telehealth by both patients and providers has been slow," Gov. Cuomo said in a statement. "COVID-19 has changed not only the way we live, but the way healthcare providers support their patients, especially in regard to mental health. New Yorkers have adapted throughout 2020, but it is time to push telehealth to the next level in New York State and fully integrate it into our existing healthcare system. These proposals will better allocate our healthcare and technological resources for the 21st century."
The governor proposes several widespread reforms to permanently adopt COVID-19-era innovations that expanded access to physical health, mental health and substance use disorder services. These include the following regulatory and statutory changes:
- Eliminating obsolete location requirements by requiring Medicaid to offer telehealth reimbursement for services rendered to patients regardless of where the patient or provider is located in a non-facility setting
- Developing interstate licensing reciprocity with states in the Northeast region for specialties with historical access shortages to ensure that there is sufficient access to medical and behavioral health professionals
- Continuing COVID-era flexibilities for mental health and substance use disorder services by allowing certain unlicensed staff, such as Credentialed Alcoholism and Substance Abuse Counselor trainees or Peer Specialists, to deliver substance use disorder and mental health services. This also includes eliminating the remaining in-person evaluation requirements before telehealth services can be delivered, expanding the types of staff who can deliver remote services, developing a regulatory structure for a predominantly virtual outpatient substance use disorder treatment program and exploring the expansion of existing initiatives that extend behavioral health services into nursing facilities. This will include reimbursement of all mental health and substance abuse provider types, including certified recovery peer advocates so patients and providers can choose the care setting that best suits their needs.
Further related to coverage and reimbursement for telehealth services, the proposal will:
- Require commercial health insurers to offer a telehealth program to members, and provide Medicaid coverage, subject to federal approval, to cover services furnished telephonically when medically appropriate
- Ensure that telehealth is reimbursed at rates that incentivize use when medically appropriate
- Require providers to disclose to patients in writing or through their websites whether they provide telehealth services. Require insurers to provide up-to-date information in their provider directories about which providers offer telehealth services. Any telehealth platforms offered as part of a mandatory telehealth program will be required to participate in the Statewide Health Information Network for New York (SHIN-NY) or otherwise demonstrate interoperability with other providers in the insurer's provider network.
And related to technology innovation, the proposal will:
- Require insurers to offer members an e-triage or virtual emergency department platform that enables individuals to receive a symptoms assessment and a referral to a network of providers or a nearby emergency department when warranted
- Facilitate the use of expert consultations between providers via telehealth by encouraging insurers to reimburse providers directly for engaging in e-consults or permitting the inclusion of insurers' costs associated with e-consult platforms within the healthcare service costs
- Streamline the SHIN-NY patient consent process to increase interoperability and record access amongst healthcare providers.
The American Telemedicine Association (ATA) said it commends Governor Cuomo for his leadership in seeking to expand telehealth access to New York residents. Ann Mond Johnson, CEO, the ATA, noted, “In response to the public health emergency, telehealth shored up a troubled healthcare system, when our nation needed it most. It is now vital for states, such as New York, to act as soon as possible this year to ensure telehealth remains available to all, wherever and whenever it is needed. The ATA is hopeful that the New York state legislature will work with Governor Cuomo to pass this needed telehealth modernization legislation.”
The association also pointed out that earlier this month, Massachusetts Governor Charlie Baker signed into law a healthcare bill that requires insurance companies to cover behavioral telehealth visits the same way they cover in-person care, mandates rate parity for two years for primary and chronic disease care and provides a short-term model for how those services will be paid. In addition, this new law allows providers to use all available and appropriate telehealth technologies to deliver care and communicate with both new and existing patients.
Right before the holidays, the Trump administration’s $900 billion pandemic relief bill included funding for broadband expansion, including the FCC’s COVID-19 Telehealth Program, and Medicare coverage for telemental health and telehealth at rural hospitals. But the ATA was not satisfied with other elements that the group believes were missing from the package. The association expressed disappointment that the telemental health provision includes an in-person requirement, “as we strongly believe a provider-patient relationship can be established via telehealth. Particularly in light of the crippling provider shortage, this in-person pre-existing relationship requirement will unnecessarily deprive Medicare beneficiaries of telemental health options, and we are hopeful Congress will remove this provision in the near future,” Mond Johnson said in reaction to the bill.
She continued, “In addition, the noticeable lack of permanent reform or a guaranteed extension of the telehealth flexibilities in this relief package is disheartening for the millions of Americans who relied on telehealth to access care, and our healthcare providers still on the frontlines of the pandemic. We believe arbitrary restrictions on telehealth must be permanently removed to make way for a modernized and more accessible healthcare system. We applaud Congress for starting down this path this year but urge state and federal lawmakers to take definitive measures next year to act on permanence. There is still much work to be done to set the course ahead for access to telehealth following the PHE…”
During the public health emergency, the Centers for Medicare & Medicaid Services (CMS) added 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. In August, the federal agency proposed to permanently allow some of those services to be done by telehealth, including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments.
Throughout the course of the pandemic, hundreds of healthcare organizations have urged Congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. Importantly, those groups noted that statutory restrictions within the Social Security Act and that the authorities granted to HHS and CMS through recent coronavirus legislation are limited to the COVID-19 public health emergency period, meaning that “Congress must act to ensure that the Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services.” Payment-focused telehealth changes are under the authority of Congress rather than HHS and CMS.
The ATA said it still “remains optimistic that we will see movement in the new Congress during the months ahead and will continue to work to ensure access to telehealth becomes a permanent modality in a hybrid delivery system that includes both in-person and virtual care.”
