Four Western States Collaborate on Telehealth Best Practices

Aug. 18, 2020
Colorado has already expanded telemedicine reimbursement in Medicaid and placed further requirements on private payers to cover telehealth

The governors of the states of Colorado, Nevada, Oregon and Washington have agreed to work together to identify best practices that support telehealth services for their residents with a focus on health equity.

Washington Gov. Jay Inslee joined Colorado Gov. Jared Polis, Nevada Gov. Steve Sisolak and Oregon Gov. Kate Brown in issuing a statement noting that “telehealth is here to stay.”

The Center for Connected Health Policy notes that the joint statement comes as states are considering making many of the telehealth expansions spurred by the COVID-19 public health emergency permanent. For example, it reports that Colorado has already passed SB 20-212, which expands telemedicine reimbursement in Medicaid (including interactive audio services), and places further requirements than previously established on private payers to cover telehealth. Colorado has now published a proposed rule to implement the Medicaid portion of SB 20-212.  Other states may be considering similar approaches, the Center says.

During the COVID-19 crisis, each state has sought flexibilities from the federal government to expand health services available through telehealth, modify payment policy for services provided using this modality, and expand the allowable technologies used to provide telehealth services. The Centers for Medicare & Medicaid Services (CMS) has announced its intention to make permanent some of the telehealth flexibilities afforded during this pandemic.

Because these four states have significant individual and collective experience with telehealth, they are coming together to ensure that the nation benefits from their collective knowledge as changes to federal regulations are contemplated and to support continued application and availability of telehealth in their states.

 Because the pandemic has made clear several aspects of inequity in healthcare delivery, another goal is to address the inequities faced in particular by tribal communities and communities of color.

 While they will each have individual state-driven approaches to implementing telehealth policies, there work will be guided by seven overarching principles:

1.  Access: Telehealth should be used as a means to promote adequate, culturally responsive, patient-centered equitable access to health care, and to ensure provider network adequacy.

2.  Confidentiality: Patient confidentiality should be protected, and patients should provide informed consent to receive care and the specific technology used to provide it.

3.  Equity: The states will focus on improving equitable access to providers and addressing inequities and disparities in care. Telehealth should be available to every member, regardless of race, ethnicity, sex, gender identity, sexual orientation, age, income, class, disability, immigration status, nationality, religious belief, language proficiency or geographic location.

4.  Standard of Care: Standard of care requirements should apply to all services and information provided via telehealth, including quality, utilization, cost, medical necessity and clinical appropriateness.

5.  Stewardship: The states will require the use of evidence-based strategies for the delivery of quality care, and will take steps to mitigate and address fraud, waste, discriminatory barriers and abuse.

6.  Patient choice: Patients, in conjunction with their providers, should be offered their choice of service delivery mode. Patients should retain the right to receive health care in person.

7.  Payment/reimbursement: Reimbursement for services provided via telehealth modalities will be considered in the context of individual state’s methods of reimbursement.