Telehealth Policy Coalition Meeting August 16, 2019 MEETING NOTES

I. Introduction/Updates

Ms. Kwong welcomed everyone to the August Coalition call and provided brief updates. DHCS released their Medi-Cal telehealth policy manual, however they have not released other manuals. Additionally, they released an All Plan Letter last week, but it is not currently on the list of available All Plan Letters. It is available via direct link, however the reasoning is not clear. The dates of release were set for August 15th or 16th. Ms. Kwong stated she sent an email to DHCS with questions on how they wrote the All Plan Letter, but she has not received a response. She further stated that her question raised issues that need clarification. Within the letter, under the policy for telehealth, the language is similar to what is found in the fee for service manual, which would give health plans the option of whether they want to provide telehealth services.

II. Legislation Committee Update

Ms. Kwong provided an update to the Legislative Committee. The Legislative Committee has been working with the Education Committee on the legislative briefing sessions. Additionally, CCHP and BluePath had a discussion with the California Health Care Foundation (CHCF), who funds the Coalition. They provided clarification on how Coalition funds may be used. The main concern regards support letter writing, which would include the time taken for Ms. Kwong to draft a support letter for Coalition supported legislation. The Coalition will be unable to draft letters of support with the current funding structure. Individual members of the Coalition may still send letters of support and templates can still be distributed to members of the Coalition, however no letters may be sent under the Coalition name.

III. AB 744 Update

Ms. Durbin provided a brief update on the status of AB 744. There has not been much movement since the previous update. The bill was discussed in the Senate Appropriations Committee on Monday, August 12th. Currently, they are working with the Committee and having conversations with leadership and the Governor’s Office as they approach the end of the legislative process. On August 29th or 30th, there will be two weeks to move the bill off the Senate floor and back to the Committee. There have been amendments taken to address concerns from opposition, however health plans and other opponents to the bill are being more active in lobbying against it.

Ms. Kwong mentioned knowing that CMA was waiting on the release of the DHCS manuals, which had the potential to rearrange some of the costs and asked if it has helped. Ms. Durbin stated that they are continuing to tell others, including the Chairperson for the Senate Appropriations Committee, that there have been developments from DHCS. She had thought that costs would be recognized without AB 744, but considering the language in the All Plan Letter, she is unsure if it will.

Dr. Ozeran asked for more information regarding why the Chamber of Commerce is opposing the bill. Ms. Durbin stated her understanding is that health plans are large members of the Chamber and have many bills they track. It seems as though they have primarily given control to the Chamber on this bill. Dr. Ozeran asked how to reach out to the Chamber to change their stance. Ms. Durbin replied that CMS has attempted to speak with them and have gotten some individual members of the Chamber to support the bill, however she is unsure how impactful it is.

IV. AB 1494 Update

Ms. SanMiguel provided a brief update on AB 1494. There were no significant updates. The bill is on the Senate floor and will need to go through a concurrent vote. Afterwards, affiliates will prepare a conversation ideally in September. If the bill goes through quickly and without concerns, they will be able to start doing increment visits without prior examination in the way which medical doctors are more comfortable.

V. Legislative Update

Ms. Kwong briefly overviewed the status of legislation. Most of the bills listed in the slide deck are on the Coalition’s watch list. There have been little movement in legislation since the previous Coalition call.

In Federal updates, the physician fee schedule was released recently. There were some additions for telehealth, cleanup, and changes. New codes were added to address substance use disorder and to use telehealth in home for substance use disorders. Comments are due in September. Additionally, CCHP is releasing a factsheet on the changes.

VI. Education Committee Update

Ms. Bates provided an update of the Education Committee. The Committee is moving forward with a plan to have a legislative briefing in early October. Additionally, fact sheets are being worked on and will be able to be shared with everyone soon.

Ms. Kwong added that the briefing will likely be held in early October due to conversations with CHCF, who provided information that there is another regularly scheduled briefing being held during the previously selected dates. In order to avoid competing for attendees, the briefing will be held later.

Ms. Kwong stated that the Coalition website has been built out. There are still some technical issues being resolved, however it is currently accessible for Coalition resources, past meeting notes and slides, and other materials.

VII. November Coalition Meeting

Ms. Leslie updated the Coalition regarding the end of the year Coalition meeting set for November. The meeting is set to be held on November 5th, at the Sierra Health Foundation in Sacramento. There will be a member reception held at the same location on November 4th. The goal of the meeting will be to look for outcomes to be listed on the Coalition charter and to discuss the potential diversification of Coalition funding. Look for a notice and invitation and share with others who are interested in attending. Since the event will be held at the Sierra Health Foundation, there will be an audience cap, so RSVP early.

VIII. Fall Briefing

Ms. Kwong provided an update on the Fall briefing. The Fall briefing will likely be held in early October. The topics for the briefing include telehealth 101, telehealth across the lifespan, and the current state of telehealth policy. The Education Committee is working to refine this, and will hopefully have something to be sent out. They are also working to secure a venue. Once all those details are solidified, work can begin on setting up marketing materials.

Mr. Perrone added that CHCF has secured some resources for the Fall briefing. He added that if any Coalition members have patients who would be willing and able to be good spokespeople to talk about telehealth, they are interested in having a few individuals participate during the briefing. Ms. Kwong agreed that it can be difficult to find someone with the experience and ability to discuss the topic effectively. She added that if any members know of such a person, please share. Ms. SanMiguel mentioned that Planned Parenthood may be able to connect with individuals through their public affairs department.

CCHP serves as the convener of the Telehealth Policy Coalition monthly conference calls. The purpose of these calls is to share relevant information and provide a forum for strategy discussions.

California Telehealth Policy CoalitionMonthly Meeting

August 16, 2019

Agenda

Introductions and Agenda Overview 5 min

DHCS Telehealth Provider Manual- Update 15 min

Legislation Committee• Recap of July meeting• State and federal updates

15 min

Education Committee• Recap of July meeting• Fall briefing update• New organization engagement

15 min

News and Announcements 5 min

Wrap up 5 min

DHCS Telehealth Provider Manual Update

DHCS recently revised the Medi-Cal telehealth policy on the DHCS Telehealth website — Includes new e-consult specialist code— Streamlined policy on billing for synchronous and asynchronous telehealth for all modalities

Effective July 1, 2019; however, since DHCS is performing system testing, the final Provider Manual section will be published in August 2019

— Providers should hold telehealth claims until the system is updated and the policy is published on the Medi-Cal website

APL 19-009: Telehealth Services Policy: available online via direct link

Coalition staff are aggregating questions for DHCS. Please send Provider Manual questions to Trey at trey@cchpca.org

CCHP Provider Manual Crosswalk

CCHP Provider Manual Crosswalk

CCHP Provider Manual Crosswalk

CCHP Provider Manual Crosswalk

CCHP Provider Manual Crosswalk

CCHP Provider Manual Crosswalk

Legislation Committee Update

Updates from August 6 meeting:

Advocacy-support discussion

Legislation update— Reviewed legislative developments and discussed fall briefings

Recap from Education Committee discussion on September briefing

September meeting agenda items— Discuss policy slate for 2020, items for November convening

Legislation Committee- State Updates

Bill Status Leg. Comm. Recommendations/Next Steps

A.B. 744 (payment parity) Sen. Approps. 8/12: placed on suspense

Letter of support submitted to Senate Health

A.B. 848 (Medi-Cal coverage of glucose monitors)

Sen. Approps. 6/24: placed on suspense Watch List

A.B. 1264 (prescribing via telehealth) Sen. Floor 7/9: Read second time, ordered to third reading Watch List

A.B. 1494 (Medi-Cal telehealth reimbursement in emergencies)

Sen. Approps. 8/12: placed on suspense Watch List

A.B. 1519 (dentistry prof. resp., conduct, standard of practice apply to telehealth)

Sen. Approps. 8/12: placed on suspense Watch List

A.B. 1642 (DHCS approval, EQRO review of alternative access plans inc. telehealth; consideration in capitation)

Sen. Approps. 8/13: Placed on suspense Watch List

S.B. 24 (college abortion access and telehealth startup funding)

Asm. Approps. 8/14: Placed on suspense Watch List

Bill updates:

Federal Updates

CMS publishes proposed Physician Fee Schedule for 2020. The proposed PFS for 2020 includes bundled payments for opioids, which can include telehealth encounters for individual and group psychotherapy part of MAT. It also contains the interprofessional consultation codes for e-consults that were introduced in the PFS this year. View the CCHP Fact Sheet here.

Medicare pilot to give providers access to patient claims data using Blue Button. CMS has a pilot program underway to leverage HL7’s Fast Healthcare Interoperability Resources (FHIR) standard to enable clinicians to access claims data directly within their workflow. This new Data at the Point of Care pilot is intended to help better connect clinicians to their patients’ healthcare information via the FHIR API. Read more here.

Education Committee Updates

Updates from August 5 meeting:

Updates on fall briefing

Educational materials— Staff will work with Education Committee to rework and create new educational materials in

advance of fall briefing

Webpage Update

September meeting agenda items— Further develop outreach strategy for legislature, executive, administrative agencies— Discuss agenda for November convening— Further plan fall briefing

November Coalition Meeting in Sacramento – RSVP forthcoming November 4: Member Reception

— 4-6pm— Chevy’s, 1369 Garden Highway, Sacramento

November 5: Convening— 9am-4pm— Sierra Health Foundation, 1321 Garden Highway, Sacramento— Agenda to be shaped by Education Committee, September to October

Interested in shaping the format, content, and outcomes of the in-person meeting?

— Send ideas to Coalition staff— Join the Education Committee’s monthly calls

Discussion of fall briefing – to be updated

Dates: September 26

Topics:

Telehealth 101: An Introduction to Telehealth— Learn about what telehealth is, and isn’t, and what the different modalities are

Telehealth Across the Lifespan — Understand how telehealth can be used to meet the needs of specific populations, including

pregnant women, children, older adults, among others

Opportunities to Expand Telehealth in California — Identify areas for expanded coverage of modalities, new access points for utilizing telehealth

with Californians

Timeline of Activities

Activity Date(s)

September Coalition-Wide, Committee Meetings September 20, 2019

Ongoing Coalition Meetings September through December 2019

Telehealth Coalition Legislative Briefing September 26, 2019

Pre-Meeting Member Reception November 4, 2019

In-Person Meeting to Review 2019 and Plan for 2020 November 5, 2019

News and Announcements

J.D. Power to Publish First-Ever Telehealth Satisfaction Study in November 2019. The study will measure direct-to-consumer, payer-owned and health system-owned telehealth provider types, tracking awareness and selection; enrollment; consultation; billing and payment; and customer serviceRead more here.

Focus on digital health for the 'worried well' may be exacerbating the digital divide. Sarah Lisker at Tech Crunch examines health technology tools and the lack of tools target to the needs of low-income populations. "If we’re designing health apps for those who already have access to healthcare, nutritious food, clean air to breathe, and stable housing, we’re missing the point." Read more here.

Connecticut empowers DSS to expand Medicaid coverage of telehealth services. On June 28, 2019, Connecticut Governor Ned Lamont signed into law Public Act No. 19-76 “An Act Expanding Medicaid Coverage of Telehealth Services” (PA 19-76). PA 19-76 revises the criteria and process by which the Connecticut Department of Social Services (DSS) determines the telehealth services covered by the Medicaid program. PA 19-76 is effective July 1, 2019. Find the law here.

Appendix

Bill No. Title Details Recent Updates, Notes

A.B. 156(Voepel)

Eye care: remote assessment

• Would prohibit use of virtual eye exams unless certain prescribed requirements are met

Two year bill

A.B. 385(Calderon)

Medi-Cal: EPSDT mental health services

• Requires DHCS to create quality performance measurement system for mental health services within CHIP ESPDT

• Requires DHCS to convene stakeholder group

Held in Assembly Appropriations

A.B. 537(Wood)

Medi-Cal Managed Care: QI and value based incentive program

• Requires DHCS to establish quality assessment and performance improvement program and value-based to ensure Medi-Cal MCPs achieve minimum performance level

Held in Assembly Appropriations

A.B. 744(Aguiar-Curry)

Health care coverage: telehealth

• Requires payment parity for telehealth services for all DOI and DMHC regulated products (including Medi-Cal Managed Care)

• Amends definition of asynchronous telehealth to S-A-F• Prohibits annual and lifetime limits on telehealth• Prohibits separate telehealth cost-sharing requirements not imposed

on non-telehealth benefits• Removes Medi-Cal requirement that individuals be able to request in-

person consult w/ distant site provider for teleoph., teledentistry, telederm.

Senate Approps. Suspense

A.B. 848(Gray)

Medi-Cal: covered benefits: continuous glucose monitors

• Would require Medi-Cal cover continuous glucose monitors and related supplies

Senate Approps. Suspense

Telehealth-Related Bills

Bill No. Title Details Recent Updates, Notes

A.B. 1494 (Aguiar- Curry)

Medi-Cal: telehealth: state of emergency

• Requires DHCS to reimburse FQHCs, RHCs and public hospitals for covered services provided via telehealth following declaration of state of emergency, regardless of whether patient is physically located at clinic, or whether existing provider-patient relationship exists

Senate Approps. Suspense

A.B. 1642 (Wood)

Medi-Cal: managed care plans

• Requires MMC plans to provide DHCS with justification for requesting alternative access standards; must arrange for non-emergency medical transportation if alternative access standards are approved

• Requires actuarial rate methodology to include beneficiary access to Medi-Cal covered services, including travel times to receive services, and the ability of a Medi-Cal MCP to comply with the time and distance req’ts w/o seeking authorization to adopt alternative access standards

• Authorizes DHCS to impose fines of up to $100K if plan fails to provide medically necessary services that the contractor is required to provide to an enrollee covered under the contract

Senate Approps. Suspense

A.B. 1676 (Maienschein)

Health care: mental health

• Requires DOI and DMHC regulated products to establish telehealth consultation programs to diagnose and treat child and postpartum mental illness

• Requires communication 2x per year to enrollees regarding programs• Requires plans to keep utilization records

Held in Assembly Appropriations

Telehealth-Related Bills

Bill No. Title Details Recent Updates, Notes

A.B. 1689 (McCarty)

College Mental Health Services Program

• Establishes grant program for community college, UC, CSU mental health programs

• Requires submission of program evaluation to the state regarding state-funded mental health programs

• Opportunity to promote use of telehealth to increase access to college mental health services

Held in Assembly Appropriations

S.B. 12 (Beall)

Mental health services: youth

• Would create Integrated Youth Mental Health Programs with sites across the state based on headspace model using MHSA dollars

• Headspace model on which this is based includes telehealth

Sent to Assembly Appropriations

S.B. 24 (Leyva)

Public health: public university student health centers: abortion by medication techniques

• Requires health clinics on UC and CSU campuses to offer medication abortions onsite

• Established College Student Health Center Sexual and Reproductive Health Preparation Fund to provide private monies to public university health centers for medication abortion readiness

• Grants each campus $200K for readiness assessments, including determining costs associated w/ using telehealth to provide abortions

• Grants each campus $200K for direct and indirect costs that can be used to establish a corporate account to provide telehealth services

Sen. Approps. 8.14: Placed on suspense file

S.B. 66(Atkins and McGuire)

Medi-Cal: FQHCs and RHCs

• Would allow for max. of 2 visits per day to FQHC or RHC under PPS rate if second visit is for mental health or dental visit

• Opportunity to advocate for visits to be via telehealth, and not just in-person

Sent to Assembly Appropriations

Telehealth-Related Bills

Bill No. Title Details Recent Updates, Notes

S.B. 612 (Pan)

Health care data reporting

• Requires DOI and DMHC regulated products and medical groups to report to OSHPD on services and supports that are geographically located close to enrollees, or that are offered nontraditional settings, such as telehealth

Held in Senate Appropriations

Telehealth-Related Bills