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State Telehealth Laws & Reimbursement Policies

The Center for Connected Health Policy, the National Telehealth Policy Resource Center, has released its latest biannual update on state telehealth laws, regulations, and policies, with a primary focus on Medicaid fee-for-service programs. However, managed care/private payer laws are also covered when available.

Telehealth policy trends are briefly summarized from a national perspective, followed by detailed state profiles. Each state profile on telehealth reimbursement includes:

  • Key state agencies/organizations
  • State policy overview
  • Definitions
  • Live video, store-and-forward, and remote patient monitoring
  • Eligible providers, sites, geographic limits, facility/transmission fees, services/specialties
  • Consent
  • Professional regulation/health and safety, including cross-state licensing and online prescribing

States vary considerably on telehealth policies. Overall, the report noted live video Medicaid reimbursement is far more prevalent than reimbursement for store-and-forward and remote patient monitoring. Other trends noted for some states are specific documentation and/or privacy and security guidelines; the addition of home and schools as eligible originating sites; and the inclusion of teledentristy and substance abuse services as qualifying specialties.

State telehealth laws & reimbursement policies; a comprehensive scan of the 50 states & the District of Columbia. Center for Connected Health Policy, Spring 2019. https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Health Innovations State Law Database

The Health Innovations State Law Database created by the National Conference on State Legislatures is  a resource for identifying over 800 recently enacted state laws and regulations that address health policy innovations related to access, Medicaid, private and commercial insurance markets, the Accountable Care Act and social determinants of health.. The database supports searching by keyword, state, legislative status, bill number, sponsor, and/or these topics:

  • Exchanges and Health Marketplaces
  • Free Market; Challenges and Alternatives
  • Market-Cost Containment
  • Market-Coverage
  • Market-Delivery Reform [includes accountable care]
  • Market-Health Insurance Reforms
  • Market-Mandates and Essential Health Benefits
  • Market-Network Adequacy
  • Market-Other
  • Market-Payment Reforms
  • Market-Price Transparency
  • Medicaid Expansion and Waivers
  • Medicaid Payment Reform
  • Medicaid-General
  • PPACA – ACA-Health Reforms
  • State-Run Programs
  • Telehealth Programs

However, the full-text of the legislation located is restricted to NCLS members.

Source: Health innovations state law database: tracking state laws for health care transformation, 2015-2016. National Conference of State Legislatures, accessed Jan. 27, 2017. http://www.ncsl.org/research/health/health-innovations-database.aspx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Summary of Major Health Care Reform Proposals & Other ACA Repeal/Replace Resources

The Kaiser Family Foundation has published a summary outline of HHS Secretary nominee Tom Price’s health plan.  It’s planning comprehensive summaries of other major health reform proposals soon for comparison, with an overview of House Speaker Paul Ryan’s plan scheduled next. The summaries will be updated as changes occur in proposal.

The Foundation has also created a web site compiling other background resources related to the proposed repeal and replacement of the Affordable Care Act: http://kff.org/tag/aca-repeal/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org 

 

Medicaid and CHIP Data: Findings from a 50-State Survey

The Kaiser Family Foundation has just released its 15th annual 50-state survey on Medicaid and the Children’s Health Insurance Program [CHIP].

The report provides and discusses state data on eligibility, enrollment, renewal and cost-sharing policies and identifies changes over the past year. It also documents the key health coverage role the Medicaid and CHIP programs play for low-income families.

As health coverage policy direction gets debated, this report will provide helpful background information.

Source: Brooks T and others. Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies as of January 2017; findings from a 50-state survey. Kaiser Family Foundation, Jan. 2017. http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-as-of-Jan-2017

Related:

Rosenbaum S and others. Medicaid’s future: what might ACA repeal mean? Commonwealth Fund Issue Brief, Jan. 2017. http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal

State health facts: Medicaid and CHIP. Kaiser Family Foundation, accessed Jan. 12, 2017 at http://kff.org/state-category/medicaid-chip/

State Medicaid fact sheets. Kaiser Family Foundation, Jan. 26, 2017. http://kff.org/interactive/medicaid-state-fact-sheets/?utm_campaign=KFF-2017-January-Medicaid-State-Fact-Sheets

Blumberg LJ and others. Implications of partial repeal of the ACA through reconciliation. Urban Institute, Dec. 2016. http://www.urban.org/sites/default/files/publication/86236/2001013-the-implications-of-partial-repeal-of-the-aca-through-reconciliation_0.pdf

Cunningham P and others. Understanding Medicaid hospital payments and the impact of recent policy changes. Kaiser Commission on Medicaid and the Uninsured Issue Brief, June 2016. http://files.kff.org/attachment/issue-brief-understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes

Guy J and others. Repeal of the ACA Medicaid expansion: critical questions for states. State Health Reform Assistance Network, Robert Wood Johnson Foundation Issue Brief, Dec. 2016. http://statenetwork.org/wp-content/uploads/2016/12/State-Network-Manatt-Repeal-of-the-ACA-Medicaid-Expansion-Critical-Questions-for-States-December-2016.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OBAMACARE: President Barack Obama and others report on health reform progress and future

If you are working up a presentation on the current and near term future of the health care system in the United States, take a look at this great source material.

President Barack Obama, writing a special communication in the first person, summarizes the effect of the first years of his landmark health reform legislation, the Affordable Care Act, popularly known as Obamacare.  Issued online July 11, the communication will also be published more formally in JAMA, the Journal of the American Medical Association, an influential journal intended for medical professionals but widely read in policy and academic circles as well.

The president opens by describing what it was like when he took office – the challenges of working through the Great Recession.  He discusses progress, noting that there has been a decline in the rate of insured Americans – from 16 percent in 2010 to 9.1 percent in 2015 – a 43 percent decrease.  He reviews how the health care delivery system has been changed, with movement toward alternative payment models.  Mr. Obama closes not only by expressing his sense of pride in the accomplishments to date but also by indicating how to build on progress and take the next steps.

WAIT, WAIT, there’s more!  This July 11 “online first” communication also includes related editorials by other eminent individuals.  Look below for more specifics on these sources.

Sources:

Obama, B. (2016, July 11). United States health care reform: Progress to date and next steps. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533698

Bauchner, H. [editor in chief, JAMA] (2016, July 11). The Affordable Care Act and the future of US health care. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533694

Orszag, P.R. [Lazard] (2016, July 11). US health care reform: Cost containment and improvement in quality. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533695

Butler, S.M. [Brookings] (2016, July 11). The future of the Affordable Care Act: Reassessment and revision. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533696

Skinner, J. [Dartmouth], and Chandra, A. [Harvard] (2016, July 11). The past and future of the Affordable Care Act. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533697

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

ACA: Surgeons assess the impact of the Affordable Care Act

The American College of Surgeons asked members of its Board of Governors to report on the effect of the Affordable Care Act on their surgical practice.  The following findings are based on responses from 208 U.S. surgeons.

  • There are more people who have health insurance
  • There are more people who have Medicaid coverage
  • There is a slight increase in surgical caseload
  • However, more patients are delaying elective surgery
  • And the surgeons report that patients are first coming for care at a later stage of disease

Source: Puls, M.W. (2016, May). 2015 ACS Governors Survey: Surgeons describe the ACA’s effects on access to care. Bulletin of the American College of Surgeons, 101(5), 19-24.  Click here: http://bulletin.facs.org/2016/05/2015-acs-governors-survey-surgeons-describe-the-acas-effects-on-access-to-care/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Accountable Care Organizations in 2016: Private and Public-Sector Growth and Dispersion

There were 838 active accountable care organizations as of January 2016, and they have service areas in every state. That’s all according to a new analysis by Levitt Partners  and the Accountable Care Learning Collaborative. The count of ACOs has grown from 64 in early 2011, and has increased 12.6% just over the past year. The number of accountable care contracts is now at 1,217, and an estimated 28.3 million people are covered by an accountable care arrangement.

The report also charts:

  • ACOs over time
  • ACOs by state
  • ACOs by hospital referral region
  • ACO lives over time
  • ACO lives per payer type
  • ACO penetration by state
  • ACO penetration by hospital referral region

ACO contract renewals and dropouts, policy drivers, ACO challenges, and the future of accountable care are all discussed briefly.

Source: Muhlestein D; McClellan M. Accountable care organizations in 2016: private and public-sector growth and dispersion. Health Affairs Blog, April 21, 2016. http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/

Posted by AHA Resource Center (312) 422-2050 rc@aha.org