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WASHINGTON – Monday, September 8, 2014 - The American Telemedicine Association (ATA) today released two critical state policy reports which identify gaps in coverage and reimbursement, and in physician practice standards and licensure. These first-of-their-kind reports identify and compare state policies on a report card, assigning each state grades ranging from A-to-F based on telemedicine reimbursement and physician practice standards. ATA has captured the complex policy landscape of 50 states with differing telemedicine policies, and translated the data into an easy-to-use format. “We hope these reports serve a dual purpose: to showcase the states that are doing an excellent job when it comes to telemedicine, and to serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state,” said Jonathan Linkous, CEO of ATA. “We hope that states will respond by streamlining policies to improve medical practice rules, licensure, healthcare quality, and reduce costs through accelerated telemedicine adoption.” 50 State Telemedicine Gaps Analysis – Coverage & Reimbursement The first report reviewed and compared telemedicine coverage and
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Over 200 counties have had some portion of their county lose eligibility for the Federal Communication Commission's Rural Health Care (RHC) Program definition of "rural area" has not changed, but the designation of rural census tracts was routinely updated based on the 2010 census and other new data. 

For information about these changes, please see http://www.usac.org/rhc/tools/news/default.aspx#1072

The Eligible Rural Areas Search website is at http://www.usac.org/rhc/telecommunications/tools/Rural/search/search.asp.

The next webinar about the RHC program will be September 18 (register at https://attendee.gotowebinar.com/register/1150473249088342529).









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During today's webcast, This Month in Telemedicine, I used PowerPoint slides to compare the incremental Medicare provisions of major telehealth bills pending in Congress.  The slides were based on a one-pager you can get at

http://www.americantelemed.org/docs/default-source/policy/menu-of-short-term-options-for-medicare-telehealth-improvements.pdf?sfvrsn=4.

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Less than One Week to Save on Fall Forum Registration:

 The early-bird deadline to register for the ATA Fall Forum (Sept. 6-9, Palm Desert, Calif.) is this Friday, August 8! We invite you to register today at the member, early-bird rate and join your colleagues for two full days of program related to telehealth in chronic care, a half-day forum focused on telemedicine opportunities in China, and golf and tennis outings at the magnificent JW Marriott Desert Springs Resort and Spa.  In addition, several round table discussions will cover hot-topic areas and a state-of-the-art trade show will feature the leading technologies for chronic care management. Register and find more info at www.ATAFallForum.org

 ATA Applauds Bill on Medicare Telemedicine Improvement:

 Last week, Reps. Mike Thompson (D-CA), Gregg Harper (R-MS), and Peter Welch (D-VT) introduced H.R. 5380, the Medicare Telehealth Parity Act of 2014, which improves telemedicine coverage in Medicare. H.R. 5380 creates a phased approach over four years to expand coverage of telemedicine-provided services and remove arbitrary barriers that limit access to services for Medicare beneficiaries. Included in these provisions are the gradual removal of geographic restrictions to patient care, and the addition of coverage for healthcare services that take place in other locations such as the home and walk-in retail health clinics. Read more here:

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Less than Two Weeks to Save on Fall Forum Registration:

 The early-bird deadline to register for the ATA Fall Forum (Sept. 6-9, Palm Desert, Calif.) is next Friday, August 8! We invite you to register today at the member, early-bird rate and join your colleagues for two full days of program related to telehealth in chronic care, a half-day forum focused on telemedicine opportunities in China, and golf and tennis outings at the magnificent JW Marriott Desert Springs Resort and Spa.  In addition, several roundtable discussions will cover hot-topic areas including:

-  Internal Awareness and Adoption

-  Telehealth and Network Deployment

-  Business Models and Sustainability

-  State Policy

-  Surgical Telementoring

-   and a Telemedicine Service Provider Forum

More info at www.ATAFallForum.org

 
Online, Direct to Consumer Patient Consultations Becoming Mainstream:

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Join us tomorrow from 2 - 3 p.m. EDT as ATA CEO Jonathan Linkous and Senior Policy Director Gary Capistrant cover breaking telemedicine policy and industry developments during a live webcast of This Month in Telemedicine. Post your questions in the comments field below and tune in for the answers live tomorrow! 

Access the webcast here
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There are now 120 Members of Congress on one or both of the 2 pending bipartisan bills to expand the "one state license" to other Federal interstate telehealth.  With these bills a health care professional would need only one state license to serve patients anywhere who are covered a specific federal health program.

Please urge your Representative to join the list of sponsors below.


The bills are--
  • H.R. 2001 for the Department of Veterans Affairs with the VETS Act (Veterans E-Health & Telemedicine Support Act) introduced by Charles Rangel (D) and Glenn Thompson (R) with a total of 69 sponsors
  • H.R. 3077 for Medicare with the TELE-MED Act (TELEmedicine for MEDicare Act) introduced by Devin Nunes (R) and Frank Pallone (D) with a total 64 sponsors
There are no Senate companion bills at this time -- so there is an opening for your Senators.

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Would you be interested in writing a 5-page printed book chapter (no more than 10-manuscript pages) about your work with technology in behavioral or mental health? 

As a team of three editors, Marlene Maheu, Ph.D., Kenneth Drude, Ph.D., and Shawna Wright, Ph.D., we have contracted with the second largest mental health publisher worldwide to edit our book. It is to be a "field guide" that is intended to inspire our colleagues to who earn a living in whole or in part with technology. We're asking you to show us how you managed to move from a graduate behavioral degree to your distinguished work with technology. Our ultimate goal then, is to publish a field guide for evidence-based employment using technology in behavioral and mental health care.

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In the proposed Medicare rulemaking for 2015, the Centers for Medicare and Medicaid Services (CMS) approved requests by the American Telemedicine Association to expand healthcare services that are eligible for reimbursement.  These include telehealth services, remote testing and, for the first time, non-face-to-face chronic care services.  They are proposed to go into effect January 1, 2015.

The 609-page notice of proposed rulemaking is available at http://www.ofr.gov/OFRUpload/OFRData/2014-15948_PI.pdf.  Pages 139-150 are for telehealth services and 170-185 for chronic care management.  This notice will be published in the Federal Register of July 11 and open for comment on or before September 2.

Services to be covered when provided by telehealth

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See the New York Times article about the recent "model act" in support of telemedicine advanced by the Federation of State Medical Boards (FSMB).

See : http://www.nytimes.com/2014/06/30/us/medical-boards-draft-plan-to-ease-path-to-out-of-state-and-online-treatment.html?ref=health&_r=2

-------------------------------------------
Marlene Maheu
Executive Director
TeleMental Health Institute, Inc.
www.telehealth,org
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Telehealth parity legislation in NY has received some last minute support by its state law makers.  S07852 - formerly S04337b - has been amended and passed through the Senate and Assembly with unanimous biparitsan support.  The bill would still require private insurers and Medicaid to cover and reimburse for health care services delivered via telehealth.  Additionally, the bill also includes coverage of services provided via store-and-forward and remote patient monitoring, as well as services provided in the home.  The amended version of the bill has been returned to the Senate for consideration of further amendments or passage.  If the Assembly and Senate can agree on the final language of the bill, it will be sent the Governor.
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The U.S. Food and Drug Administration issued a draft guidance "Medical Device Data Systems, Medical Image Storage Devices, and Medical Image Communications Devices" available at http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm401785.htm.

This draft guidance document proposes that the Agency does not intend to enforce compliance with the regulatory controls that apply to medical device data systems (MDDS), medical image storage devices, and medical image communications devices, due to the low risk they pose to patients and the importance they play in advancing digital health.  This draft would supersede FDA's February 15, 2011 regulation down-classifying MDDS to Class I (low-risk).

A period for public comment will be open until at least August 25 (the actual period will be for 60 days after the draft guidance is published in the Federal Register.)

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I was wondering if anyone was doing in home tele-mental health and if they might have a consent to treat form for this. I have a few autistic kids that I treat and they get really agitated when they have to come in for an appointment. The families have requested that we do in home services. any input would be welcome
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The Ohio Depart of Medicaid has issued revised rules concerning the coverage of telemedicine-provided services. The agency received a high level of feed back from stakeholders since the rules were originally released in February and has issued an explanation of its proposed changes:
  • using the term "telemedicine" versus "telehealth" or "telemedical",
  • expands the mileage restriction to a 5 mile radius and removes the undue hardship exception,
  • recognizes an FQHC look-like as an eligible originating site,
  • clarifies that providers must comply with existing laws which restricts the use of telemedicine by physicians and psychiatrists to prescribe dangerous drugs, and
  • clarifies that the distant site provider must me an MD, DO, or licensed psychologist if services are rendered from an FQHC.
In February the OH governor signed a law requiring the State's Medicaid agency to establish rules regarding the coverage and reimbursement for telemedicine-provided services. The agency expects the telemedicine regulation to go into effect
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Colleagues, 
As a reminder, we will be hosting our very first tele-Neurology Ad hoc Discussion Session.  

The purpose of this group is to formulate a Tele-Neurology group to discuss our cumulative experiences with the current state of practice of tele-Neurology.  This will be held at the upcoming ATA meeting.  If you are interested in attending, please let me know in response to this post (and how many will be attending) and I will give you specifics, and will be in communication regarding the charter, etc.   

Nima Mowzoon, MD
Telespecialists, LLC
ceo@tele-specialists.com
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ATA Submits Comments on TN Proposed Telemedicine Rulemaking

ATA submitted public comments urging the TN Medical Board to adopt regulatory standards that would hold providers using telemedicine to the same standard as those practicing in office settings.  A few weeks ago ATA reported that the Tennessee Board of Medical Examiners issued a notice of rulemaking hearing (0880-02) which proposed telemedicine practice guidelines that would drastically reduce access to care.  The Board's proposal is timely, considering that the state recently enacted a telehealth parity law for private insurance, Medicaid and state employee plans.  Despite the forward thinking action by the legislature, the Board's proposal would create additional barriers and more stringent standards for all physicians practicing telemedicine in Tennessee, including the requirement for an in-person visit prior to using telemedicine. A
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Colleagues, 
As a reminder, we will be hosting our very first tele-Neurology Discussion Group.  

The purpose of this group is to formulate a Tele-Neurology group to discuss our cumulative experiences with the current state of practice of tele-Neurology and eventually help write up a basic standards and guidelines for practice of Tele-Neurology.  This will be held at the upcoming ATA meeting.  If you are interested in attending, please let me know in response to this post (and how many will be attending) and I will give you specifics, and will be in communication regarding the charter, etc.   

Nima Mowzoon, MD
Telespecialists, LLC
ceo@tele-specialists.com
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The House Energy and Commerce Subcommittee on Health seeks input on how 21st century technology can improve health care and help patients.  The full Subcommittee announcement is at http://energycommerce.house.gov/press-release/health-subcommittee-explores-how-21st-century-technology-can-improve-health-care-and.


Chairman Joe Pitts (R-PA) commented, “We will be looking for specific policy and legislative ideas on how the federal government can support technology adoption in our health care programs for the express and explicit purpose of reducing costs and increasing the overall quality and efficiency of the programs. We are also looking for ways in which the federal government currently inhibits the use or adoption of such technologies by all players in the health care system – be they insurer, provider, or patient. The more specific and targeted the policy, the greater chance it will hold for Congressional support down the line.”

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The National Institutes of Health seeks perspectives and comments on scientific opportunities, critical needs and optimal configurations for conducting research in the area of unobtrusive in-home monitoring for the aging population and individuals with chronic disabilities.  Comments can include but are not limited to:
1. The most important questions and challenges over the next 5-10 years regarding technology to facilitate independent aging.

2. Programs, investments, and/or grant mechanisms that NIH ought to consider in order to foster clinical and epidemiologic research in the use of in-home monitoring devices, including tele-health, to assist the elderly and individuals with chronic disabilities to remain at home.
3. Recommendations for programs, infrastructure or investments to best address the important questions in this field focused on research questions.

4. Optimal configurations for allowing innovation and autonomy of private companies to interact with academic research to provide information for improving health care and reducing transitions in care to facilities.

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Colleagues, 
As a reminder, we will be hosting our very first tele-Neurology Discussion Group.  

The purpose of this group is to formulate a Tele-Neurology SIG to discuss our cumulative experiences with the current state of practice of tele-Neurology and help write up a basic standards and guidelines for practice of Tele-Neurology.  This will be held at the upcoming ATA meeting.  If you are interested in attending, please let me know in response to this post (and how many will be attending) and I will give you specifics, and will be in communication regarding the charter, etc.   

Nima Mowzoon, MD
Telespecialists, LLC
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