COVID-19 has limited the ability of healthcare providers to offer in-person care to their patients. With medical facilities at risk of being overwhelmed and citizens encouraged to stay home, timely access to medical care may be harder than ever to achieve.
In light of this, governmental and healthcare authorities and systems are increasingly backing virtual care (telehealth) as one of the safest, most efficient ways to provide care during such times, as it allows patients and providers to connect without face-to-face visits. Virtual care is not a distinct service, but a way that providers deliver health care to their patients that approximates in-person care. The standard of care is the same whether the patient is seen in-person or virtually.
Actions resulting from these acknowledgments above, however, were already underway in 2019, a landmark year for telehealth legislation in California, including the passage of AB 744, which requires payment parity for telehealth and AB 1264, which allows a prior examination to be conducted over telehealth.
In California, the Department of Health Care Services (DHCS) considers telehealth a cost-effective alternative to health care provided in-person, particularly to underserved areas. Effective on July 1, 2019, DHCS’s revision of the Medi-Cal telehealth policy increased flexibility for providers to use telehealth as a medical platform to deliver necessary medical services to patients. DHCS’s updated policies include allowing Medi-Cal providers the flexibility to decide clinically appropriate medical services or benefits for telehealth and no limitations on beginning or distant sites. DHCS’s coverage and reimbursement policies for telehealth align with the California Telehealth Advancement Act of 2011 and federal regulations.
State law defines telehealth as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.” Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” This definition applies to all health care providers in California, not just Medi-Cal providers.
With the first emergency Covid-19 authorization, Congress lifted provisions that limited telemedicine services to rural areas, allowing the use of telemedicine services for all beneficiaries of fee-for-service Medicare. The Center for Medicare and Medicaid Services expand the use of telehealth by using the Center for Medicare and Medicaid Innovation (CMMI). The CMMI have experimented with and tested new payment options and care delivery models for patients and their influence on the quality and cost of healthcare. To enhance the technology infrastructure available to clinicians to support these visits, the Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) has announced that it is using its enforcement discretion and will not impose penalties for using HIPAA-noncompliant private communications technologies to provide telehealth services during this public health emergency (Covid-19 and Health Care’s Digital Revolution, NEJM).
Medi-Cal also complies with federal regulations for telehealth, which are the same for Medicaid as they are for Medicare. According to the COVID-19 Medi-Cal Services and Telehealth Notice, Medi-Cal providers may utilize existing telehealth policies as an alternative modality for delivering Medi-Cal covered health care services when medically appropriate, as a means to limit patients’ exposure to others who may be infected with COVID-19, and to increase physician capacity.
Because virtual care has a vast scope, policy makers have taken various approaches when governing the industry including regulating:
- Patient and physician settings: the patient’s location, or the “originating site,” and/or the location of the provider offering care or consultation, or the “distant site;”
- Allowable provider types (e.g., psychiatrists);
- Eligible technology and services (e.g., videoconferencing or remote monitoring);
- Distance or geography standards (e.g., requiring a patient to live in a rural setting to receive services via telemedicine);
- Requirements that another certified individual, or telepresenter, be present with a patient during a telemedicine visit; and
- State licensure requirements that require providers to be licensed in the state which they are delivering telemedicine services.
Each year, new federal and state legislation is introduced to address some of the barriers to telehealth use. On the state level, California continues to make adjustments to existing and new policies in order to mitigate the COVID-19 crisis (California Telehealth Policy Coalition).