Health Information Technology  Telehealth  

Overview

Telehealth is the use of medical information shared through two-way audio and video and other forms of telecommunication technology, including mobile communication devices and remote monitoring devices, with the goal of improving a patient’s health status[1] [2]. The definition of telehealth is more expansive than that of telemedicine. Telehealth refers to the broader scope of health care services and includes non-clinical services, such as provider training, case management support, administrative meetings and continuing medical education[3]. The term telehealth is used to synchronize the wide range of definitions that exist to describe this form of care delivery and encompasses telemedicine[4]. Widespread adoption of telehealth can increase access to health care, reduce health disparities, and create efficiencies in health care delivery. However, before its full potential can be realized, a number of technology and policy challenges need to be resolved[5]

For more information, please visit the American Telemedicine Association: About Telemedicine? page.

Telehealth Implementation: Challenges and Considerations

There are several challenges impacting telehealth initiatives in the State. Challenges include ensuring physician licensing for practitioners providing services over state lines, credentialing for telehealth services, and adequate liability and malpractice coverage when providing telehealth services. In addition, limited information on return on investment for providing telehealth services make the financial decision to provide telehealth services difficult. Limited broadband access, and lack of defined standards for maintaining health care data confidentiality and integrity when providing telehealth services poses technology challenges for organizations. Current organizational processes are set up to support face-to-face encounters, and implementation of telehealth services would require organizations to shift how they operate and deliver care. For more information, visit the Challenges and Considerations page.  

Telemedicine Task Force Overview

In 2010, the Maryland Health Quality and Cost Council (Council) created the Telemedicine Task Force (Task Force) to develop a plan for a comprehensive statewide telemedicine system of care. The Task Force submitted a report to the Council in September 2010. A Leadership Committee was subsequently established in 2010 and was tasked with developing recommendations to advance telemedicine in Maryland. The Leadership Committee established three advisory groups: Clinical; Finance and Business Model; and Technology Solutions and Standards. In December 2011, the Leadership Committee submitted a report to the Council with recommendations for the implementation of telemedicine in Maryland[6].

In 2013, the General Assembly enacted legislation requiring the Maryland Health Care Commission (MHCC), in conjunction with the Council, to reconvene the Task Force, including the three advisory groups. The Task Force used the term telehealth instead of telemedicine to encompass the non-clinical practices such as public health, education, and care coordination[7]. The Task Force was required to identify opportunities for using telehealth to improve health status and care delivery in the State, assess factors related to telehealth, and identify strategies for telehealth deployment in rural areas[8]. The Task Force developed recommendations for expanding telehealth adoption in the State and submitted an interim report in December 2013, and a final report in December 2014 to the Governor, the Senate Finance Committee, and the House Health and Government Operations Committee. For more information visit the Telemedicine Task Force page.

MHCC Telehealth Grants

The MHCC has awarded 14 telehealth grants to qualified organizations to implement innovative projects in the State that assess the effectiveness of telehealth in various care settings. Collectively, a total of $675,042 in grants has been awarded. Highlights from the grants are included below by month and year in which awarded:

October 2013 - Three grants awarded for a 12-month period assessed the use of telehealth to improve transitions of care between hospitals and long-term care (LTC) facilities. The Brief and Final Reports published in April of 2016 provide a summary of the findings from the telehealth projects.

June  2015 – Three grants were awarded for an 18-month period to demonstrate the impact of using remote patient monitoring devices to support chronic care management of high risk children, adults, and elderly patients. The Brief and Final Reports published in March of 2017 provide a summary of the findings from the projects. 

November 2015 – Three grants were awarded for an 18-month period to assess the effectiveness of telehealth with various technology, patients, providers and clinical protocols in a variety of settings to improve the patient experience and overall health of patients with chronic conditions living in underserved rural and minority communities.

June 2016 – Two grants were awarded for an 18-month period to support value-based care delivery in primary care settings through expanding access to health services and addressing the needs of different patient populations.

Findings from the November 2015 and June 2016 grants were published in March 2018 in the Advancing Population Health and Primary Care Transformation via Telehealth:  A compilation of 2015 & 2016 Telehealth Grant Final Reports.

January 2017 - One grant was awarded for an 18-month period to demonstrate the impact of increasing access to health care and improving population health in rural communities of the eastern shore through enhanced palliative and behavioral health care services.

April 2018 - One grant was awarded for an 18-month period to advance medication management and reconciliation within a multi-disciplinary care team through accurate medication reconciliation by levering the use of telehealth with the State-Designated Health Information Exchange (HIE).  The awardee, the University of Maryland Quality Care Network (UMQCN) plans to improve access to medication reconciliation by a pharmacist for patients with chronic obstructive pulmonary disorder (COPD) in rural Maryland.  

May 2018 - One grant was awarded for an 18-month period to increase access to medication-assisted treatment (MAT) to underserved Maryland residents with opioid dependence through telehealth interventions in an integrated care delivery approach.  The grant, awarded to Mosaic Community Services, Inc. (Mosaic), plans to connect a Baltimore area prescriber to a new addiction treatment in a jurisdiction that is currently lacking capacity, establish telehealth capabilities and protocols for MAT in Montgomery County, and allow Mosaic prescribers to enable MAT via telehealth.

For more information on MHCC telehealth grants, visit the Telehealth Grants page.

Telehealth Lunch and Learn Series

The Teleheath Lunch and Learn Series is a virtual educational webinar featuring telehealth adopters and experts in the field.  The sessions provide peer-to-peer learning opportunities regarding the selection, adoption, and use of telehealth.  Targeted audience typically includes primary care practices, hospital administrators, compliance officers, local health department staff and others considering or involved in telehealth deployments.

Session 1:  Health Care Consumer Engagement and Awareness Building in Telehealth (September 2017) 

    Agenda and Slides

Session 2:  Navigating Telehealth Compliance and Reimbursement (February 2018)

    Agenda and Slides

    Recording

Session 3:  Remote Patient Monitoring:  Medicaid New Rules & Pediatric Asthma Project (May 2018)

               Slides

               Recording

Session 4:  Enhancing Patient Involvement in Telehealth:  Readiness, Engagement, and Adherence

    Slides

    Recording

Telehealth Symposium 

The Telehealth Symposium: Remote Monitoring and Chronic Care Management of High Risk Patients was held on February 22, 2016 at Anne Arundel Medical Center. The Symposium showcased the work of the Round 2 grantees that include: Crisfield Clinic, LLC; Lorien Health Systems; and Union Hospital of Cecil County. The Symposium also featured guest speakers with expertise in telehealth for remote patient monitoring, including Lois Freeman, Doctor of Nursing Practice of the Veterans Affairs Maryland Health Care System and Gary Capistrant, Chief Policy Officer of the American Telehealth Association.

For presentation materials from the Symposium as well as more information on previous Symposiums, visit the Telehealth Symposium page.

Telehealth Resources

MHCC Resources

Organizations and Initiatives

Reimbursement

Medicare

Medicare pays for a limited number of Part B services furnished by physicians or practitioners to eligible beneficiaries in rural/shortage areas via telehealth.  Rural areas are defined by the Health Resources & Services Administration (HRSA); providers can search for rural/shortage areas (called Health Professional Shortage Areas or HPSAs) by individual addresses using the  Medicare Telehealth Payment Eligibility Analyzer.  Maryland has a limited number of HPSAs.  Additionally, any county that is not part of a Metropolitan Statistical Area is considered a non-Metro county and is completely eligible for Telehealth payments for authorized originating sites. The non-metro counties in Maryland are Caroline, Dorchester, Garrett, Kent and Talbot.  The Metro counties may contain an eligible area, but only if the Rural Census Tract is also part of a geographic HPSA.  Medicare reimburses for certain services provided via telehealth.  These services or codes are identified in the Physician Fee Schedule.  A list of covered telehealth services or codes can be found on the CMS website.  CMS recently decided to eliminate the required use of the GT modifier in favor of the new place of service (POS) code 02 in most circumstances for use by the physician or practitioner furnishing telehealth services from a distant site. More information about the POS code is available within the CMS policy document.  Summary information regarding Medicare coverage of telehealth services is also available in the Medicare Telehealth Services Fact Sheet

Maryland Medicaid

In order to bill Maryland Medicaid for services provided via telehealth, the provider must register.  Registration is available on Maryland Medicaid's Telehealth Program website.   Limitations exist on the types of providers that are eligible, which is detailed in the Telehealth Provider Manual.  Maryland Medicaid also covers remote patient monitoring in certain circumstances.   More information is available on the Maryland Department of Health's Remote Patient Monitoring webpage.

Private Payors

Private Payors are required to cover telehealth services that otherwise are covered via face-to-face.  The law is Maryland Insurance Code §15-139.  It is best to reach out to the individual payor to determine their policy around telehealth reimbursement and billing procedures.  CareFirst's policies is available by searching their Medical Policies on their page.

Contact Information

For more information, contact Angela Evatt by phone 410-764-3574 or email at angela.evatt@maryland.gov.


 
 
 1. Maryland Telemedicine Task Force Final Report, October 2014 
 2. American Telemedicine Association. About Telemedicine? 2012.  
 3. HealthIT.gov. What is telehealth? How is telehealth different from telemedicine?
 4. Maryland Telemedicine Task Force Final Report, October 2014
 5. Information Technology and Innovation Foundation, Unlocking the Potential of Physician-to-Patient Telehealth Services, May 2014
 6. Telemedicine Recommendations, December 2011 
 7. Maryland Telemedicine Task Force Final Report, October 2014 
 8. 2013 Md Laws, Chap. 319   

Last Updated: 10/16/2018