Health Information Technology  Telehealth  

Overview

Telehealth is the use of two-way audio and video and other forms of telecommunication technology, including mobile communication devices and remote monitoring devices, to share medical information with the goal of improving a patient’s health status. The definition of telehealth is broader in scope than that of telemedicine and encompasses both clinical and non-clinical services, such as provider training, case management support, administrative meetings and continuing medical education. The term telehealth is used to synchronize the wide range of definitions that exist to describe this form of care delivery. 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.

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 may 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.  

MHCC Telehealth Grants

The MHCC has awarded 16 telehealth grants to qualified organizations to implement innovative projects in the State that assess the effectiveness of telehealth in various care settings. Highlights from the grants (telehealth grants summary table) are included below by month and year in which awarded:

January 2019 - Charles County Public Schools was awarded for an 18-month period to increase access to special education services via teletherapy by expanding access to qualified service providers to assist students in meeting their goals in accordance with their Individual Education Program (IEP) determinations. 

May 2018 -  Mosaic Community Services, Inc. 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. 

April 2018 – University of Maryland Quality Care Network was awarded for an 18-month period to improve medication management and reconciliation by leveraging the use of telehealth with the State-Designated Health Information Exchange (HIE). 

January 2017 – University of Maryland Shore Regional Health was awarded for an 18-month period to demonstrate the impact of enhanced palliative and behavioral health care services on improving population health in rural communities of the Eastern Shore.  

December 2016 - Johns Hopkins Pediatrics at Home was awarded for an 18-month period to demonstrate the impact of mobile heatlh on patient engagement and heatlh outcomes for pediatric patients with asthma.

June 2016 – MedPeds, LLC and Gilchrist Greater Living were awarded for an 18-month period to support value-based care delivery in primary care settings through expanded access to health services and addressing the needs of different patient populations.

November 2015 – Associated Black Charities, Gerald Family Care, and Union Hospital of Cecil County were awarded for an 18-month period to assess telehealth effectiveness in improving the patient experience and overall health of patients with chronic conditions living in underserved rural and minority communities.

June 2015 – Crisfield Clinic, Lorien Health Systems, and Union Hospital of Cecil County 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.

October 2014 – Atlantic General Hospital Corporation, Dimensions Healthcare System, and University of Maryland Upper Chesapeake Health were awarded for a 12-month period to assess the use of telehealth to improve transitions of care between hospitals and long-term care (LTC) facilities

The Telehealth Briefs and Final Reports highlight the lessons learned and implementation considerations from the grantees awarded in October 2014, June 2015, November 2015, and June 2016. 

Advancing Population Health and Primary Care Transformation via Telehealth:  A Compilation of 2015 & 2016 Telehealth Grant Final Reports

Remote Patient Monitoring Telehealth Grants:  Brief and Final Reports

Long Term Care and Hospital Telehealth Project Grants:  Brief and Final Reports 

Telehealth Lunch and Learn Series

Virtual educational webinars were conducted that featured telehealth adopters and experts in the field.  The sessions provided peer-to-peer learning opportunities regarding the selection, adoption, and use of telehealth.  The audience included 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

School-Based Telehealth Workgroup

During the 2018 legislative session, the Senate Finance Committee (Committee) requested MHCC to convene a workgroup to identify deficiencies in existing policies related to school-based telehealth programs and develop an approach for improving these policies, which may be statutory, regulatory or technical in nature. The Committee required MHCC to report on the workgroup’s findings and provide legislative and regulatory recommendations, including associated budget estimates for programs the State should undertake to improve the delivery of school-based telehealth services. An interim report was submitted to the Committee in January 2019 and a final report is due in November 2019. For more information on the Workgroup’s activities, visit the School-Based Telehealth Workgroup page.

Telehealth Readiness Assessment Tool

As a result of lessons learned from telehealth demonstration projects and discussions with telehealth leaders in the State, a need was identified for an assessment tool to help practices understand barriers, facilitators, patient and environmental factors associated with telehealth readiness. The TRA tool can be used by small physician practices to assist with determining their readiness for implementing or scaling up telehealth.

Reimbursement

Medicare

Medicare reimburses for a limited number of Part B services furnished by physicians or practitioners to eligible beneficiaries in rural/shortage areas via telehealth. Eligible beneficiaries must be located in a Health Professional Shortage Areas or a county outside of a Metropolitan Statistical Area defined by the Health Resources & Services Administration (HRSA). Providers can search the individual addresses of the originating site using Medicare Telehealth Payment Eligibility Analyzer to determine eligibility for reimbursement. The services or codes that are eligible for reimbursement are identified in the Physician Fee Schedule and a list of covered telehealth services or codes can be found on the Centers for Medicare and Medicaid Services (CMS) website. There are certain exceptions to the geographic conditions for the following: for the treatment of substance use disorders; for the diagnosis, evaluation, or treatment of an acute stroke; and for hospital-based and Critical Access Hospital-based renal dialysis centers, renal dialysis facilities, and beneficiary homes when practitioners provide monthly home dialysis end stage renal disease (ESRD) related medical evaluations. CMS recently decided to eliminate the required use of the Health Care Common Procedure Coding System (HCPCS)-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

Maryland Medicaid will reimburse for services in the same manner as in-person visits on a fee-for-service basis. Services are still subject to the same restrictions, limitations, and utilization review that exist for the service when provided in-person. In order to bill Maryland Medicaid for services provided via telehealth, the provider must register as a telehealth provider 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 additionally covers remote patient monitoring in certain circumstances. More information is available on the Maryland Department of Health's Remote Patient Monitoring webpage.

Private Payors

Maryland Insurance Code §15-139 requires private payors to cover telehealth services in the same manner as in-person services. Reimbursement cannot be denied based solely on services being delivered via telehealth and not in-person. Payors are permitted to impose utilization review, such as preauthorizaiton, as long as they are the same requirements as for in-person services. Providers should also use the appropriate POS-02, Current Procedural Terminology (CPT)-95, or HCPCS-GT modifiers to indicate the location where the services that were implemented was through telehealth

Telehealth Resources

MHCC Resources

Organizations and Initiatives

Contact Information

For more information, contact Christine Karayinopulos by phone 410-764-3444 or email at christine.karayinopulos@maryland.gov.


Last Updated: 5/16/2019