A Timeline of Events

2010:  Creation of the Telemedicine Task Force

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.^[1]

2011:  Task Force Recommendations

The Task Force identified several areas for improvement to promote effective telemedicine delivery in the State.  In order to address these areas, the telemedicine taskforce made several recommendations:  (1) State-regulated payors should provide reimbursement for health care services delivered through telemedicine to the same extent as health care services provided face-to-face, regardless of the location for which the services are provided; (2) Establish a centralized telemedicine network built on existing industry standards and is integrated into the state-designated health information exchange to enable broad provider participation, allow networks to connect to other networks, and have access to clinical information through the exchange; (3) Implement changes in alignment with the Centers for Medicare and Medicaid Services (CMS) in licensure, credentialing, and privileging of providers to permit privileging and credentialing by proxy, a process in which the originating hospital may rely on decisions from a distant-site telemedicine entity, to facilitate the adoption of telemedicine. 

The full report detailing these recommendations can be found here:

Telemedicine Recommendations:  A report prepared for the Maryland Quality and Cost Council (December 2011)

2012 - 2013:  Telemedicine Laws

The recommendations resulted in two laws:

Senate Bill 781, Health Insurance - Coverage for Services Delivered through Telemedicine, was passed by the General Assembly during the 2012 legislative session and signed into law May 2012. The law requires, among other things, certain insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for health care services delivered through telemedicine^[2].

Senate Bill 798, Hospitals – Credentialing and Privileging Process – Telemedicine, was passed by General Assembly during the 2013 legislative session and signed into law May 2013. The law allows a hospital to rely on the credentialing and privileging decisions made of the physician by a distant-site hospital^[3].

2013 - 2014:  Task Force Activities

Senate Bill 776, Telemedicine Task Force – Maryland Health Care Commission (MHCC), signed into law on May 2, 2013, required MHCC in conjunction with the Council to reconvene the Task Force.  The law identified several categories for study by the Task Force including:  identify opportunities to use telehealth to improve health status and care delivery in the State; assess factors related to telehealth, including but not limited to supportive uses of electronic health records and health information exchange; and identify strategies for telehealth deployment in rural areas of the State to increase access to care and any increased demand for health care services due to implementation of the Patient Protection and Affordable Care Act. 

Priorities

The categories were assigned to the three advisory groups of the Task Force (Clinical; Finance and Business Model; and Technology Solutions and Standards).  The advisory groups included broad representation of individuals with clinical, financial, and technical backgrounds.  The MHCC invited stakeholders to participate in the advisory groups and also encouraged public participation.

Reports

The Task Force began meeting in July 2013. In December 2013, MHCC released an interim report detailing the progress of the Task Force. In general, the report highlighted the efforts of the Task Force to identify and define telehealth use cases and develop a registry of telemedicine providers and their technology capabilities.

In October 2014, MHCC released a final report detailing the Task Force recommendations for expanding use of telehealth in the State.  The report includes 10 telehealth use cases intended to have an impact on vulnerable populations; be consistent with health care reform; and be implementable, testable, and cost-effective.  The Clinical Advisory Group developed the use cases; the Finance and Business Model Advisory Group identified potential financial and business challenges with implementing the use cases; and the Technology and Solution Standards Advisory Group assessed telehealth technology needed to support the use cases and identified a lack of available information about telehealth services as a barrier to telehealth adoption in the State. The 10 use cases include:

1. Improve transitions of care between acute and post-acute settings through telehealth
2. Use telehealth to manage hospital Prevention Quality Indicators
3. Incorporate telehealth in hospital innovative care delivery models through ambulatory practice shared savings programs
4. Require value-based reimbursement models to factor in reimbursement for telehealth
5. Use telemedicine in hospital emergency departments and during transport of critically ill patients to aid in preparation for receipt of patient
6. Incorporate telehealth in public health screening and monitoring with the exchange of electronic health information
7. Deploy telehealth in schools for applications including asthma management, diabetes, childhood obesity, behavioral health, and smoking cessation
8. Use telehealth for routine and high-risk pregnancies
9. Deploy telehealth services widely at community sites, connected to health care professionals and/or the statewide health information exchange
10. Use telehealth for remote mentoring, monitoring and proctoring of health care practitioners through telehealth for the expansion, dispersion and maintenance of skills, supervision, and education

Contact Information

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