Telehealth Study

The Maryland Health Care Commission (MHCC) is required by Chapter 70 (House Bill 123) and Chapter 71 (Senate Bill 3) of the 2021 Laws of Maryland, Preserve Telehealth Access Act of 2021 to study the impact of telehealth as it relates to use of audio-only and audio-visual technologies in somatic and behavioral health interventions. The MHCC, in consultation with select State agencies, must submit recommendations on telehealth coverage and payment levels relative to in-person care to the Senate Finance Committee and the House Health and Government Operations Committee by December 1, 2022.  

The legislation follows an MHCC convened Telehealth Policy Workgroup (workgroup) in the fall of 2020. The workgroup consisted of about 70 diverse stakeholders that discussed changes in telehealth policies implemented in response to the COVID-19 public health emergency. The workgroup suggested that MHCC study the quality and cost of telehealth and its impact on access to care, alignment with new models of care, and consumer and provider satisfaction. See report for more information.  

About the Study

The MHCC issued an Emergency Request for Proposals in June 2021 to obtain a contractor with subject matter expertise in telehealth and new models of integrated care, and proficiency in conducting quantitative and qualitative research. In September 2021, the National Opinion Research Center (NORC) at the University of Chicago was competitively selected to complete study activities. Study goals include: 

	Conduct quantitative and qualitative research on telehealth that considers both audio-only and audio-visual technologies relative to in-person care for somatic and behavioral health interventions in accordance with specified study components in law; and
	Develop a Final Recommendations Report and Technical Report. The Final Recommendations Report will be based in evidence from study findings and cross-referenced to the appropriate section(s) of the Technical Report. The Technical Report will include evidence and supporting rationale for all findings and conclusions.

A high-level, one-page summary of the recommendations and supporting rationale is available here. 

For more information on NORC study activities, click here.

Updates

If you would like to receive notice when updates are posted to this web page, please subscribe by contacting mhcc.telehealth@maryland.gov. 

January 5, 2023 

The Commission approved the telehealth study recommendations report with one change at the Commission meeting on December 15, 2022.  The report was submitted to the Senate Finance Committee and House Health and Government Operations Committee.  The recommendations are based on study findings, stakeholder feedback, and lessons learned from the COVID-19 public health emergency and are intended to provide a framework for how to approach future telehealth legislation.  The MHCC appreciates the many stakeholders that contributed to the study. 

An interstate telehealth study has commenced to study the matters presented in House Bill 670, which was withdrawn during the 2022 legislative session.  Recommendations for expanding interstate telehealth are due to the Health and Government Operations Committee by December 1, 2023.  Click here for more information about the interstate telehealth study. 

October 13, 2022 

The MHCC and Maryland Insurance Administration have prepared draft recommendations that take into consideration study findings, stakeholder feedback, and lessons learned from the public health emergency.  The draft recommendations and supporting rationale are being incorporated into a final report that will provide direction to the Maryland General Assembly on how to approach future legislation.  More information on the final report will be made available in the coming weeks.

August 24, 2022

NORC is drafting a Technical Report on the impact of telehealth based on findings from the study.  The findings are being used to inform development of preliminary, informal draft recommendations due to the Senate Finance Committee and the House Health and Government Operations Committee by December 1, 2022.  Additional interviews with select consumers are underway to supplement data collected as part of the study.  Informal draft recommendations will account for consumer perspectives and help identify future policy considerations.

August 8, 2022 

A summary and recording of the provider and payer telehealth town halls that were convened in July are now available.  The MHCC appreciates stakeholders' contributions to the discussion.  For stakeholders that would like to submit written comments, please email Christine Karayinopulos at christine.karayinopulos@maryland.gov by Friday August 19, 2022.

Provider recording

Payer recording 

Summary

June 30, 2022 

Study activities are advancing related to the literature review, claims analysis, provider survey, consumer interviews, and behavioral health focus groups.  The MHCC will virtually host two Telehealth Town Hall Meetings in July where participants can share their perspectives on the current telehealth landscape as it relates to use of audio-only and audio-visual technologies for somatic and behavioral health interventions.  The town halls will take place on the dates and times that follow:

Provider:  July 14, 2022; 1-2:30 pm - To register, click here

Payer:  July 20, 2022; 1-2:30 pm - To register, click here

For questions or additional information, please email christine.karayinopulos@maryland.gov

May 19, 2022 

An analysis is underway of over 1,000 responses to the provider survey and 78 consumer interviews.  The claims analysis continues to ascertain the number of audio-only and audio-visual services before and during the public health emergency.  A focus group with consumer advocates for consumers of behavioral health services took place on May 18th; a focus group with representatives from behavioral health provider organizations is planned for May 19th.  The two focus groups are intended to address the distinct needs of behavioral health providers and patients in Maryland.  NORC continues to monitor literature for updated federal policy and legislative directives for telehealth.

April 20, 2022 

About a week and a half remains for eligible providers to respond to the telehealth survey; the survey inquires about use of audio-only and audio-visual technologies in care delivery.  The survey can be completed at:  mdtelesurvey.norc.org.  For more information about the survey, click here.  Select telehealth interviews with Spanish-speaking consumers are underway.  Interviews with telehealth users and non-users are near complete; interviewees were identified based on key demographic characteristics, including age, sex, race and ethnicity, income, educational level, insurance coverage, and language spoken.  The claims analysis continues; private payers provided information on telehealth billing codes and modifiers for services delivered using audio-only and audio-visual technology.

April 1, 2022 

A claims analysis for government and private payers is underway.  Three interviews with subject matter experts in behavioral health are being scheduled to inform the structure and approach for the behavioral health focus groups.  Nearly 4,000 articles have been identified as part of a literature review examining the effectiveness of telehealth to deliver somatic and behavioral health care; data extraction is ongoing to guide development of six topic specific briefing papers.  The provider telehealth survey remains open to give providers an opportunity to report on their personal experiences and perceptions with telehealth, particularly as it relates to use of audio-only and audio-visual technologies.  Eligible providers are encouraged to complete the survey at:  mdtelesurvey.norc.org.  For more information about the survey, click here.

March 2, 2022

The provider telehealth survey is now open to all eligible health care providers, including primary care providers, specialty providers engaged in primary care, nurse practitioners, and behavioral health providers (psychiatrists, psychologists, licensed certified social workers, and licensed professional counselors).  Providers may access the survey using their National Provider Identifier (or NPI) at the following link: mdtelesurvey.norc.org.  For more information about the survey, click here.

February 22, 2022

Planning is underway to convene two behavioral health focus groups (consisting of 8-10 participants) and three structured interviews.  These study activities are responsive to recent stakeholder requests for MHCC to consider additional ways to collect qualitative data on use of audio-only and audio-visual technologies for the delivery of behavioral health services, including mental health and substance use disorder services.  Findings will supplement findings from other study activities (a provider survey, consumer interviews, a literature review, and claims analyses) to inform development of evidence-based recommendations for telehealth coverage and reimbursement relative to in-person care. 

January 21, 2022

Recruitment efforts to screen consumers for virtual interviews has so far yielded nearly 30 eligible telehealth and non-telehealth users.  Interviews are being scheduled and will explore consumers' experiences and perceptions regarding access to and use of audio-only and audio-video technologies; a goal of 80 interviews is targeted to be conducted by the end of March.  Provider organizations were contacted to help promote awareness of the provider survey anticipated to be released in February.  The literature review and applications requesting claims data are progressing.  NORC is preparing an analytical plan for conducting a statistical analysis of the data.

December 14, 2021

A systematic literature review is underway examining the effectiveness of telehealth in delivering physical and behavioral health care.  NORC’s request for commercial and Medicaid claims is under review by MHCC’s Data Release Committee.  The telehealth provider survey is being vetted with select provider types through January.  Consumer engagement protocols were established; recruitment of consumers to participate in virtual interviews is anticipated for January.  

November 18, 2021 

A draft telehealth provider survey is nearing completion and will be vetted with select health care providers in December.  Planning activities are underway to promote provider awareness of the survey in advance of its January release. NORC provided MHCC with the telehealth literature review protocol for developing topic specific briefing papers.  The literature review is targeted to begin by the end of November.

October 22, 2021

A kick-off meeting was held with the NORC project team to discuss the workplan and activities related to the provider survey, consumer engagement, and statistical analysis.  NORC is exploring some additional options for MHCC’s consideration as it relates to consumer engagement.  Next steps are to finalize the timeline and approach for distribution of the provider survey and the statistical analysis using claims data. 

October 5, 2021

Planning is underway with NORC to commence study activities.  NORC is preparing a final workplan to include each major step of the study with specific tasks, task milestones, responsible staff, and completion dates.  A study kick-off meeting with representatives from MHCC and NORC is planned for October 20th.  The purpose of the kick-off meeting is to discuss the study workplan, communication processes with MHCC and other stakeholders, and next steps for select study activities to be completed by the end of the year. 

Questions
Nikki Majewski
Chief, Health Information Technology
nicole.majewski@maryland.gov
410-764-3839