2024 Telehealth Studies

Background

The Maryland Health Care Commission (MHCC) is required by Chapter 382 (Senate Bill 534), Preserve Telehealth Access Act of 2023 and Chapter 291 (House Bill 1148), Behavioral Health Care - Treatment and Access (Behavioral Health Model for Maryland) of the 2023 Laws of Maryland to conduct two studies and make recommendations regarding the delivery of somatic and behavioral health services through audio-visual and audio-only telehealth technologies, including payment parity for the delivery of health care services through audio-visual and audio-only technologies. Findings will inform the debate on payment parity and support health policy goals. Final reports are due to the General Assembly by December 1, 2024.

The impetus for these studies are based on recommendations included in MHCC’s final report (December 2022) required by Chapter 70 (House Bill 123) and Chapter 71 (Senate Bill 3) Preserve Telehealth Access Act of 2021 of the 2021 Laws of Maryland. The law tasked MHCC with conducting a study on the impact of telehealth as it relates to use of audio-only and audio-visual technologies in somatic and behavioral health interventions. The study was informed by an MHCC-convened Telehealth Policy Workgroup (workgroup) in 2020 that discussed telehealth policy changes implemented in response to the COVID-19 public health emergency; the workgroup generally concluded there was a need to study quality and cost of telehealth by examining trends in access and utilization of audio-only and audio-visual technologies (see final report, February 2021).

About the Studies

The MHCC issued two Request for Proposals in October 2023 (Study 1) and November 2023 (Study 2) to obtain a contractor with subject matter expertise in telehealth and actuarial science methods to assess the adequacy of payer reimbursements, among other things. In December 2023, Milliman, Inc. was competitively selected to complete the studies by conducting an analysis using private payer, Medicaid, and Medicare data from MHCC’s All Payer Claims Database (APCD).

Study 1 will develop a Health Payment Adequacy Assessment Framework (Framework) to benchmark reimbursements by private payers and Maryland Medicaid to the Medicare Physician Fee Schedule (MPFS). An analysis of claims data from the APCD will examine payment levels for somatic and behavioral health care services delivered via telehealth and in person.

Study 2 will determine if it is more or less costly for health care providers to deliver health care services through telehealth, and whether the delivery of health care services through telehealth requires more or less clinical time and clinical intensity on the part of the health care provider. An analysis of provider costs and level of work using claims data from the APCD will estimate the percent of the in-person rate that should be reimbursed for services delivered via telehealth.

Findings will inform development of potential statutory, regulatory, or policy-based recommendations.

Updates

September 10, 2024

Milliman drafted two technical reports based on findings from its analysis using private payer, Medicaid, and Medicare data from the APCD.  The technical reports informed drafting of telehealth coverage and reimbursement recommendations.  Stakeholder viewpoints and telehealth policy changes adopted by the Centers for Medicare & Medicaid Services were considered in preparing draft recommendations and supporting rationale in a final report that will provide guidance 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. 

May 10, 2024

Milliman completed an analysis of evaluation and management (E/M) codes to identify the distribution of services provided (2019-2023).  E/M codes for behavioral health and primary care were identified as the foundation for a framework to compare reimbursement rates as a percent of the Medicare Physician Fee Schedule.  An examination of providers time and intensity to deliver care virtually and in-person is underway.   

March 5, 2024

Milliman scoped out draft parameters for the methodology that will guide development of a framework for assessing payment parity. A provider roundtable was convened virtually on February 27, 2024 to solicit informal feedback on the proposed methodology and a preliminary list of codes for primary care and behavioral health outpatient services to be used in the analysis.  The list of participants is available here; a recording of the discussion is available here.