Public Health Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING THE FACILITATION OF TELEHEALTH.
Joint Favorable Substitute
SPONSORS OF BILL:
Public Health Committee
REASONS FOR BILL:
This bill sets standards for telehealth. It applies to telehealth provided by several categories of state-licensed providers. The bill allows them to provide telehealth services only under certain conditions the Provider:
1. Is communicating through (a) face-to-face, real-time interaction or (b) store and forward technologies (such as recording patient data with a camera for later review);
2. Has access to or knowledge of the patient's medical history or medical record;
3. Conforms to the otherwise applicable standard of care (except diagnostic testing and physical examinations may be done through appropriate peripheral devices); and
4. At the first telehealth interaction with a patient, obtains the patient's consent to provide telehealth services, after informing the patient of telehealth's limitations.
The bill requires health insurance policies to cover medical services provided through telehealth to the same extent they cover services through in-person visits. Insurers can exclude coverage if telehealth is not appropriate for the service provided.
The bill also prohibits a provider, when providing telehealth services, from (1) prescribing schedule I, II or III controlled substances or (2) charging a facility fee.
RESPONSE FROM ADMINISTRATION/AGENCY:
Julia Starr, Executive Director, Connecticut's Legislative Commission on Aging: The bill will help establish safe guards and standards regarding the practice of telehealth. If Connecticut were to establish health insurance coverage for telemedicine, it would join at least 21 states and Washington D.C., which have already enacted telehealth parity laws. Telehealth will provide a new model for the delivery of adequate healthcare services.
Victoria Veltri, Office of the Healthcare Advocate: As society integrates the digital environment into daily life, telemedicine represents a logical extension of this trend. Telemedicine has been integrated into healthcare treatment for well over a decade, especially for chronic disease management. A pilot study linking homebound patients to report monitoring systems resulted in a reduction of hospitalizations by 54%, with substantially better patient outcomes and cost savings.
NATURE AND SOURCES OF SUPPORT:
Mag Morelli, President, LeadingAge Connecticut: Telemedicine will play a crucial role in the future of aging services. While this is promising, we retain reservations and remain cautious about implementations. We feel that standards must be put into place for all providers through state statue and regulation.
James Leahy, Executive Director, Connecticut Physical Therapy Association: Access to this service delivery system will allow for care that can be critically important to a patient's long term health. There is a tremendous amount of pressure on the US health system and telemedicine can help alleviate some of that pressure.
Edmund Tierney: The goals of telemedicine are to give increased patient access, reducing costs, improving health outcomes and patient satisfaction. 47 state Medicaid programs cover services via telemedicine.
Connecticut Hospital Association: CHA applauds the goal of these bills, but seeks to have clarifications made to avoid the potential unintended effect of reducing the current necessary services and technologies now used in a variety of care settings. Providers use these interactive audio, visual, and data communications technologies to expand their ability to provide rapid consultation with specialists when surgery, urgent care, or emergencies require instant communication, and to supplement coverage for radiology interpretations. Often there are no other options and the delivery of care depends on use of these technologies, particularly during emergency situations. Unfortunately, the text of the bills is broadly written and sweeps in vital healthcare services accidentally, potentially creating patient quality and safety problems. With serious gaps in ambulatory community care in Connecticut adversely affecting racial and ethnic minorities and the poor, all strategies and tools should be developed to their fullest to improve care. To avoid these unintended consequences, CHA respectfully requests that the following concepts be included in any telemedicine bill's language to clarify that the bill is not intended to apply to settings outside of non-urgent, physician office care.
● Telemedicine laws should not interfere with, or negate, the provision of services as set forth in section 20-9(d) of the Connecticut General Statutes, particularly those services that are routinely provided by indirect care providers who rarely, if ever, have direct patient contact (e.g., lab, imaging).
● Telemedicine rules for connectivity, privacy, and security should be consistent with HIPAA Security Rules and other federal rules for health information technology.
● Telemedicine must not reduce the ability to improve access to care for the underserved or ethnic minority populations.
Community Health Center, Inc.: With over 250 locations through the state, we have been an early adopter of telemedicine. Telemedicine is moving the delivery model creatively in many states and I worry that Connecticut is lagging because of the limitations currently placed on providers. As we seek to remove barriers to health care through the appropriate use of technology, we need to be careful not to introduce new barriers by limiting telemedicine to just one group of health care providers, such as physicians. Passing bills to define facilitate and establish standards for telemedicine in Connecticut, will make it possible to increase research and positive results in this area. We encourage you to adopt these bills.
Paul Taheri, Yale Medical Group: Telemedicine is a promising innovation in healthcare delivery and with a proven ability to improve access to and reduce the cost of care while maintaining quality. According to a recent survey among physicians at Yale University, the single greatest obstacle to adoption of this promising innovation is the lack of reimbursement.
Morgan Villano, Connecticut Occupational Therapy Association: Telemedicine is an opportunity to provide medically necessary services in the event that a patient and provider are physically in different locations. There is wide international support for telemedicine.
Mary Jane Williams, Connecticut Nurses Association: Supports telemedicine, but with the development of standards of practice at the state level. The Association would recommend that an “advisory committee” be created to deal with the issue of establishing standards utilizing the resources and research.
LouAnn Perugini, DermAestheticsCT: Described personal experience providing military medical assistance through web based electronics.
Laima Karosas, CTAPRNS: They ask the law be amended to include providing coverage by APRNs for telemedicine services for APRN patients. They also agree that telemedicine can provide valuable care to the patient for timely delivery of clinical health care services.
Yale New Haven Health: Telemedicine is often the gateway to establishing a relationship with a primary care provider. Telemedicine benefits include reduced wait times and cost efficiency.
NATURE AND SOURCES OF OPPOSITION:
Connecticut Association of Health Plans: Health insurance carriers support the concept of telemedicine or telehealth which can be employed in a variety of ways including:
● Virtual visits: medical evaluations psych assistance, or clinical peer to peer consultation.
● Case or care management under medical home delivery models.
● Adjuncts to home care service:electronic or telephonic monitoring for blood sugar, weight etc.
● Teleradiology: expert consolation in interpreting radiology reports
Health plans are exploring some or all of the various initiatives outlined above and are bringing technology and social media to bear on behalf of their members. Carriers are looking to be innovators in the field to telemedicine, but fear passage of overly restricted legislation that may impede their ability to expand access to quality, effective health care in a way that's affordable and convenient for consumers.
In addition, health plans are still navigating the practical considerations of telehealth such as assuring that services are delivered as indicated, that confidentiality of treatment is provided in accordance with the appropriate national and state standards and that outcomes actually prove beneficial. It's important that legislation not compromise these quality assurance efforts which unfortunately could be the unintended result if some of the proposal before you move forward.
Ross Benthien, MD, Connecticut Orthopaedic Society: There are identified problems with telemedicine including venue, licensure, standard of care and info red consent. The current bill lacks clarification, details and criteria for the practice of telemedicine. There must also be a way to ensure privacy and confidentiality through the technological component of medicine.
Jennifer Herz, Connecticut Business & Industry Association: there are concerns with the cost and quality of healthcare. The Association is concerned about setting prices and other barrier when telemedicine services are still developing may hinder progress in this field.
Reported by: Zani Imetovski