Tan Lines & Video Visits; The Summer of Telehealth Continues!
July 2020 Recap
Dear Colleagues,
Can you believe we're in August?! Amidst a fast paced and jam-packed summer of telehealth, we hope that you've been able to find a few moments of sunshine and relaxation recently, and that you all are staying cool in the "dog-days" of northeastern summer heat!

July continued the unprecedented pace & times for telehealth utilization in 2020, with a variety of new information and events happening throughout the entire month; As usual, this edition of NETRC"s Northeast Connections aims to help you keep track of it all. This newsletter is full of regional and national updates, including an overview of Federal guidance updates & announcements, information on NETRC & MATRC's collaborative #LaunchTelehealth2020 event & how to access recordings, upcoming regional and national telehealth events, the most recent publications and headlines, and more!

But before we dig into all of the fascinating materials, from the entire NETRC team, our continued first and most important message is this:
THANK YOU, to each & every one of you who continue to be out on the front lines AND behind the scenes, as part of our essential workforce! Your innovation and passion is sincerely appreciated during this PHE response!

Best wishes to all, & please don't hesitate to reach out with your telehealth questions or success stories. Thanks!

On Behalf of the NETRC Team Be well,
Reid Plimpton, MPH - Project Manager
Federal Policy and Guidance Updates
In Case You Missed It!
On Thursday, July 23rd, DHHS Secretary Alex Azar signed a renewal of the Federal Public Health Emergency Declaration (PHE) due to the COVID-19 Pandemic.

On Monday August 3rd, President Trump signed an Executive Order related to Rural Health and Telehealth Access

Subsequently, on Monday August 3rd, CMS Administrator Seema Verma released the proposed Calendar Year (CY) 2021 Physician Fee Schedule (PFS) for public comment period
Things to Consider and Key Takeaways
Federal Public Health Emergency Declaration (PHE) due to the COVID-19 Pandemic (click here)
With this extension, the current Federal Guidance and Waivers issued in March 2020 are to be active at least into October 2020.

Presidential Executive Order (click here)
The purpose of this order is to increase access to, improve the quality of, and improve the financial economics of rural healthcare, including by increasing access to high-quality care through telehealth. The executive order describes the following goals:
  • HHS will investigate and announce a new payment model to test An innovative payment model to enable rural health care transformation
  • The Department of Agriculture along with the Federal Communications Commission and other relevant governmental agencies will develop and implement a strategy to improve physical and communications infrastructure in rural America
  • A report to Congress on existing and upcoming policy initiatives
  • Direction to the Secretary of Health and Human Services to review current temporary measures put in place during the PHE and propose a regulation that would extend the telehealth services offered to Medicare beneficiaries and the services, reporting, staffing and supervision flexibilities offered to providers in rural areas beyond the duration of the PHE.
Centers for Medicare & Medicaid Services (CMS) Update- Proposed 2021 Physician Fee Schedule (PFS) Codes (for full code document, click here ; For fact sheet synposis, click here)
CMS has released the PFS Codes on an annual basis since they began paying for physician services in the early 1990's, typically following a timeline of: receiving and soliciting physician feedback, revising the current code schedule, releasing an update for public review and comment, and implementing the final codes on or before January 1st of each year.

This year, the PFS codes include a number of COVID-19 PHE Considerations, pursuant to the Presidential E.O. referenced above. With the 2021 PFS Codes, CMS took steps to extend availability of certain telemedicine services after the PHE ends, giving Medicare beneficiaries more convenient ways to access health care particularly in rural areas where access to health care providers may otherwise be limited. There are also new telehealth codes included; overall, there are at least 472 mentions of “telehealth”, 4 “telemedicine”, 271 “virtual” and 38 “telecommunication in the 2021 PFS codes.

The CY 2021 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on August 4, 2020 (link above). This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021. 
#LaunchTelehealth2020- Recap Below;
Register now & view all recordings FOR FREE!
We had an absolute blast designing and hosting our collaborative #LaunchTelehealth2020 Virtual Conference Series with our colleagues at the Mid-Atlantic TRC (MATRC) throughout June and July; to the 900+ attendees who joined us from over 15 states, thanks for participating, and we hope you had a great time as well!

If you missed it (we know there's lots going on), no worries! All Event Sessions were recorded, and are available on the platform "on-demand" now, for FREE! To access all event materials and recordings, visit our Virtual Event Platform at: https://eventmobi.com/launchtelehealth2020/
  • The first time you visit the Virtual Event Platform, you will need to log in with your email address.  
  • If your email address is already in the system, but you have never accessed to content before, you will be prompted to create a password. If you have previously created a password, you will be prompted to enter your password. If you cannot remember your password, click on the “forgot password” link.
  • If your email address is not in the system, please go to https://telehealth2020.swoogo.com/launchtelehealth2020/ and click on “Register Now”. Registration is simple and FREE and once you are registered, a button will appear to redirect you to the Virtual Event Platform!

With recordings and slides available from over 40 Plenary or Breakout Presentations, 15+ Industry Partner Interviews to listen too, and 20+ Telehealth Academic Posters available for viewing, this is a resource you'll want to have in your pocket; we hope you enjoy!

If you have any questions, contact Reid Plimpton at: rplimpton@mcdph.org
National Provider Perspectives
Survey Opportunity
On behalf of a NETRC colleague who has nearly completed their DNP pursuit, the NETRC is excited to share an opportunity for individuals across our region to share their thoughts and participate in a national survey of telehealth providers.

Dissertation Study Title: Telehealth Education: Impact on Provider Experience and Adoption

Background: The purpose of this study is to determine where and what kind of telehealth education practicing telehealth providers receive and whether there is a correlation between the type of telehealth education received and provider practice site, level of self-efficacy, perceived knowledge, use and satisfaction with telehealth.
Our Colleague is requesting that you complete an electronic research survey at the link below; The survey will take less than 15 minutes to complete.

Your participation is voluntary and the information reported is anonymous with no traceability of your answers. Computer information used to complete the survey will not be collected. Consent to participate is implied by completion of the survey and may be withdrawn at any time. Additionally, Please feel free to distribute with your colleagues.

Please access the anonymous survey at the following link: https://redcap.musc.edu/surveys/?s=7TPLRJM3KH

If you have any questions, please feel free to email the survey contact at kgarb002@odu.edu
HHS Telemedicine Hack

HHS Telemedicine Hack: A 10-week learning community to accelerate telemedicine implementation for ambulatory providers

When: Wednesdays, July 22-September 23, 2020; 12:00-1:00pm ET

Outline: Although telemedicine use has grown exponentially during the COVID-19 pandemic, many ambulatory providers still lack the knowledge and skills needed to implement video-based telemedicine into their practices.

To support wide adoption of telemedicine, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Preparedness and Response is partnering with the ECHO Institute at the University of New Mexico and the Public Health Foundation’s TRAIN Learning Network to deliver a 10-week, virtual peer-to-peer learning community called Telemedicine Hack.

Key Components of Telemedicine Hack
  • Five teleECHO sessions on key topics (e.g., workflows, documentation, reimbursement) highlighting best practices and case studies from the field
  • Five virtual “office hour” discussion panels with case presenters, government agencies, topical experts, and stakeholder associations responding to your questions
  • Inter-session peer-to-peer learning facilitated via virtual discussion boards and ad hoc interest groups
  • CME/CEU credits are available for attending, at no cost to participants

There is no cost to join the Telemedicine Hack initiative. All ambulatory providers (e.g., primary care, surgical, rural/urban, dental, mental health, solo practitioners, physical therapy, school-based practitioners) are invited to participate. Click here to learn more and register today!
Telehealth and COVID-19
Over the past few months, telehealth has continued to tranform in the blink of an eye, and on top of numerous changes in the policy and reimbursement worlds due to COVID-19, we've seen an impressive amount of adapting and innovative implementation from providers.

As referenced above, July brought a new Federal PHE, A Presidential Exeuctive Order pertaining to rural health & telehealth, and CMS's annual Public Comment Period for the new PFS code proposals. On top of the insights on those found in this newsletter, the TRCs have continued to stay on top of compiling information as soon it becomes available; NETRC provides updates to the COVID-19 webpage on our website at least weekly to highlight these materials and more. Be sure to check there frequently for the newest information and materials!

In an attempt to continue to provide our stakeholders with the most recent information, we've addded on to the federal guidance links available here in the past two newsletters with three recent Federal Agency Data Briefs pertaining to telehealth utilization.

Recent Federal Agency Data Reports and Issue Briefs
Centers for Medicare & Medicaid Services (CMS) Final Report to Congress entitled, “Reducing Barriers to Using Telehealth and Remote Patient Monitoring for Pediatric Populations under Medicaid” (Released 08/11/2020) Click Here

Agency for Healthcare Research and Quality (AHRQ): "Issue Brief: Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis" (Released 08/2020) Click Here

Office of the Assistant Secretary for Planning and Evaluation (ASPE): Issue Brief: Medicare Beneficiary Use of Telehealth Visits: Early Data From the Start of the COVID-19 Pandemic (Released 07/28/2020) Click Here

Federal COVID-19 Webites and Guidance Documents (updated as changes are made)
Office for Civil Rights (OCR) Guidance on HIPAA privacy and Novel Coronavirus. Original FAQ (Released 02/2020) Click Here; Recent Guidance available here

Drug Enforcement Administration (DEA) Telemedicine—COVID-19 information page- Click Here

Federation of State Medical Boards (FSMB) States waiving licensure requirements/renewals in response to COVID-19. As of August 5th, 2020 Click Here

Medicare Telemedicine Healthcare Provider Fact Sheet:. Click Here
Upcoming & Archived Webinars
Coming up Soon!
August 20th, 2:00PM- 3:00PM (Eastern)
NCTRC Webinar: Novice to Expert: A Guide to Comprehensive Patient Assessment Using Telehealth in the Home
Hosted by: South West Telehealth Resource Center (SWTRC)
Guest Speaker: Kimberly Shea RN, PhD, CHPN

Webinar Description:
Technology mediated home visits have an advantage of eliminating vulnerable patients’ exposure to health complications, but compromises the use of touch and vision to gain knowledge. Commonly when senses are compromised, tools are needed to enhance existing senses. A tool, such as a guide, can enhance tele-homecare providers’ abilities to assess and communicate with patients and their families.

Without a guide, the potential brevity of videoconferencing visits puts providers at risk for missing cues to potential problems. The purpose of this presentation is to examine Comprehensive Patient Assessment using Telehealth in the Home (CPATH) as a validated guide to prompt telehealth providers to ask to observe items in the home within key domains of concerns.
September 14-18, 2020
Xtelligent Healthcare Media's Connected Health Virtual Summit:
Delivering Quality Care in the COVID era

Xtellingent Media has planned a 4 day event series packed full of the insightful presentations you can expect from this national telehealth communication organization; transitioning their typical in-person summit to a virtual platform for this September!

Registration for healthcare providers is FREE for the entire event; Registration for Industry Partners has varying price points, click below to learn more and sign up today!
August 25th, 2020- 1pm-2pm EST
IPRO QIN-QIO Webinar Series, Telehealth Practice Innovations During the COVID-19 Pandemic:
Telehealth Then & Now – A Provider’s Perspective
Speaker: Terry Rabinowitz, MD, DDS
Professor of Psychiatry and Family Medicine, Larner College of Medicine
Medical Director, University of Vermont Medical Center at The University of Vermont 

And in case you missed it:
July 21st, 2:00pm- 3:00PM (Eastern)
National TRC Webinar Series:
Using Telehealth to Support Mental Health during COVID-19

Join the California Telehealth Policy Coalition for a webinar focused on how mental health providers have turned to telehealth during COVID-19.

Speakers will discuss how to successfully use telehealth for mental health visits, key operational and workflow considerations for other providers, and opportunities for policymakers to support mental health providers and their patients beyond COVID-19.

Moderator and speakers include:
• Mei Wa Kwong, JD, Executive Director, Center for Connected Health Policy
• Tonya Wood, Ed.S, President, California Psychological Association
• Denise Gordon, Psy.D, Department Chair, Behavioral Health, Borrego Health

Recent Telehealth News
How CMS changes, trump’s executive order affect telehealth coverage
mHealth Intelligence, August 6, 2020 Link
Alongside President Trump's call for more rural telehealth coverage, CMS' proposed 2021 Physician Fee Schedule could keep the momentum going for connected health. But is it enough?
Senators eye telehealth licensure freedom during COVID-19 emergency
mHealth Intelligence, August 5, 2020 Link
A bill introduced this week would allow healthcare providers in good standing to use telehealth to treat patients in any state during the coronavirus pandemic.
CMS proposes expanding telehealth reimbursement after COVID-19
mHealth Intelligence, August 4, 2020 Link
A recent Executive Order prompts CMS to make many of the telehealth flexibilities expanded during the coronavirus pandemic permanent.
Quarter of Medicare members can't access telehealth visits, JAMA studies show
Healthcare Dive. August 3, 2020 Link
A pair of studies recently published in JAMA Internal Medicine outline the many difficulties facing older adults, especially low-income seniors, in accessing telemedicine despite historic availability amid the COVID-19 pandemic.
Telehealth gives a pediatric physical therapist a new outlook on care
mHealth Intelligence, August 3, 2020 Link
This story profiles the successes of a physical therapist from Texas in launching a telehealth service to improve her work-life balance and care for her young patients. She finds that the platform can improve her work with their parents as well.
Patients to avoid in-person care access moving into the fall
mHealth Intelligence, July 29, 2020 Link
According to a new survey by OnePoll, most patients appreciated telehealth as a means to alleviate concerns about in-person care during the pandemic. 43 percent of patients say they likely won’t access in-person care until the fall at the earliest.
Epic Systems, Cerner exceeds EHR client expectations during COVID-19
EHR Intelligence, July 27, 2020 Link
KLAS surveyed over 170 healthcare professionals to gauge their respective EHR vendor satisfaction levels throughout COVID-19. Epic Systems and Cerner have both stepped up and exceeded expectations, with telehealth integration a feature health systems appreciate.
Avera to use telehealth to connect police, mental health professionals
mHealth Intelligence, July 31, 2020 Link
South Dakota-based Avera eCARE is using a $1 million donation to launch a telehealth program that connects police and court officers with mental health experts to help assess and treat people in crisis.
Connecticut lawmakers vote to extend telehealth coverage - for a while
mHealth Intelligence, July 30, 2020 Link
Lawmakers have passed a bill extending the state's emergency measures to expand telehealth coverage through next March, adding they want to study the issue further before addressing permanent coverage.
New HHS report makes the case for continued telehealth coverage
mHealth Intelligence, July 29, 2020 Link
A new report issued by the Health and Human Services Department tracks the effects of expanded Medicare telehealth coverage during the COVID-19 crisis and calls for more discussion on 'the future of patient-centered care.'
Student-based non-profit secures mhealth donations for seniors
mHealth Intelligence, July 29, 2020 Link
Founded by three Yale students and a high school sibling, Telehealth Access to Seniors has given more than 1,100 donated mHealth devices to healthcare providers to distribute to patients who lack access to telehealth services.
Telehealth made up almost half of all Medicare beneficiaries' primary care use in April
Healthcare Dive, July 29, 2020 Link
Fee-for-service Medicare beneficiaries adopted telehealth for primary care at unprecedented rates as COVID-19 spread in the U.S., according to a new HHS report. Providers in rural counties, compared to urban ones, saw a smaller increase in virtual care visits as a proportion of all primary care visits in March and April, and a larger decrease in May.
Massachusetts payer expands telehealth coverage for mental health services
mHealth Intelligence, July 28, 2020 Link
Blue Cross Blue Shield of Massachusetts has added telemental health services to its telehealth platform and expanded access to an online wellness program and will be maintaining reimbursement parity for telehealth visits.
'Weeks where decades happen': Telehealth 6 months into COVID-19
Healthcare Dive, July 27, 2020 Link
The nascent industry exploded out of necessity earlier this year, but its future staying power will depend on what insurers are willing to cover and what regulations stay rolled back. It's difficult to predict what the regulatory landscape will look like coming out of the pandemic, but experts say it's hard to see the U.S. going back to the previous potpourri of federal and state rules and regulations.
Expanding the mHealth platform to address more than just healthcare
mHealth Intelligence, July 24, 2020 Link
Pushed by the COVID-19 crisis, health plans like New York's Healthfirst are beefing up their telehealth and mHealth platforms to address a wide variety of member needs - including food.

FORE Grants Target Telehealth, mHealth Use in Addiction Treatment
mHealth Intelligence, July 24, 2020 Link
The Foundation for Opioid Response Efforts is funding four care providers and two research organizations to expand telehealth and mHealth programs and study how they've improved care during the COVID-19 crisis. Among them, New Jersey’s Rutgers University will focus its research on the impacts of emergency Medicaid waivers on healthcare affect via telehealth.
Congress aims to keep telehealth momentum going beyond the COVID-19 crisis
mHealth Intelligence, July 27, 2020 Link
A bill to add money to the FCC's COVID-19 Telehealth Fund - one of at least three new bills introduced - and a meeting of the Taskforce for Telehealth Policy made last week a busy week for connected health on Capitol Hill.
Providers scramble for telehealth, pick Microsoft, Zoom and doxy.me in pandemic's early days
Healthcare Dive, July 23, 2020 Link
Providers have overwhelmingly turned to virtual care and telehealth platforms during the COVID-19 pandemic to see patients, but most reported frantic efforts to adopt the technology with little time to consider a long-term strategy, according to a recent Klas Research study.
Consortium uses FCC COVID-19 funds to bring telehealth to the underserved
Healthcare IT News, July 20, 2020 Link
The Boston-based MA FQHC Telehealth Consortium was created for Federally Qualified Health Centers to come together to master telehealth so that their patients could access quality care despite the pandemic.
How Mass General Brigham planned its digital response to Covid-19
MedCity News, July 20, 2020 Link
Mass General Brigham Chief Innovation Officer Chris Coburn shares how the health system prepared itself for Covid-19 by scaling up its digital operations.
Leadership: Leveraging digital solutions to manage the COVID-19 crisis
Healthcare IT News, July 17, 2020 Link
The COVID-19 pandemic is forcing healthcare organizations to rethink communications with their patients and members, but forward-thinking leaders are already leveraging technology to address the increased workload to their workforce-management challenges.

Federal judge clears way for telemedicine abortions during pandemic
mHealth Intelligence, July 14, 2020 Link
A U.S. District Judge in Maryland has granted a preliminary injunction allowing care providers to prescribe drugs used in medication abortions via virtual care, eliminating the in-person requirement, during the COVID-19 emergency.
CMS outlines telehealth reimbursement for 2020-21 eCQM programs
mHealth Intelligence, July 13, 2020 Link
The Centers for Medicare & Medicaid Services has released additional details on telehealth reimbursement through quality reporting programs for ongoing alternative payment models. The documentation includes 42 Clinical Quality Measures for the 2020 performance period and 39 for 2021.
The promise and potential for telehealth in home health
mHealth Intelligence, July 10, 2020 Link
Despite reimbursement barriers, home health care providers have long used telehealth and mHealth tools to improve care. This overview asks if health system responses to the COVID-19 epidemic will spawn an expanded use of home telehealth and monitoring of patients at high risk for hospitalization.
VA, DoD launch national telehealth projects for critical care
mHealth Intelligence, July 09, 2020 Link
The US Defense Department’s Telemedicine & Advanced Technology Research Center and Medical Technology Enterprise Consortium recently launched Phase 1 of the National Emergency Telecritical Care Network Project, aimed at creating a network of virtual critical care wards to address the coronavirus pandemic. Partners include the Veterans Health Administration, Avera Health, the Oregon Health and Science University, the Medical University of South Carolina, the University of Pittsburgh Medical Center.
60% of patients interested in using digital communication tools
Patient Engagement, July 9, 2020 Link
Patients often took up digital communication tools for the first time during the pandemic, with 63% saying they saw good or excellent care quality in a recent survey by Accenture.
Telemedicine: the future of family planning care
John Snow, Inc., July 7, 2020 Link
The JSI consulting organization notes how a large majority of Title X-funded family planning providers have adopted telehealth for provision of services during the pandemic. Through work with the Family Planning National Training Center, they have helped create a toolkit with clinical guidelines and resources to help with telehealth program development.

Senators seek telehealth expansion for substance abuse treatment
mHealth Intelligence, July 6, 2020 Link
A bill before the Senate would extend telehealth coverage for substance abuse disorder treatment, including MAT therapy and Medicare reimbursement for audio-only phone calls, beyond the COVID-19 emergency.
Holyoke Health Center melds Zoom and telehealth tech to replace in-person visits
Healthcare IT News, July 6, 2020 Link
Holyoke Health Center in Holyoke, Massachusetts, has used NextGen as its electronic health records system for several years, and had to quickly pivot to telemedicine appointments when it became apparent that the COVID-19 pandemic would not allow for in-person appointments.
Telehealth claim lines increased more than 8,335% in April: Fair Health
Healthcare Dive, July 6, 2020 Link
The volume of telehealth claim lines increased more than 8,335% in April 2020 compared to April 2019 as the pandemic continues to drive utilization, according to the most recent analysis of insurance trends by nonprofit FAIR Health.

Recommended Telehealth Research/Resources
Lacktman NM, Wein EH, Ferrante TB. Health Care Law Today, August 4, 2020
Center for Connected Health Policy, July 2020

Centers for Medicare & Medicaid Services, May 2020
Graber ML, Hunte HE, Smith KM.   Agency for Healthcare Research and Quality Issue Brief, August 2020
Harris M, Johnson S, Mackin S, et al. J. Addict. Med. 14(4):e136-e138, 2020
Dawson AZ, Walker RJ, Campbell JA, Davidson TM, Egede LE. mHealth 6:30, 2020

Medicare Learning Network Special Addition, July 31, 2020
Centers for Medicare & Medicaid Services, May 2020
Graber ML, Hunte HE, Smith KM.   Agency for Healthcare Research and Quality Issue Brief, August 2020
Harris M, Johnson S, Mackin S, et al. J. Addict. Med. 14(4):e136-e138, 2020
Dawson AZ, Walker RJ, Campbell JA, Davidson TM, Egede LE. mHealth 6:30, 2020

Alavi Z, Haque R, Felzer-Kim IT, et al.  Community Ment. Health J. [epub ahead of print], July 2020
American Academy of Asthma, Allergy, and Immunology, June 22, 2020
Archbald-Pannone LR, Harris DA, Albero K, et al. J. Amer. Med. Dir. Assoc. [epub ahead of print] June, 2020
Arneson SL, Tucker SJ, Mercier M, Singh J. Crit. Care Nurse [epub ahead of print], July 2020
Chenneville T, Schwartz-Mette R. Amer. Psychol. 75(5):644-654, 2020
Chua IS, Jackson V, Kamdar M. J. Palliat. Med. [epub ahead of print],June 2020
deLima Thomas J, Leiter RE, Abrahm JL, et al. J. Pain Symptom Manage. 60(2):e22-e25, 2020
Dosaj A, Thiyagarajan D, Ter Haar C, et al. Telemed. eHealth [epub ahead of print], July 2020
Edison K.  Missouri Med. 117(3):214-215, 2020

Elliott T, Tong I, Sheridan A, Lown BA. Mayo Clin. Proc. Innov. Qual. Outcomes 4(3):305-314, 2020
Greenhalgh T, Koh GCH, Car J. Brit. Med. J. 368:m1182, 2020
Harris DA, Archbald-Pannone L, Kaur J, et al. Telemed. eHealth [epub ahead of print], July 2020
Holtz BE. Telemed. eHealth [epub ahead of print], June 2020
Lau J, Knudsen J, Jackson H, et al. Health Affairs [epub ahead of print], June 2020
McIntyre M, Robinson LR, Mayo A. Amer. J. Phys. Med. Rehabil. 99(6):464-467, 2020
Mihalj M, Carrel T, Gregoric ID, et al. Best Pract. Res. Clin. Anaesthesiol. 34(2):345-351, 2020
Peahl AF, Smith RD, Moniz MH. Amer. J. Obstet. Gynecol. [epub ahead of print], July 2020

Yang L, Brown-Johnson CG, Miller-Kuhlmann R, et al. Neurology [epub ahead of print], June 2020
About the NETRC
The Northeast Telehealth Resource Center (a proud member of the National Consortium of Telehealth Resource Centers) aims to increase access to quality health care services for rural and medically underserved populations through Telehealth. Our service area includes New England, Northern New Jersey, and New York. Learn more at www.netrc.org
This newsletter was made possible by grant number G22RH30352 from the Office for the Advancement of Telehealth, Health Resources and Services Administration, DHHS
NETRC | netrc@mcdph.org | 800-379-2021 | www.netrc.org