January 2, 2018

Happy New Year! We hope you had a wonderful holiday season and are staying warm on these cold days - perhaps a perfect time to try telehealth at home!

In this newsletter, we'll take a look back at key activities and developments in telehealth for 2017. A few highlights for the NETRC team include hosting a successful Regional Telehealth Conference in May, participating in a number of regional events including the New England Rural Health Conference and the North Country (NY) Telemedicine Conference, and providing individual technical assistance to more than 200 clients. For a sampling of telehealth activity in the region, check out the Regional Telehealth Practice Headlines below.

It was not at all surprising that 2017 was also an active year for regional telehealth policy and regulatory changes. Here are just a few of the updates:
  • Vermont enacted an expanded telehealth coverage parity law for health insurance plans and Medicaid. The law is notable for including the patient's home or another nonmedical environment such as a school-based health center or the patient's workplace in the definition of an "originating site." However, as we have observed in other states, we expect there may be some variation in how this language is interpreted (see the Telehealth Private Payer Laws report examining the ambiguous way some parity laws are written). The Vermont Agency of Human Services did announce in October changes to Vermont Medicaid based on Act 64, which are now reflected in the GreenMountainCare Provider Manual (see page 103).
  • New Jersey became the 7th state in our 8 state region to enact telehealth coverage parity legislation with SB291!
  • Massachusetts has included telemedicine language in a high-profile healthcare cost containment bill that passed the Senate in November. In collaboration with the Massachusetts Telemedicine Coalition, we will continue to follow this bill and are hopeful MA may finally pass telehealth-promoting legislation soon. 
  • Following a pilot program, the Connecticut Medical Assistance program established a policy for coverage of electronic consultations with 36 eligible specialties. However, the policy requires the specialist to bill for the service and stakeholders in CT have indicated this is a barrier to implementation when specialists prefer to contract with the primary care or treating practitioner.
  • Several exciting changes happened in Maine this year:
    • The State became what we believe is the first and only state to require integration of a "telemedicine room" for new housing development projects to qualify for the Low Income Housing Tax Credit. The requirements can be found on page 26 of the 2017 MaineHousing Qualified Allocation Plan
    • The Legislature adopted the Interstate Medical Licensure Compact (becoming the second state in the region after New Hampshire to join) and also passed a bill requiring MaineCare to adopt rules related to telemonitoring, submit an annual report, and establish a Maine Telehealth and Telemonitoring Advisory Group.
    • In addition to telemonitoring changes, MaineCare proposed to allow FQHCs, RHCs, and IHCs to provide covered telehealth services as the providing site and bill under their encounter rate.
  • The most active state in the region this year may have been  New York :
    • As part of the NYS Department of Health Regulatory Modernization Initiative, a Telehealth Work Group was convened to provide feedback to DOH on potential regulatory reforms to facilitate the provision of services by telehealth. Archived webcasts are available for the September 5 and September 27 meetings.
    • NYS DOH is encouraging Telehealth Innovation in Medicaid Managed Care (MMC), including a request in September for plans to submit a Telehealth Innovation Plan (TIP). MMC plans which receive DOH approval of their TIP will earn bonus points for their annual Quality Incentive award.
    • The New York State legislature passed AB4703 and SB4285, adding elementary or secondary schools, child care programs/centers, assisted living facilities, adult homes, continuing care retirement communities, and other senior living residences to the State's definition of "originating site" for Medicaid. We understand a Medicaid Update may be published this spring to reflect all statutory requirements for NYS Medicaid coverage of telehealth since the coverage parity law was first passed in 2015.
    • Following the 2016 updated telepsychiatry regulation for Office of Mental Health-licensed clinics, OMH released new Telepsychiatry Guidance for Contracting with Telepsychiatry/Telemedicine Companies this year. Requirements include that the practitioner's office is located within NYS.
    • The NYS Office of Alcoholism and Substance Abuse Services released Proposed Guidance for Telepractice (public comments were due December 16).
For a national review of 2017 telehealth policy activity, check out this Center for Connected Health Policy newsletter and their 2017 State Telehealth Policy Legislative Roundup Fact Sheet. Also, don't miss our Top 2017 Telehealth Policy Headlines below!

As we welcome 2018, we look forward to continued opportunities to collaborate and support your telehealth efforts! We hope you will contribute to the regional telehealth conversation and consider attending our next conference - see below and stay tuned for more information.

Save the Date! 
Northeast Regional Telehealth Conference
June 5-6, 2018
Holiday Inn By the Bay
Portland, Maine

Please do not hesitate to reach out with any questions or requests for assistance!


Andrew Solomon on behalf of the NETRC Team
CMS CY2018 Physician Fee Schedule Changes

Have you reviewed the updated Medicare telehealth reimbursement policy published in the CY2018 Physician Fee Schedule? Changes include:
  • The addition of three codes to the list of eligible telehealth services
    • G0296: Counseling visit to discuss need for lung cancer screening using low dose CT scan
    • 90839 and 90840: Psychotherapy for crisis; first 60 minutes and each additional 30 minutes
  • The addition of four add-on codes:
    • 90785: Interactive complexity (add-on code)
    • 96160 and 96161: Administration of patient (or caregiver) focused health risk assessment instrument with scoring and documentation (add-on code)
    • G0506: Comprehensive assessment of and care planning for patient requiring chronic care management services (add-on code)
  • Eliminating the requirement to use the GT modifier (via interactive audio and video telecommunications systems). The telehealth Place of Service (POS) Code 02 should still be used.
Although not considered a "telehealth service," CMS also finalized separate payment for CPT code 99091 (collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional requiring a minimum of 30 minutes) for remote patient monitoring. For more information about this and the other CY2018 telehealth changes, please review:
Join the Virtual Conversation!


This year, the Northeast Telehealth Resource Center formed the Northeast Telehealth Leadership Forum to foster collaborative problem solving and networking across the region. Monthly meetings have explored telehealth reimbursement, regional and national policy, direct-to-patient best practices, and more. If you haven't already,  register today to join us for these virtual meetings at  2:00pm ET on the FIRST Wednesday of every month (please note no January meeting).

Next Meeting: Wednesday, February 7
Featured Discussion: Provider Training and Engagement Strategies

We are using a recurring meeting link that you receive after signing up for the Leadership Forum. If you misplace your link, please email asolomon@mcdph.org

Regional Telehealth News for December

Is Project ECHO the Telemedicine Model That Healthcare is Missing?
mHealth Intelligence, December, 2017
A fast-growing international program, Project ECHO uses telemedicine to help rural and remote providers learn from specialists...

NH Hospitals unveil virtual connection to improve emergency care
WMUR 9, December 7, 2017
Dartmouth-Hitchcock Medical Center has partnered with Valley Regional Hospital to provide tele-emergency services...

MedCityNews, December 11, 2017
Walgreens has embarked on a deal with NewYork-Presbyterian health system to provide non-emergency telemedicine services at drugstore retailer Duane Reade stores...

Telemedicine Helps NYC Jails Cut Costs and Complexity in Prisoner Care
mHealth Intelligence, December 14, 2017
NYC Health + Hospitals is coordinating virtual visits for New York's City's municipal jails, including some 30 telemedicine stations...

Harvard Pilgrim grants aim to advance telehealth in CT
Hartford Business, December 20, 2017
Harvard Pilgrim Health Care has awarded $32,000 in grants to the Community eConsult Network to expand the use of eConsults in Connecticut...
A Maine hospital thinks the best medicine for telehealth is staying local
Internet Health Management, December 20, 2017
York Hospital is offering consumer telehealth in an effort to keep care local and provide more community healthcare service...

Top 2017 Telehealth Policy Headlines PolicyHeadlines
As Selected by our Editors

FierceHealthcare, November 7, 2017
Top 2017 Regional Telehealth Practice Headlines Regional
As Selected by our Editors

mHealth Intelligence, January 25, 2017
Model: System-wide telehealth integration including direct-to-consumer

NC Advertiser, January 30, 2017
Model: Health Department facilitated chronic care management

North Country Now, February 5, 2017
Model: Telestroke

Hartford Business, February 15, 2017
Model: Direct-to-patient urgent care

WTNH, March 20, 2017
Model: Project ECHO

mHealth Intelligence, May 18, 2017
Model: School-based telehealth including behavioral health

mHealth Intelligence, May 18, 2017
Model: Grant funded collaborative telehealth network facilitating telepsychiatry and more

mHealth Intelligence, May 26, 2017
Model: eConsults (asynchronous provider-to-provider specialty consultations) for FQHCs

WHEC, May 29, 2017
Model: Grant funded Parkinson's Disease care at home

mHealth Intelligence, June 14, 2017
Model: Emergency room telepsychiatry

The Leader-Herald, June 20, 2017
Model: Community-based telehealth stations to improve health care access

Bennington Banner, June 21, 2017
Model: Tele-emergency care

The Daily Star, June 23, 2017
Model: Telespecialty care including infectious disease

Healthcare IT News, August 17, 2017
Model: Telehealth-enabled emergency room express care 

mHealth Intelligence, August 22, 2017
Model: Improving health care access in unique locations

The Westerly Sun, October 22, 2017
Model: Tele-ICU or eICU

See also:  E-Health Program Goes on the Road [ICU ambulances]
mHealth Intelligence, November 20, 2017
Model: Teledermatology for Community Health Centers

HRSA Funding Opportunity

 Rural Health Network Development Planning Grant Program
Application Deadline: February 23, 2018

The Rural Health Network Development Planning Grant Program provides grants to promote the planning and development of healthcare networks in order to achieve efficiencies; expand access to, coordinate, and improve the quality of essential healthcare services; and strengthen the rural healthcare system as a whole.

Upcoming National Webinar

Nemour Children's Hospital: Nemours Anytime, Anywhere!
Thursday, January 18, 2018 at 2:00pm EDT

Hosted by the Southeastern Telehealth Resource Center
Presented by Natalina Zisa, Telemedicine Operations Program Manager, Nemours Children's Hospital

Join us to learn about Nemour's enterprise strategic solution aligning all consumer-facing digital properties to expand a more accessible continuum of care.