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The follwing is a report from the March 26 Telemedicine & Telehealth Advisory Committee.

  • Meeting minutes from September 23, 2013 were approved
  • Presentation and discussion about the utilization of telemedicine in Medicaid
    • Handout of utilization detail provided to committee
    • There is a difference in the numbers between the years 2012 and 2013
    • Staff currently thinks it may be due to managed care
    • Staff needs to make follow up queries in order to better determine the reason for the change in numbers
    • The committee will be provided with these utilization reports at every meeting in the future and staff will continue to break down numbers – may include managed care
    • It was also pointed out it could take a year for the data to settle
  • Discussion and briefing regarding federal legislation (House Resolution 3077) and the potential impacts on telemedicine: Sam Tessen
    • Does not apply to Medicaid yet
    • It does not look likely this legislation will pass
    • There are 60 sponsors on the bill including some members from Texas
    • Tessen has been told that telemedicine could be a successful means to support ACA
    • Even if bill does NOT pass, it is likely language from bill may surface again
    • Concerns include:
      • There is a provision in the legislation that would require federal agency to issue guidance to states for definition of telemedicine to be applied
      • Could be expanded to Medicaid
      • Could give federal government oversight over state licensure standards
      • Texas has more rigorous standards than some states so individuals practicing in other states could practice here and not meet our standards (committee member points out his disagreement on this point. His interpretation of the language is that people practicing from another state here in Texas would need a “comparable license”).  
  • Sub-committee report from the Telemonitoring Prior Authorization Sub-committee: Sarah Mills
    • Handout to committee includes prior authorization form that was designed
    • The handouts provided show what went into effect on March 1
    • Since March 1, there have been 57 prior authorizations vs just 1 claim under the previous system October-March
    • No complaints
    • The form does need to be faxed in
    • Staff stated there is a process being developed for all prior authorizations to be submitted online
  • Sub-committee report from the Status of Telemedicine, Telehealth and Telemonitoring Sub-committee
    • Discussion on how to include managed care better
    • Request for input on experts proposed to reach out to
      • Quality Based Payment Group on Managed Care
    • Discussion on clarifying “site” definition
      • FAQ reviews establishment of “site” but staff is open to adding examples or clarity the committee thinks is necessary
    • Would like to see maybe the Prior Authorization Sub-committee develop reporting metrics to better determine impacts
      • Focus is not just raw data but providing information
    • During next subcommittee meeting they will hear a presentation on 1115 waiver/DSRIP
    • Would like to work on clarification/looking at how definitions align between Telemedicine, Telehealth and Telemonitoring
  • DEA – Cease and Desist Discussion
    • Providers with DEA license have all activity looked at when they have their 2 year review and as such, some are being told they must see a person face to face in order to prescribe a controlled substance
    • As a result some are being told to Cease and Desist and that they cannot prescribe via telemedicine
    • It was pointed out that in 2001 there was an explosion of internet evaluations leading to prescriptions and this DEA action may be the result of those 2001 incidents
    • Committee thinks they may need to contact DEA to help educate
  • Public testimony
    • Tara Kepler spoke to the committee and offered her services to assist as she has background and has written on the DEA concern. She also offered to give them background on the tele docs case in the third circuit court to which agency staff said they cannot get involved in ongoing litigation.
    • Spokesperson for a telemonitoring company voiced his concern with MCO’s fully grasping telemedicine/telehealth developments. He also would like to see more breakdowns on next utilization report such as the technical vs the professional components.
      • Agency staff clarified MCO’s are given information in a variety of ways including during a quarterly MCO Leadership meeting.  
    • Spokesperson for Superior said he is available for input or can answer questions.
  • Next meeting September 24