Morning Plenary Session
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Presentation by Cindi Jones, Director, Virginia Department of Medical Assistance Services

Presentation by Cindi Jones, Director, Virginia Department of Medical Assistance Services

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Morning Plenary Session Morning Plenary Session Presentation Transcript

  • Department of Medical Assistance Services Mid-Atlantic Telehealth Resource Summit “Morning Plenary”, March 16, 2012 Charlottesville, Virginia Cindi Jones, Director Virginia Department of Medical Assistance Services and Virginia Health Reform Initiative dmasva.dmas.virginia.gov www.vita.virginia.gov 1 1
  • Department of Medical Assistance Services Purchasers Task Force Medicaid Reform Task Force Insurance Reform Task Force dmasva.dmas.virginia.gov www.vita.virginia.gov Technology Task Force VHRI Advisory Council Delivery/ Payment Reform Capacity Task Force 2 2
  • Department of Medical Assistance Services Status Report on VHRI Advisory Council Recommendations by Task Forces Service Delivery and Payment Reform • Through the Virginia Chamber of Commerce, created a private, non-profit Innovation Center to promote and spread best practices in service delivery and payment reform Technology • Completed Broadband survey of health care providers • Continue Health Information Technology efforts, including implementing HIT, including behavioral health • Continue the expansion of telemedicine • Continue work on the one stop electronic gateway to our health and human services dmasva.dmas.virginia.gov www.vita.virginia.gov 3 3
  • Department of Medical Assistance Services Work Continues on Advisory Council Recommendations by Task Forces Capacity  Through the Board of Health Professions, conducted a research project to identify barriers to safe healthcare access and effective team practice.  Other professional groups are meeting to discuss similar issues. Medicaid  Continue to expand Medicaid funded care coordination models as laid out in 2011 Budget language 297.1, MMMM  Continue to implement and plan for changes to the Medicaid program as the result of federal health care reform.  Work with other State Leaders and Congress on Potential Changes to the Current and Future Medicaid program dmasva.dmas.virginia.gov www.vita.virginia.gov 4 4
  • Department of Medical Assistance Services Work Continues on Advisory Council Recommendations by Task Forces Purchaser • Conducted focus groups and a survey to gain employers’ perspective on the Exchange and health care reform in general. • Virginia Health Care conferences June 2011 and June 2012, sponsored by the Virginia Chamber of Commerce Insurance Reform • Bureau of Insurance developed regulations to implement the insurance market legislation. • Virginia Plans for Health Benefit Exchange. dmasva.dmas.virginia.gov www.vita.virginia.gov 5 5
  • Department of Medical Assistance Services High Level Timeline for Exchange dmasva.dmas.virginia.gov www.vita.virginia.gov 6 6
  • Department of Medical Assistance Services 35 States Provide Medicaid Reimbursement for Telemedicine (2009) • States With Medicaid Reimbursement States with coverage dmasva.dmas.virginia.gov www.vita.virginia.gov 7 7
  • Department of Medical Assistance Services States’ Telemedicine Policies Vary Widely, But Commonalities Exist • Medical and psychological consultations/treatments are the most prevalent services • Fee-for-service reimbursement is generally provided to both the originating site (where the Medicaid recipient is located) and remote site where the physician or other provider is located • Primarily physicians but also other providers are eligible for reimbursement, depending on the state • Coverage and coding/billing inconsistencies across the states makes it difficult to track telemedicine utilization and impact dmasva.dmas.virginia.gov www.vita.virginia.gov 8 8
  • Department of Medical Assistance Services Virginia Medicaid’s Interests in Telemedicine Coverage • Improved patient access to medical services • Improved patient compliance with treatment • Medical services rendered at an earlier stage of disease, improving long-term patient outcomes • Reduction in service expenditures such as hospitalizations and transportation • Allows for an opportunity to work proactively with physicians and other providers; has potential to be a “win-win” situation dmasva.dmas.virginia.gov www.vita.virginia.gov 9 9
  • Department of Medical Assistance Services Virginia Medicaid Telemedicine Coverage, Early Years • Virginia Medicaid started with a telemedicine pilot project in 1995. Services covered were: – Some consultations – One psychotherapy service – A few clinical services such as in cardiology • Used Virginia defined billing codes • Only physicians recognized as providers dmasva.dmas.virginia.gov www.vita.virginia.gov 10 10
  • Department of Medical Assistance Services Virginia Medicaid Telemedicine Coverage, Early Years, continued • Reimbursed providers at originating and remote site, using the existing fee schedule • Pilot project was limited to three Virginia localities; one was for psychiatric care and the other two were for medical consultations • Virginia Medicaid was one of the first states with telemedicine coverage dmasva.dmas.virginia.gov www.vita.virginia.gov 11 11
  • Department of Medical Assistance Services Virginia Medicaid Telemedicine Coverage Expansion, 2003 • Virginia Medicaid expanded telemedicine coverage July 1, 2003 from a pilot to statewide. • Additional services covered – Evaluation and management, office visits – Range of individual psychotherapies – Full range of consultations – Select clinical services such as in cardiology – Mental health and substance abuse crisis intervention dmasva.dmas.virginia.gov www.vita.virginia.gov 12 12
  • Department of Medical Assistance Services Virginia Medicaid Telemedicine Coverage Expansion, 2003, continued • Providers recognized by Virginia Medicaid for telemedicine: – – – – – – – – Physicians Nurse practitioners Clinical nurse specialists Clinical psychologists Clinical social workers Licensed professional counselors Licensed marriage and family therapists Licensed substance abuse practitioners dmasva.dmas.virginia.gov www.vita.virginia.gov 13 13
  • Department of Medical Assistance Services Virginia Medicaid Current Telemedicine Coverage • Originating sites (where the recipient is located) were expanded in October 2009 to include: – Certified Outpatient Rehabilitation Facilities – Community Services Boards – Dialysis Centers – Federally Qualified Health Centers – Health Department Clinics – Hospitals Homes dmasva.dmas.virginia.gov www.vita.virginia.gov – Nursing Homes – Rural Health Centers – Program for AllInclusive Care for the Elderly – Plus physicians and other providers on previous page 14 14
  • Department of Medical Assistance Services Virginia Medicaid Current Telemedicine Coverage • Under fee-for-service, billing telemedicine to DMAS involves: – Originating site (where the patient is located) typically bills a Q3014 code for presenting patient – Remote practitioner bills for services such as an evaluation and management code – Reimbursement is according to the Virginia Medicaid fee schedule and is the same as when the service is delivered conventionally – A procedure modifier for telemedicine is to be entered on the claim form – No telemedicine equipment costs recognized in reimbursement dmasva.dmas.virginia.gov www.vita.virginia.gov 15 15
  • Department of Medical Assistance Services Virginia Medicaid Current Telemedicine Coverage, continued • Providers of telemedicine services are expected to fully comply with service documentation and other coverage and billing requirements described in the Virginia Medicaid provider manuals • Providers can only bill for services using telemedicine, which are services Virginia Medicaid already covers when delivered conventionally and are on a list of Virginia Medicaid approved telemedicine services • Virginia Medicaid telemedicine coverage is similar to Medicare coverage but is not tied to rural area definitions for the originating site dmasva.dmas.virginia.gov www.vita.virginia.gov 16 16
  • Department of Medical Assistance Services Virginia Medicaid Current Telemedicine Coverage, continued • Additional services DMAS has added recently: – Cochlear implant related procedures (CPT 92601-92604, 95974) for post operative analysis and fitting of devices, measurements and adjustments – Teledermatology, dermatology services utilizing store and forward – “Telepractice” speech therapy services for children in special education – Diabetic retinopathy screening, digital images of the retina are captured (stored) and forwarded to ophthalmologists for evaluation dmasva.dmas.virginia.gov www.vita.virginia.gov 17 17
  • Department of Medical Assistance Services DMAS Telemedicine Billing Experience • Telemedicine “billing” has been low for Virginia Medicaid. In FY11, 3799 claims and encounters were received. This reflects approximately $183,762 of services using DMAS reimbursement amounts. Other Medicaid programs have reported low billing volume as well • Psychiatric care was the predominant service billed. Community Services Boards, which are the point of entry in Virginia into the publicly-funded system of services for mental health, intellectual disability, and substance abuse, were the primary providers dmasva.dmas.virginia.gov www.vita.virginia.gov 18 18
  • Department of Medical Assistance Services DMAS Telemedicine Billing Experience, continued • Possible explanations as to why telemedicine billing is low: – Providers not using telemedicine billing modifiers on claims form – Telemedicine as part of the larger bundle of services rendered to patients with particular diagnoses – Contracts for services with hospitals/clinics do not break out telemedicine dmasva.dmas.virginia.gov www.vita.virginia.gov 19 19
  • Department of Medical Assistance Services Telemedicine, Virginia Medicaid Managed Care Organizations • Telemedicine is included in the contracts DMAS has with Managed Care Organizations. The contract coverage parallels the DMAS coverage • An informal DMAS survey was conducted in February of MCOs regarding telemedicine activities, with the following comments provided: – A focus is on underserved areas such as Danville for adolescents needing psychiatric services. Also eICU is used by intensivist physicians to continuously manage remotely patients in the ICU. This has reduced ICU length of stay. (MCO A) dmasva.dmas.virginia.gov www.vita.virginia.gov 20 20
  • Department of Medical Assistance Services Telemedicine, Virginia Medicaid Managed Care Organizations, continued • Currently 51 telemedicine presentation sites exist with approximately 90% or more of these located in the western part of the Commonwealth. The specialty locations include the University of Virginia and Virginia Commonwealth University. (MCO B) • An increasing emphasis is taking place on a telemedicine partnership with the Office of Telemedicine at the University of Virginia School of Medicine. (MCO C) • Over the last two quarters, 30 telemedicine encounters were conducted primarily in Danville and Lynchburg. Aged, blind and disabled Medicaid recipients were the primary users. (MCO D) 21 21 dmasva.dmas.virginia.gov • mco itemsxxxxxxxxx www.vita.virginia.gov
  • Department of Medical Assistance Services Telemedicine, Virginia Medicaid Managed Care Organizations, continued • The value of telemedicine is recognized and is covered without preauthorization. Until December, telemedicine has generally focused on members in the urban and suburban areas of Virginia. As we have expanded into the southwest, and in anticipation of expansion into the far southwest, we have providers ready to provide telemedicine services. (MCO E) dmasva.dmas.virginia.gov www.vita.virginia.gov 22 22
  • Department of Medical Assistance Services Future Possibilities for Virginia Medicaid Telemedicine Coverage • Adding home health services to the telemedicine coverage. DMAS currently covers home health services when delivered conventionally – The Medicaid recipient’s home serves as the telemedicine originating site with an electronic connection to the home health agency office. The Medicaid recipient’s condition is monitored by the home health agency – Studies have documented savings particularly due to fewer hospitalizations and shorter hospital lengths of stay. Medicaid transportation is reduced dmasva.dmas.virginia.gov www.vita.virginia.gov 23 23
  • Department of Medical Assistance Services Future Possibilities for Virginia Medicaid Telemedicine Coverage, continued • Home health telemedicine applications for Medicaid recipients at home include: – post-operative care – high risk pregnancies – diabetes – congestive heart failure • Use of telemedicine for home health patients depends on the diagnosis, medical need, permission of the patient, and patient’s ability to use the equipment • The telemedicine visit is not intended to substitute for needed physical visits to the home by the nurse dmasva.dmas.virginia.gov www.vita.virginia.gov 24 24
  • Department of Medical Assistance Services Future Possibilities for Virginia Medicaid Telemedicine Coverage, continued • text •Expanding DMAS telemedicine “store and forward” coverage •Store and forward involves electronic medical information, such as video and still images, which is stored and transmitted for review by a physician or other practitioner at a later time •The patient is not present when the physician conducts the evaluation of the image but findings are reported back to the patient’s primary care provider dmasva.dmas.virginia.gov www.vita.virginia.gov 25 25
  • Department of Medical Assistance Services Future Possibilities for Virginia Medicaid Telemedicine Coverage, continued • Store and forward applications under consideration include: – Tele ophthalmology • Store and forward can be inexpensive for the originating and remote sites because the electronic medical information, such as a digital picture, simply needs to be captured and transmitted to the physician or other practitioner dmasva.dmas.virginia.gov www.vita.virginia.gov 26 26
  • Department of Medical Assistance Services Questions? • DMAS Website http://dmasva.dmas.virginia.gov/ • DMAS telemedicine coverage description (“Provider Memo”, September 30, 2009) at https://www.virginiamedicaid.dmas.virginia.gov/ECMPdfWe b/ECMServlet?memospdf=Medicaid+Memo+2009.09.30.pdf • Contact DMAS staff Jeff Nelson- 804-371-8857 or jeff.nelson@dmas.virginia.gov dmasva.dmas.virginia.gov www.vita.virginia.gov 27 27