The push for permanent telehealth expansion in Maryland

Demand for telehealth in Maryland continues to be at the forefront of discussions among health experts and lawmakers. The 2021 Legislative Session marked an important development in virtual care with the passage of the Preserve Telehealth Access Act, which ensured telehealth would be available to all Medicaid recipients regardless of the state public health emergency, which ended last July. 

Now, six months into the Preserve Telehealth Access Act’s implementation, health providers, plans, lawmakers, and other health leaders are reflecting on its success—and room for improvement.

 

 

Last week, over a dozen health leaders from different silos across the health care sphere met to update the Maryland House Health and Government Operations Committee (HGO) on telehealth usage across the state. Speaking from the providers’ perspective, Brian Hasselfeld, M.D., medical director of digital health and telemedicine at the Office of Johns Hopkins Physicians, provided a snapshot of how telehealth services have increased over the pandemic.

According to Hasselfeld, since March 2020, Johns Hopkins Medicine has completed over 1.25 million telehealth visits for over 375,000 unique patients—45,000 of which were under Medicaid. As of December 2021, Hopkins averaged about 35,000 telehealth visits per month. Although this is a decrease from its initial peak of 93,000 visits in April 2020, telehealth usage still remains higher than pre-pandemic levels. 

A common thread among providers and health associations was the importance of audio-only telehealth calls. Lower-income or rural communities have limited access to video telehealth visits, either through lack of bandwidth, physical devices, or the proficiency to operate them.

“For those folks who use [audio-only telehealth], it is their only means of telehealth,” said Steve Wise, who lobbies on behalf of MedChi, the Maryland State Medical Society. “That has turned out to be as important as we thought it would be last year, even though it constitutes a smaller percentage of telehealth visits.”

Delegate Terri Hill, M.D. (D – Baltimore County), expressed her concern over licensure restrictions that may prevent  providers from maintaining a relationship with patients who move to a different state, which prompted health leaders to highlight programs such as the Interstate Medical Licensure Compact (IMLCC). Under this compact, providers can apply for licensure through one set of paperwork, and have access to practice in multiple states. 

Others were concerned by the compact’s potential lack of accountability for providers. 

“Licensure is how the state obtains the ability to discipline a provider when there’s a bad [health] outcome,” Wise said. “We tend to think, ‘This is great, I can see my provider and stay in touch.’ Let’s hope that’s 99% of cases, but in the 1% of cases where there’s a bad outcome, and the state doesn’t have a way to impose discipline or reach that provider, it’s a problem.”

Aside from discussing how providers can maintain services, the HGO heard from health plans on how they are approaching telehealth. 

Allison Taylor, director of government relations at Kaiser Permanente, highlighted a new prepaid plan that would offer unlimited virtual appointments with in-network primary care and specialty care providers. 

“There is room for a carrier to innovate in [the telehealth] space too,” she said. 

One of the provisions of the Preserve Telehealth Access Act requires the Maryland Health Care Commission to provide a report on the impact of providing telehealth services. The report would include recommendations on both coverage for telehealth services and payment levels for telehealth services compared to in-person care. The report will also include a provider survey on their experiences with telehealth delivery. The report is due to the Senate Finance Committee and House HGO Committee by Dec. 1, 2022.

While the provider survey will provide insight on the impact of telehealth on Maryland, other entities, such as community-based behavioral health organizations, are concerned their perspectives will not be reflected in the study. 

“When the results of the survey are released, there could be important information missing, specifically to the public behavioral health system,” said Ann Ciekot, a lobbyist representing the Maryland Addictions Directors Council. 

As the demand for telehealth access remains high in Maryland, panelists expressed concerns and urged the legislature to ensure any flexibilities that expired at the end of the state PHE be reinstated or made permanent.

For example, the Behavioral Health Administration (BHA) discontinued telehealth delivery options for psychiatric rehabilitation services (PRP) after the PHE ended. Additionally, substance use disorder (SUD) residential treatment services under the BHA were restricted to providing a maximum of 50% of services via telehealth. 

“As an unintended consequence of that regulation, providers are really unable to use telehealth in SUD residential [services] in really supplemental and limited ways,” said Kim Wireman, president and CEO of the Powell Recovery Center. 

Due to the rise of the Omicron variant, BHA did temporarily reinstate full telehealth services as of Dec. 22, 2021. It raised the question on how the health care system can evolve to provide consistent telehealth services for those who need it. Jennifer Crockett, director of the Telehealth Department and the Behavioral Health Program for Military Families, said: 

“Telehealth is allowing us to be responsive to [changes in demand for services] and to adjust how we provide care during these surges to ensure that we are keeping our patients and our staff members safe.”