The Alliance for Connected Care (the Alliance) is a 501(c)(6) organization that was formed to create a statutory and regulatory environment in which every provider in America is permitted to deliver and be adequately compensated for providing safe, high quality care using Connected Care at his or her discretion, regardless of care delivery location or technological modality. Our members are leading companies from across the health care and technology spectrum, representing insurers, retail pharmacies, technology and telecommunications companies, and health care entrepreneurs. The Alliance is advised by a distinguished group of patient and provider advocacy organizations.

Advocacy Principles

 

Overall Goal

The goal of the Alliance is to create a legal and regulatory environment in which every provider in America is permitted to deliver safe, high quality care using telehealth technology at his or her discretion, and be compensated at a consistent rate regardless of care delivery location or technological delivery method.

Principles

The Alliance is committed to achieving its goal through developing a legislative framework that advances the following principles:

Expand patient access to telehealth services by removing geographic and site limitations to enable patients to communicate remotely with their providers regardless of location.

Rationale: The Medicare program limits the coverage of telehealth services to specific sites and geographic regions. Generally, covered telehealth services must be provided in rural areas as determined by the Department of Health and Human Services (HHS). In addition, the coverage of telehealth services by the Medicaid program and private payers varies by state. As Medicare is often the payer that state and private payers follow, it program should expand its coverage of telehealth services to additional sites and beyond rural areas.

Ensure the appropriate reimbursement of providers for the delivery of telehealth, regardless of payer.

Rationale: State, federal, and private payers of telehealth services determine the types of services that are covered and the payment amount for the provision of such services. Ensuring increased access to these cost-effective services requires that providers are appropriately reimbursed for the services furnished to their patients.

Include telehealth, remote patient monitoring and other Connected Care technology as a tool in new models of care and payment, such as medical homes and Accountable Care Organizations.

Rationale: The use of Connected Care technology will allow for greater care coordination and improved quality of care based on the ability to monitor patients with greater frequency, using less time and presenting patients and providers with the opportunity to coordinate their care through different modalities of communication.  Under the Medicare program, new models of care are still subject to Section 1834(m) restrictions.

Establish a consensus-based, standardized definition of safe, high quality “telehealth services” and Connected Care, eliminating restrictions that hinder access to those services, including limits on applicable technology.

Rationale: There is no single legislative or regulatory definition that adequately describes modern technologically-supported care delivery care mechanisms. As a result, different definitions have emerged in various forums, resulting in a patchwork-approach that has made it difficult to implement consistent policies that would make Connected Care available to all Americans.

Develop and propose a robust consensus-based anti-fraud construct that will help ensure the secure delivery of medically appropriate telehealth services to patients and serve as guidance to state, federal, and private payers.  

Rationale:  The limitations placed on the coverage and payment of telehealth services are intended to protect patients from fraudulent providers and medically unnecessary services. An anti-fraud construct is necessary to enable payers to expand access to telehealth services, while ensuring patients are provided safe, high quality services.

Incorporate privacy and data security protections into any Connected Care innovations to ensure patients and providers are following best practices to safeguard patient information.

Rationale: Health information is sensitive information that must be protected through the creation of strong privacy policies and disclosure principles. With strong privacy and data protection safeguards built into the system, patients and providers will be able to utilize innovative technologies to improve the health care delivery system in a way that is secure and provides better outcomes.

Eliminate state regulatory barriers to the practice of telehealth.

Rationale: State regulatory frameworks exist that hinder the use and reimbursement of telehealth.  While some states mandate the coverage of telehealth services by private payers, others do not. There are also coverage variations across state Medicaid programs. Removing these regulatory barriers is critical to promoting greater patient access to telehealth services.

Eliminate state licensure barriers to the practice of telehealth that prohibit providers from furnishing telehealth services to patients across state lines.

Rationale: Each state medical board regulates the practice of medicine within its state. In order to practice telehealth from one state to another, a physician must be licensed to practice medicine in each state. A solution is needed to enable licensed physicians and other practitioners to deliver telehealth services to patients who need it, even if the patients are located in a different state.