Telehealth in the Era of COVID-19: Resources for Providers and Patients

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Telehealth has been thrust into the spotlight during the COVID-19 pandemic in an unprecedented manner. Although telemedicine has been a viable option for connecting with patients for many years, it has historically been underutilized due to patient and provider expectations around in-person care delivery, limited financing options, and inconsistencies in technology. In particular, state and federal statutory and regulatory requirements limited the scope and availability of telehealth prior to the pandemic. However, the federal government has recently taken a number of emergency measures and provided flexibilities to enable more providers to use technology to reach their patients remotely, and states have been getting on board.The changing role of telehealth has led to the immediate need for resources aimed at helping providers understand changing policies and implement telehealth workflows quickly. This blog outlines how telehealth policy has evolved due to pandemic and provides a list of telehealth resources for physical health care providers, behavioral health care providers, and patients.

Telehealth and COVID-19

The COVID-19 pandemic has created an imperative to encourage providers and patients to use telehealth to reserve limited medical resources for the COVID-19 response and to align with social distancing requirements designed to curb the spread of the disease. Policymakers, medical professionals, health care delivery systems, and payers have been trying to adapt in real time.The urgent demand for telehealth has led the federal government to relax regulations that previously limited the scope of telehealth for the duration of the public health emergency including:

  • HIPPA flexibility: Health care professionals may now use widely available applications such as Facetime, Facebook, Zoom, Skype, and text messaging to provide telehealth services.

  • Location: Providers can offer telehealth services to patients inside their homes and bill for these services as if they were provided in person. Providers may also offer services to patients in other states, as long as the states have waived practice acts;

  • Services: The Centers for Medicare & Medicaid Services (CMS) has expanded the list of allowable telehealth services to include emergency visits, initial nursing facility assessments and discharge visits, home visits, and therapy services;

  • Providers: Federally Qualified Health Centers and Rural Health Clinics can provide telehealth services to patients wherever they are located; and

  • Billing and Cost-sharing: Providers can reduce or waive cost-sharing obligations for services covered by Medicare and Medicaid.

To help make telehealth more accessible to Medicaid and Medicare enrollees, CMS launched a toolkit in late April aimed at medical professionals, health systems, and payers. The toolkit addresses many of the previous barriers to telehealth implementation (HIPAA restrictions, technological restrictions, payment restrictions, and patient and provider location restrictions).As more providers adapt to telehealth, there is a need for resources to help them implement new workflows, effectively reach and treat their patients, and bill for patient “visits” that were previously required to be conducted in person. Many organizations have worked quickly to publish guidance and best practices to address these needs. Harbage Consulting compiled these resources in the list below to help providers and patients understand current policies and how they can use them to provide and access health care during the pandemic.

COVID-19 Telehealth Resources

The following list is a compilation of resources developed by the federal government, foundations, and health policy experts regarding the role of telehealth in the context of the COVID-19 pandemic. It is intended to provide telehealth resources reaching various parts of the health care system.

General Policy Guidance

  • General Provider Telehealth and Telemedicine Toolkit – Centers for Medicare & Medicaid Services (CMS). Under Section 1135 waiver authority, CMS is broadening telehealth services temporarily due to the Covid-19 pandemic. This document provides general policy guidance, information on establishing telehealth, provider types, and HCPCS/CPT Codes in addition to a toolkit that provides direct links to additional resources.

  • COVID-19 Resources: Telehealth – California Health Care Foundation. This resource provides links to state and federal telehealth policy changes due to the COVID-19 pandemic. It also includes webinars and links for health care providers using telehealth.

  • Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency – U.S. Department of Health and Human Services. The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) has announced it will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 public health emergency.

Policy Guidance for Substance Use Disorder Treatment

Video: DEA Current Policy Regarding the Prescription of Controlled Substances and an Overview of State Telehealth Policy - Center for Connected Health Policy. This eight-minute video by the Center for Connected Health Policy summarizes the DEA’s policy on prescribing controlled substances during the COVID-19 pandemic.

DEA Information on Telemedicine – U.S Department of Justice, Drug Enforcement Agency. This letter contains changes in prescribing controlled substances due to the January 31, 2020 Department of Health and Human Services public health emergency declaration.

DEA Notification of Buprenorphine through Telemedicine – U.S Department of Justice, Drug Enforcement Agency. This letter from the DEA notes that practitioners have flexibility during the nationwide public health emergency to prescribe buprenorphine to new and existing patients via without requiring such practitioners to first examine the patient in person or via telemedicine.

COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance – Substance Abuse and Mental Health Services Administration. SAMHSA has issued guidance on 42 CFR Part 2 compliance during the COVID-19 emergency.

Resources for Providers

  • Telehealth.hhs.gov – U.S. Department of Health and Human Services. The U.S. Department of Health and Human Services developed a website that includes telehealth information for patients and providers. For providers, the site includes information on how to implement telehealth, policy changes during COVID-19, and how to plan a telehealth workflow.

  • Opportunities to Expand Telehealth Use Amid the Coronavirus Pandemic – Health Affairs Blog. This article includes recommendations for medical providers, states, and payors using telehealth during the COVID-19 pandemic based on China’s early experience.

  • COVID-19 Telehealth Communication Tips – Ariadne Labs: A Joint Center for Health Systems Innovation. Ariadne Labs has developed guidance on communicating with patients virtually and provides suggestions on how to maintain patient privacy during telehealth visits.

  • Care Innovations Covid-19 Resources for the Health Care Safety Net – Center for Care Innovations. This resource provides links to various telehealth resources. Topics include population management, technology solutions, community-centered care, and innovation and design.

  • COVID-19 Telehealth Toolkit – National Consortium of Telehealth Resource Centers. A toolkit designed to assist organizations in implementing telehealth during the COVID-19 pandemic.

  • A Quick Start Guide to Telehealth During COVID-19 – Pacific Basin Telehealth Resource Center. This Quick Start Guide provides health care practitioners with simple steps and considerations for conducting real-time video teleconferencing with patients during the COVID-19 pandemic.

  • Quick Start Guide to Telehealth – Northwest Regional Telehealth Resource Center. A quick start guide for health care providers who wish to implement simple web-based videos to interact with their patients.

  • Video: Telehealth Best Practices – Pacific Basin Telehealth Resource Center. This three-minute video offers best practices for providing telehealth services.

  • Video Series: Telehealth Etiquette – South Central Telehealth Resource Center. A series of videos demonstrating bedside manner in a telehealth visit.

Resources for Behavioral Health Providers

Resources for Patients

  • Telehealth.hhs.gov – U.S. Department of Health and Human Services. The U.S. Department of Health and Human Services developed a website that includes telehealth information for patients and providers. For patients, the site includes resources to better understand telehealth and how to access it during the COVID-19 pandemic.

  • Resources for Telehealth at Safety Net Settings - Center for Vulnerable Populations, University of California, San Francisco. This resource provides multi-lingual video conferencing instructions, how-tos, and resources for patients to prepare for telehealth visits. It also includes resources for providers regarding special considerations, workflow, and Medicaid and Medicare reimbursement.

  • How to Prepare for a Video Appointment with Your Mental Health Clinician - SMI Adviser. This flyer includes tips to help patients prepare for a telehealth visit, including identifying a private location and testing technology.

  • Video: What to Expect from a Telehealth Visit - Pacific Basin Telehealth Resource Center. This six-minute video explains what patients can expect from a telehealth visit.

Looking Forward: Telehealth Post-COVID-19

While the emergency telehealth flexibilities that have been put into place may be adjusted once the pandemic subsides, the situation has presented an opportunity to expand learnings and best practices around how telehealth is delivered. It will be important to understand the experiences of individual providers and health systems both large and small in implementing telehealth during the pandemic, so that improvements can be made and efficiencies can be achieved. Policymakers should leverage these learnings to inform future telehealth policies that will hopefully expand access to care. 

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