823945B1634AF53D8725878200562142 Hearing Summary

Kelly Erb, Policy and Advocacy Manager, Colorado Rural Health Center, told the committee about the mission of the Colorado Rural Health Center.  She presented on the use of telemedicine in rural areas of the state.  She discussed the efforts of rural providers to use telemedicine prior to the pandemic; the cost of providing telemedicine; Medicaid specialty and behavioral health providers; workflow changes; patient access to electronic devices; and provider and patient hesitance to utilize telemedicine.

Ms. Erb discussed the advantages of using telemedicine in rural areas. She discussed innovations in telemedicine, such as remote patient monitoring (RPM) and cooperation with state agencies. She told the committee that Medicaid does not reimburse rural health clinics for RPM.

Ms. Erb discussed ways the General Assembly can help rural areas of the state, including maintaining reimbursement parity for telemedicine.  Ms. Erb responded to questions about expanding provider eligibility for RPM and explained the efforts of the Holyoke Health Clinic in the area of RPM.  She spoke about the equipment needed to provide RPM and the security of health data collected via RPM.  She responded to questions about the use of telepsychiatry in rural areas and stated that the use of telemedicine reduces the number of patients who miss appointments.

Raine Henry, Department of Health Care Policy and Financing (HCPF), discussed HCPF's efforts to support the use of telemedicine.  Ms. Henry's slides may be viewed on the committee website at http://leg.colorado.gov/sites/default/files/images/1_hcpf_telemed.pdf. She stated that HCPF has allowed the use of telemedicine since 2005 and discussed utilization rates, the ways HCPF has expanded telemedicine during the pandemic, and the changes that allowed rural health centers to bill for separate encounters.  She told the committee about payment parity for telemedicine services and the increase utilization of telemedicine during the pandemic.  She discussed studies focused on how telemedicine may increase access to care. She pointed out that the use of telemedicine helps reduced racial and ethnic disparities in no-show rates for primary care.

Ms. Henry discussed how telemedicine reduces disparities in primary care no-show rates for medically complex patients and increases access for those with complex needs. She discussed HCPF's telemedicine policy goals stating that HCPF is committed to developing a comprehensive telemedicine policy that: improves access to high-quality services; promotes health equity; integrates with medical home & neighborhood; encourages innovation through aligned payment policy; and ensures value for the taxpayer.

Ms. Henry responded to questions about policies related to care provided through telemedicine. She stated that there is no requirement that a patient utilize telemedicine appointments prior to an in-person appointments.

Carrie Paykoc, Director, Office, Hospital and Specialty Care Unit Manager, Office of e-Health Innovation (OeHI), explained that the Office of e-Health was established by executive order in 2015 to define and evolve the state’s health information technology strategy.  She discussed the office's efforts to develop Colorado's Health IT Roadmap and supports for telemedicine, focus on health equity, and virtual health and information sharing.  She discussed the Refreshed 2021 Strategy of the E-Health Commission.  She referenced Senate Bill 20-212 and funding to help community members get access to devices to participate in telehealth and funding to boost rural clinics access to broadband. She discussed the office's partnership with HCPF.

Ms. Paykoc continued her presentation and discussed community recommendations, including continued focus on telebehavioral health care, digital health equity, wifi/braodband. She suggested that going forward policies should engage the community in human-centered design, maintain payment parity, simplify contracting, and continue Medicaid payments for e-consults and telepsychiatry.

Stephanie Pugliese, State Health IT Coordinator, Deputy Director, OeHI, discussed innovations in telemedicine, including backpacks for individual experiencing homelessness, and access for senior citizens. She discussed digital health equity, and stated that not all patients or providers have access to devices to facilitate telemedicine. She discussed the challenges of telemedicine, including  broadband connectivity, the use of telephones, and connectivity to electronic health records. She discussed the need to increase connectivity in rural areas.

Ms. Paykoc responded to questions about how OeHI is addressing access to telemedicine for seniors and vulnerable populations.

Ms. Frank responded to committee questions. She told the committee that primary care visits were down in 2020 and that people are still hesitant to get health care services. Ms. Paykoc told the committee that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules apply to telemedicine services.  Ms. Frank spoke about drug rebate collection and alternate payment model information located on the CIVHC website. This information is collected by type of drug, i.e. speciality, brand, and generic. She told the committee that CIVHC will begin collection of additional information about prescription drugs soon.