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Minutes for HB2206 - Committee on Health and Human Services
Short Title
Updating certain definitions, referral to specialty services and coordination of care provisions in the Kansas telemedicine act.
Minutes Content for Tue, Feb 9, 2021
Stuart Little, President of the Behavioral Health Association of Kansas (BHAK), provided testimony in support of HB2206. The Covid-19 pandemic brought about changes at the federal and state level necessary to expand telemedicine for behavioral health services in Kansas. Anecdotal information suggested an increased level of addictive behavioral resulting from the multitude of stress factors created by Covid. Treatment for many patients was possible through the use of telephones and other devices. Mr. Little provided provided examples as to how the amendments to the Telemedicine Act were beneficial to patients. BHAK is supportive of several possible amendments to the bill including rate parity, access to qualified telemedicine platforms of choice, and ensuring that Medicaid rates cannot be reduced until the federal emergency standards are reduced. In closing, Mr. Little stated that telemedicine will not replace in-person, face-to-face healthcare. It is just another tool in the toolbox (Attachment 1).
Audrey Dunkel, Vice President of Government Relation for the Kansas Hospital Association (KHA), provided testimony on behalf of the 122 hospital members it represents to support HB2206. Kansas hospitals view telemedicine as a tool to maintain and increase healthcare access. This was more evident during the pandemic. KHA appreciated other provider groups' willingness to work together to reach a consensus on the changes needed to the Telemedicine Act. There are items that KHA would like to see moving forward. The first is rate parity. Coverage parity has created shortfalls. Without rate parity, the shift that has occurred towards telemedicine will make it impossible for hospitals to continue to subsidize telemedicine when it is in high demand by Kansans. The second is allowing hospitals to use their existing platforms to provide telemedicine without incurring additional fees or equipment costs to be a part of a platform required by insurers. Third would be a change in language substituting "location of the patient's choosing" for "non-public location" (Attachment 2).
Chris Wilson, Vice President of System Integration and Innovation, The University of Kansas Health System (TUKHS), provided testimony regarding telemedicine. Prior to Covid-19, telemedicine services were provided on a limited capacity. The pandemic made it clear that patients needed not only access to care, but a continuum of care that allowed them to remain safe and health at home. TUKHS accelerated plans to role out a comprehensive telemedicine to patients across the state. Prior to March 2020, TUKHS provided less than 100 telemedicine visits per month. At its peak, over 35,000 visits were executed during a month. In April 2020, across all patient visit volume dropped 31%, with 47% being virtual. Telemedicine has allowed physicians to continue to provide patients both in hospitals and medical offices when on quarantine for Covid-19 exposure. This allows for care to be provided even with staff shortages. Mr. Wilson continued by stating the need for rate parity to be included in the bill. The concern that the current payment process will be discontinued when the emergency declaration ends. In addition, facilities must be able to continue to use existing platform within the hospital or physician organization for the delivery of telemedicine services (Attachment 3).
Philip Newlin, MD, Clinical Dyad Leader, Ascension Medical Group Via Christi, provided testimony in support of HB2206. Ascension is committed to delivering compassionate and personal care to all, with special attention give to persons living in poverty and the medically fragile. Prior to Covid-19 the hospital has begun taking steps to expand technology-enabled service offerings. Antiquated regulatory environments had limited the ability of providers to innovate and experiment with virtual care. Covid-19 has provided an opportunity for providers and policymakers to mobilize and innovate with virtual care. Virtual care services have been scaled up as both as standalone offerings and as new tools within the contest of more traditional healthcare offerings. A list of offerings and services was provided. Covid-19 and its spread made it difficult for individuals seeking care in person. As a safer alternative, virtual care required that significant waivers and flexibilities needed to be granted. A list of these was provided. Of concern moving forward is the need for rate parity versus platform parity. Dr. Newlin hopes that this will be under consideration as the bill moves forward (Attachment 4).
Michelle Ponce, Associate Director, Association of Community Mental Health Centers of Kansas, in testimony in support of HB2206 stated that telemedicine has been a game-changer for behavioral health treatment during the Covid-19 pandemic. In areas of rural and frontier Kansas, telemedicine has been used for over two decades in treating patients. Gaps such as broadband and technology hardware have been a barrier. The use of telephones has been a significant addition and the use of telemedicine in urban areas helps provide an additional access venue. Ms. Ponce suggested a possible amendment regarding CMS allowances be retained as long as possible for behavioral health (Attachment 5).
Todd Fleischer, Executive Director, Kansas Optometric Association, provided testimony in support of HB2206. Optometrist are an integral part of the health care team. To this end, the organization encourages inclusion of language prohibiting the establishment of a patient/provider relationship solely for the purpose of distributing a product and that the medical devices used to transmit data be FDA approved. There has also been discussion regarding licensing boards granting telemedicine waivers to out of state providers. This goes to the standard of care and the clarification about oversight (Attachment 6).
Amy Campbell, Kansas Mental Health Coalition, provided testimony in support of HB2206 to expand the options for provider originating sites, distant sites and referrals to specialty services. Ms. Campbell urges the committee to consider an amendment to expand telemedicine to include the option of voice only communication. Some patients lack the smart devices that telemedicine is designed to use. Rural and frontier areas have used telehealth before the pandemic. The pandemic expanded its use. Telehealth also has benefited when barriers such as lack of transportation, lack of childcare and scheduling outside of work hours. There has also been an improvement to the no-show rate. A list of the behavioral and mental health services that telehealth provides was provided (Attachment 7).
Denise Cyzman, CEO, Community Care Network of Kansas, provided testimony on HB2206 regarding the impact Covid-19 had on patients having access of care. With stay-at-home orders in place, clinics were down almost 70%. The flexibility that was given providers to implement telehealth services was critical to providing a continuum of care. This expanded approach worked, particularly in the behavioral health arena. Clinics took full advantage of the service. The visits were consistent with the standards of practice and care established for traditional, face-to-face visits. Services were reestablished. Telehealth sessions were as high as 80% at certain centers as a percentage of visits. Telehealth visits are now a part of the new normal because they work. Even after the health emergency is over, telehealth will remain a valuable tool for providers and will increase access of care for many patients. The community Care Network supports the bill as written (Attachment 8).
The conferees responded to questions from the committee.
Written only testimony was provide by the following:
Morgan Waller, Director of Telemedicine, Children's Mercy Hospital Kansas City (Attachment 9)
Scott Wood, Vice President for Physician Network, Advent Health Mid America Region (Attachment 10)
Dr. Dean Hubbard, Public Policy Chair, Kansas Chapter American Academy of Pediatrics (Attachment 11)
Rachel Marsh, CEO, Children's Alliance of Kansas (Attachment 12)
Becky Fast, Executive Director, National Association of Social Workers (Attachment 13)
