Wednesday, June 18, 2008

Legislation in Colorado

The Colorado Department of Health Care Policy and Financing held a meeting to discuss how the new telemedicine project authorized and funded by SB-196 would work. The use of telemedicine included in the legislation is to be implemented in the home health program. Diana Huerta and Sean-Casey King are both leading the telemedicine project for the Department and at the meeting reported on the progress being made to meet the spirit of the legislation. According to Huerta and King, the next step after conducting discussions and listening to comments is for the Department to draft rules for the program.

According to King, the goals are to roll out the program quickly, enable providers to have freedom in determining telemedicine needs, ensure cost savings by closely monitoring claims data and the clinical process, and make certain that the program maintains quality of care. The project will not pay for technology equipment, but home care providers will be compensated on a flat-fee monthly basis to use technology in their own way in treating clients.

The program will be implemented in two phases. Phase 1 will be put into place to benefit clients in acute home health and at the beginning of the acute period, the provider would determine as to whether the client should receive telemedicine. During the acute period, the provider does not need to assess whether the need for telemedicine is at Level 1 of Level 2.

At the end of the acute phase, if the client is expected to go or return to long term home health, a telemedicine level determination must be made. So at this point, the agency will need to document whether they believe the client will benefit from the use of telemedicine in long term home health.

The agency will also determine if the client should receive Level 1 or Level 2 telemedicine, based on the amount of nursing interaction needed. The agency will need to document their reason in the client’s medical record. Most importantly, clients in Phase 1 can only receive telemedicine during the long term home health period if they received care during an acute home health period.

Once the telemedicine level is determined, the provider may bill Medicaid once per calendar month and must assess the client’s need and level for telemedicine at the beginning of each home health plan of care period.

The information, determination, and the patient’s records will be reviewed by a third party vendor to learn how different providers are making these decisions. At this point, the department may develop a standard tool for all providers to use in determining telemedicine needs and levels. The third party vendor also will have the responsibility to ensure that claims are submitted appropriately and the third party vendor is to be chosen through the Request for Proposal process.

Phase 2 of the plan does not include telemedicine for clients who have not had an acute episode. However, if cost savings and need can be established, the Phase 2 roll-out may include the option for providing telemedicine to long term home health clients who have not had an acute episode.

In other legislative actions, the Governor of Colorado signed legislation in June on healthcare. One of the new pieces of legislation SB 135 will streamline healthcare and make it easier for doctors, nurses, and patients to get information from insurance companies. The legislation created a standardized health plan ID card for patients will use 21st century technology for the electronic exchange of information.

Colorado’s Blue Ribbon Commission for Healthcare Reform was formed to study and to establish healthcare reform models in the state. A report released in 2008 by the Commission made a number of recommendations to increase the adoption of health information technology. The Commission’s report recommends that a statewide health information network focusing on interoperability be established and supports creating an electronic health record to work across systems for every person in the state with protections for privacy. In addition, the Commission supports a statewide data system to provide specific care guidelines and performance measures.

To help support some of the Commission’s suggestions for healthcare reform, SB 217 was introduced in March 2008 to develop the Centennial Care Choices program. The bill encourages the use of health information technology and telemedicine including health information exchanges, electronic health records, and e-prescribing. The bill would encourage establishing pay-for-performance programs and would provide consumers with educational materials on how to access internet-based healthcare tools.