States Tackling COVID-19 Using Information and Technology

By Alana Lerer, MPH, CAHIMS, Manager, Government Relations, HIMSS

As the number of confirmed cases of coronavirus (COVID-19) continues to grow, state policymakers in the United States are taking extensive actions to manage the spread through information and technology. These actions focus on increasing access to telehealth to connect patients and providers virtually throughout the duration of the declared public health emergency, supporting public health surveillance and electronic case reporting to improve disease tracking and management, and coordinating with state health information exchanges (HIEs).

The federal government is also taking important actions on telehealth. Read more: Telehealth in the COVID-19 Spotlight.

HIMSS is continuing to monitor state and federal actions, since policy changes are occurring daily. As of March 27, states have taken the following actions on telehealth.

Resources from CMS

Centers for Medicare and Medicaid Services (CMS) is offering states Section 1135 waivers and relevant checklists and tools. These waivers give states flexibilities to focus their resources on COVID-19 response. As of March 27, CMS has approved 34 states. Flexibilities include temporarily reducing delays on enrolling new and out-of-state providers, which has implications for telehealth.

Telehealth Actions

Overall, Medicaid provides states with a great deal of flexibility to use telehealth services in their programs, including various methods of communication such as telephonic or video technology commonly available on smart phones and other devices. Ultimately, no federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

In response to COVID-19, CMS issued a FAQ on March 24 on how states and health insurance carriers can leverage telehealth. The majority of actions states have taken fall into the following three categories:

• Licensure requirements and renewal waivers: (Alabama, Arizona, California, Connecticut, Delaware, Florida, Georgia, Hawai’i, Idaho, Illinois, Iowa, Indiana,  Kansas, Kentucky, Louisiana, Maine, Massachusetts, Maryland, Mississippi, Montana, New Hampshire, New Jersey, North Carolina, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Washington, D.C., West Virginia, and Wyoming)

Thirty-two states are temporarily waiving in-state licensing requirements for qualified medical personnel overall and specifically for delivering telehealth for providers outside of state lines. The Federation of State Medical Boards issued recommendations for states licenses during pandemics. Typically, in most states, healthcare providers need to maintain a license for each state in which they serve. Now, to expand the workforce during this public health emergency, many states are removing that restriction and allowing providers to practice across state lines. For example, in Florida, with approval, out-of-state providers may temporarily deliver telehealth services to Floridians without attaining a license. Some states, like Alabama, have adopted emergency licensing procedures and expedited the process to offer temporary licenses to qualified medical personnel during the declared emergency.

• Expansion of Medicaid coverage: California, Colorado, Connecticut, Delaware, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, New York, New Jersey, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, Washington, D.C., and West Virginia)

Twenty-eight states are expanding access to telehealth for Medicaid recipients. These policies include one or more of the following rules: allowing the patient’s home to be the originating site (i.e. location of patient during service), requiring that provider reimbursement for telehealth be equal to that of a traditional in-person visit, covering telehealth for specified services (e.g. physical therapy, occupational therapy), allowing for multiple methods of telehealth, such as telephone without the requirement of video, and removing the requirement of a face to face initial appointment.

• Expansion of Commercial/Private Insurance Coverage (California, Arizona, Colorado, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New York, New Jersey, Ohio, Pennsylvania, Rhode Island, and Texas)

Nineteen states are mandating that commercial insurance carriers cover telehealth throughout the duration of the declared public health emergency. This may include waiving all copays, coinsurance, and deductibles for patients relating to COVID-19 diagnostic testing and requiring provider reimbursement for telehealth be the same as reimbursement for a traditional in-person visit.

Data Surveillance and Electronic Case Reporting

Besides telehealth, states are beginning to appropriate funds for surveillance to detect and manage the outbreak and require electronic case reporting to public health entities.

• California: State entities are authorized to share relevant medical conditions, as necessary to mitigate the COVID-19 outbreak with governmental and nongovernmental partners for the limited purposes of monitoring, investigation and control and treatment and coordination of care.
• Indiana appropriated $5 million for the prevention, surveillance, treatment and containment of the COVID-19.
• Minnesota passed legislation to approve a COVID-19 emergency fund. One purpose of this fund is to cover temporary IT and systems costs to support patient triage, screening, and telehealth services.
• North Carolina approved an executive order to implement surveillance and control measures for individuals who have been diagnosed with or are risk of contracting COVID-19.

Coordination with HIEs

Several state and regional HIEs and health information networks are leading efforts to respond to COVID-19, since they have the capability to share valuable patient data. The level of infrastructure of each HIE varies by state. Here are a few examples:

• OCHIN, a health information network, partners with 26 public health departments across the country. For their COVID-19 response, OCHIN partnered with Epic and launched a mobile app that enables patient screening and triage outside of a typical healthcare setting. This innovative app aims to improve coordination, expand capacity, and reduce exposure by keeping screening outside of traditional health care settings. The Washington State Health Care Authority is ready to deploy the app for state residents and the app will be shared with other states in the future.
• Indiana Health Information Exchange (IHIE) is coordinating with the Indiana State Department of Health (ISDH), Regenstrief Institute, and healthcare providers to respond to COVID-19. This coordination allows for the following across the state: 1) publicly available real-time testing updates from ISDH, 2) a refined Notifiable Condition Detector, sending alerts of reportable labs to ISDH, and 3) a visual data dashboard in development for ISDH to track measures on how and where COVID-19 is impacting Indiana.
• In order to coordinate rapid information sharing, Western New York’s HIE, HEALTHeLINK, is waiving a requirement to get patient consent before delivering the covid-19 results to providers who have a relationship with that patient.
• Healthix, a New York State HIE is working with the New York City and New York State Department of Health to assist in daily reporting of new cases to shine a light on clinical conditions and high-risk populations.
• The Health Collaborative, a regional nonprofit based in Cincinnati, Ohio, that runs an HIE, is working with local health departments to supply real-time data and setting up external testing outside of traditional healthcare settings to reduce exposure.

HIMSS’s Recommendations for State Governments

To effectively respond to the spread of COVID-19 through the support of information and technology, HIMSS recommends that states consider the following:

1. Scale-up telehealth to reduce the number of people using healthcare facilities while at the same time preserving and improving health. The Administration has issued flexible and constructive guidelines for Medicaid, but much more is needed. States can help to account for the uninsured population or those outside of the safety net.

2. Encourage routine public health data submission and query and, wherever possible require by law or policy, to enable a health IT infrastructure to be built and maintained, including in an emergency. Investments should continue in key initiatives, such as electronic case reporting, to enable cross-jurisdiction sharing of notifiable condition reports.

3. Leverage HIEs to facilitate cross-sector health data platforms or open health data portals to collect data across sectors including emergency management encounters, EMS data, and public health surveillance data. This approach can create targeted interventions, emergency response plans relating to communicable diseases and other non-health data such as transportation to support health impact assessments for policymakers to leverage and make informed decisions during all public health emergencies.

Do you have a story to tell about how you or your organization is responding to COVID-19? Please share your story with us. HIMSS may feature your story in upcoming news. Learn more and share with us.

In the CARES Act passed on March 27th, Congress included $500 million for CDC to modernize data infrastructure to support data surveillance for COVID-19 and future public health needs.