Proposal to Expand Access to Telehealth for All

Governor Andrew M. Cuomo today announced legislation to expand and improve access to telehealth for all as part of the 2021 State of the State. The COVID-19 pandemic laid bare the inequities in our healthcare system and showed that telehealth is a critical tool to expand access and lower costs for low-income communities, especially for behavioral health support. During the crisis, the Governor took executive action to expand access to remote care, and these proposals codify and build on those successful reforms.

In partnership with the Reimagine New York Commission, the Governor will enact comprehensive telehealth reform to help New Yorkers take advantage of telehealth tools and address existing roadblocks. These reforms will address key issues like adjusting reimbursement incentives to encourage telehealth, eliminating outdated regulatory prohibitions on the delivery of telehealth, removing outdated location requirements, addressing technical unease among both patients and providers through training programs, and establishing other programs to incentivize innovative uses of telehealth.

“While New York State has been on the cutting edge of promoting telehealth for its residents, the adoption of telehealth by both patients and providers has been slow,” Governor Cuomo said. “COVID-19 has changed not only the way we live, but the way healthcare providers support their patients, especially in regard to mental health. New Yorkers have adapted throughout 2020, but it is time to push telehealth to the next level in New York State and fully integrate it into our existing healthcare system. These proposals will better allocate our healthcare and technological resources for the 21st century.”

Governor Cuomo proposes comprehensive reforms to permanently adopt COVID-19-era innovations that expanded access to physical health, mental health and substance use disorder services including:

Unlocking the Benefits of Telehealth Through Policy Modernization

The Governor’s proposal includes the following regulatory and statutory changes to allow for greater flexibility in where and when patients use telehealth, while maintaining oversight to ensure high-quality care is delivered:

•  Eliminating obsolete location requirements by requiring Medicaid to offer telehealth reimbursement for services rendered to patients regardless of where the patient or provider is located in a non-facility setting;
• Developing interstate licensing reciprocity with states in the Northeast region for specialties with historical access shortages to ensure that there is sufficient access to medical and behavioral health professionals; and
• Continuing COVID-era flexibilities for mental health and substance use disorder services by allowing certain unlicensed staff, such as Credentialed Alcoholism and Substance Abuse Counselor trainees or Peer Specialists, to deliver substance use disorder and mental health services. This also includes eliminating the remaining in-person evaluation requirements before telehealth services can be delivered, expanding the types of staff who can deliver remote services, developing a regulatory structure for a predominantly virtual outpatient substance use disorder treatment program and exploring the expansion of existing initiatives that extend behavioral health services into nursing facilities. This will include reimbursement of all mental health and substance abuse provider types, including certified recovery peer advocates so patients and providers can choose the care setting that best suits their needs.

Ensuring Coverage and Reimbursement for Telehealth

Telehealth played an indispensable role in providing quality care to those in need during the COVID-19 pandemic. To build on what we have learned during the crisis, the Governor’s proposal will:

•  Require commercial health insurers to offer a telehealth program to members, and provide Medicaid coverage, subject to federal approval, to cover services furnished telephonically when medically appropriate;
• Ensure that telehealth is reimbursed at rates that incentivize use when medically appropriate; and
• Require providers to disclose to patients in writing or through their websites whether they provide telehealth services. Require insurers to provide up-to-date information in their provider directories about which providers offer telehealth services. Any telehealth platforms offered as part of a mandatory telehealth program will be required to participate in the Statewide Health Information Network for New York or otherwise demonstrate interoperability with other providers in the insurer’s provider network.

Expanding the Use of Technological Advancements in Health Care

The Governor’s proposal will also facilitate the adoption of innovations in technology to ensure higher quality and more efficient care for patients by:

• Requiring insurers to offer members an e-triage or virtual emergency department platform that enables individuals to receive a symptoms assessment and a referral to a network of providers or a nearby Emergency Department when warranted, allowing New Yorkers, particularly in underserved areas that lack health infrastructure, to receive better and faster care in times of emergency;
• Facilitating the use of expert consultations between providers via telehealth by encouraging insurers to reimburse providers directly for engaging in e-consults or permitting the inclusion of insurers’ costs associated with e-consult platforms within the health care service costs. The increased use of e-consults will empower primary care providers to make accurate treatment decisions and help patients avoid unnecessary and costly care; and
• Streamlining the SHIN-NY patient consent process to increase interoperability and record access amongst health care providers.

Supporting Patients and Providers Through Professional Development, Education, and Innovative Support Programs

While regulatory flexibilities have increased access to services for many New Yorkers, telehealth is new for many and education and outreach is needed to help get people comfortable connecting with a provider from their home, while providers are also learning how to most effectively use this technology. With the support of the Reimagine New York Commission and the Department of Health, two initiatives are already underway to ensure the successful adoption of telehealth by patients and providers:

• Launch of a new Telehealth Training program created with the leadership of the Reimagine New York Commission in partnership with SUNY Stony Brook and the Northeast Telehealth Resource Center, and with support from Weill Cornell Medicine, Cityblock Health and additional advisors. Designing an open access, continuing professional education curriculum on telehealth will help providers deliver higher-quality care — especially as technologies continue to develop as New York State is paving the way on these tools; and
• Pilot of an innovative telehealth facilitator program conducted by AlRnyc and Mt. Sinai Health Partners, under the guidance of Schmidt Futures and the Reimagine New York Commission. The program aims to improve comfort with and access to telehealth tools for underserved populations, including through hands-on support for the intake and onboarding process. Patient discomfort with and lack of access to technology is a deterrent and this program will help inform how New York can best assist people in learning to use telehealth and lay the groundwork for future expansion.

Co-Founder of Schmidt Futures and Chair of the Reimagine New York Commissioner Eric Schmidt said, “Promoting telehealth is a clear example of how New York can build back better. The pandemic opened New Yorkers’ eyes to the efficacy and convenience of remote care. The Commission is putting forward recommendations to not only solidify the telehealth expansions that many New Yorkers have benefitted from in the last year, but also to go one step further to build a future in which telehealth can benefit us all. This comprehensive overhaul of telehealth policies, in addition to a series of innovative new programs, will ensure every New Yorker, regardless of circumstances, has the support and resources they need to gain access to physical and mental health care.”

Chief Health Officer of Cityblock Health and Co-Chair of the Reimagine New York Commission Telehealth Working Group Dr. Toyin Ajayi said, “Even before the COVID-19 pandemic, telehealth showed the potential to expand access to high-quality healthcare to traditionally underserved communities. And since the beginning of the pandemic, millions of New Yorkers have experienced firsthand telehealth’s ability to deliver quality and convenient care. As we build back better, we have an opportunity to ensure that all New Yorkers are empowered to participate in telehealth. Doing so will bring us one step closer to ensuring all New Yorkers have access to the healthcare they deserve.”

President of Cornell University and Co-Chair of the Reimagine New York Commission Telehealth Working Group Martha Pollack said, “Throughout the pandemic, use of telehealth by New Yorkers soared and patients and physicians alike saw proof of its power. We can unlock the potential of telehealth going forward by changing the ways in which New Yorkers access healthcare. This starts with comprehensive policy changes that give providers and patients greater flexibility to use telehealth as they deem appropriate. And we can and must ensure that those New Yorkers who are most in need have greater access to care, through new investments in telehealth infrastructure, and through the creative integration of telehealth technologies with the kinds of human support that cannot be replaced.”