RD415 - Options for Increasing the use of Telemental Health Services in the Commonwealth – Final Report

Executive Summary:

This final report of a two-year study was mandated by 2017 budget amendment HB1500 Item 312 #1c which directed the Joint Commission on Health Care (JCHC) to study options related to the recommendations set forth in the October, 2016 report of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century (Subcommittee,) Telemental Health Workgroup (Workgroup) for increasing the use of telemental health services in the Commonwealth.

An Interim Report was submitted to the JCHC during their August 22, 2017 meeting. The Interim Report focused on four of 12 recommendations made by the Workgroup in their October 2016 report. The four recommendations included appropriating funds for the following activities: 1) creating the Virginia Appalachia Telehealth Network Initiative - Virginia Pilot; 2) continuation and expansion of Project ECHO (Extension for Community Health Outcomes); 3) the creation, maintenance, and marketing of a telemental health provider directory; and, 4) updates to the telehealth educational resources at the Southside Training and Telehealth Academy (STAR). The JCHC approved the policy option to take no action, deferring to the Subcommittee. Actions of the Subcommittee resulted in the passage of Budget Amendment Item #312.OO allocating $1.1M in each year of the 2019-2020 biennium (total $2.2M) for these activities.

Prior to this Final Report, the Workgroup reviewed their October 2016 report and revised several of the recommendations, based on developments that had occurred over the proceeding time period. This Final Report includes updates on actions taken over the past year and provides information on possible pathways and considerations for action on the updated Workgroup recommendations.

Possible pathways for increasing the use of telemental health include: 1) increasing Medicaid fees for psychiatric services; 2) increasing Medicaid fees paid to originating sites that facilitate telehealth services; 3) creating a committee to evaluate models for consolidating contracts for psychiatric services provided to clients of Community Services Boards (CSBs); 4) allocate funding for telehealth fellowships at Virginia academic health centers; and, 5) request that the Virginia Department of Corrections (VADOC) and Virginia Commonwealth University Health System (VCU-HS) develop policies to improve the exchange of offender medical information, including electronic exchange of information and access to electronic medical chart information by providers at both institutions.

Joint Commission members and staff would like to acknowledge and thank those who assisted in this study including: Richard Bonnie, M.D. and John E. Oliver, Institute of Law, Psychiatry and Public Policy, University of Virginia School of Law; Holly Mortlock, Policy Director Department of Behavioral Health and Developmental Services; Carol Pratt, Policy Advisor to the Commissioner, Virginia Department of Health; William Lessard, Director, Provider Reimbursement, Department of Medical Assistance Services (DMAS); Brian McCormick, Director, Policy and Research Division, DMAS; Karen Rheuban, M.D., University of Virginia (UVA); Kathrine Wibberly, Director Mid-Atlantic Telehealth Resource Center at UVA; and, David Catell-Gordon, Mid-Atlantic Telehealth Resource Center at UVA.

The study and this report was assigned to and completed by Paula R. Margolis, Ph.D., MPH, Senior Health Policy Analyst at the Joint Commission on Health Care. She may be contacted at pmargolis@jchc.virginia.gov.