Telehealth in Arizona Medicaid: How AHCCCS Is Expanding Access to Care

Unlike Medicare, which is a federal program that’s managed ‘top-down, Medicaid (which provides healthcare to low-income persons and others with disabilities etc.) is a shared federal and state responsibility and provides more flexibility. As such – state Medicaid programs aren’t dependent on Congress for allowing for telehealth services.

Telehealth has been revolutionizing healthcare access for millions of people, and AHCCCS has been at the forefront of this transformation in the last couple of years… finally embracing telehealth services especially in areas like behavioral health.

AHCCCS Telehealth Services: What’s Covered?

AHCCCS’ Telehealth Policy Manual allows members to receive medically necessary services remotely using electronic communication tools like video conferencing, phone calls, or secure messaging for certain services like:

  • Behavioral Health Services: Counseling, psychiatric evaluations, and medication management are all available via telehealth. This is particularly important for those in rural or underserved areas who may struggle to access in-person behavioral health support.
  • Chronic Disease Management: Members can manage chronic conditions, like diabetes or hypertension via regular telehealth check-ins with their healthcare providers. This helps avoid unnecessary hospital visits and improves disease management.
  • Primary Care Visits: Routine checkups, some follow-up appointments, and preventive care can now be done remotely, providing members with greater flexibility.
  • Therapy and Rehabilitation: Physical therapy, occupational therapy, and speech therapy services are also available via telehealth, making these services more accessible to members who may have transportation or mobility challenges.

The Role of the Arizona Telehealth Advisory Committee

Arizona law requires that AHCCCS listen to their Telehealth Advisory Committee as they make decisions about what kinds of telehealth services to authorize and encourage.

The committee evaluates the effectiveness of telehealth services, helps set standards for delivery, and advises on any changes necessary to improve patient outcomes. This collaboration ensures that AHCCCS continues to expand and improve telehealth offerings in ways that are both effective and cost-efficient.

AZPHA commends AHCCCS for its recent commitment to embracing telehealth as a vital part of the healthcare in Arizona. 

AZPHA Breakfast & Learn – Arizona’s 2024 Ballot Measures: A Public Health Perspective

AZPHA Breakfast & Learn

Arizona’s 2024 Ballot Measures:

A Public Health Perspective

Wednesday, October 16, 2024

9-10am

There will be 13 ballot measures on your November ballot. The vast majority of them (11) were placed directly on the ballot by the legislature – largely because the Governor had earlier vetoed the measure or certainly would have. Others are designed to permanently change the state constitution.

AZPHA has taken positions against 5 of the ballot measures and is supporting two of them (both citizen initiatives). 

This session will cover each of the ballot measures with color commentary from Will Humble about the pluses and minuses of each.

Join us for this important voter education webinar: Arizona’s 2024 Ballot Measures: A Public Health Perspective, Wednesday, October 16th from 9-10am.

Our Speaker:

Will Humble, MPH

Executive Director

Arizona Public Health Association

Register Here

View Our PowerPoint

The Future of Telehealth in Medicare: Why Congress Needs to Act to Preserve Access & Improve Care

The COVID-19 pandemic forced the US to rethink how care could be delivered safely and effectively, especially for older and underserved populations. One of the most significant developments was the expanded use of telehealth services within the Medicare program.

As the country shifted to remote care, telehealth became a lifeline for millions of Medicare members. It let people get care without the risks associated with in-person visits, especially for high-risk populations. It also really helped out in rural reals that have weak networks for behavioral health, psychiatric and other critical care.

However, now that the public health emergency is over – the benefits of telehealth for Medicare members are also expiring at the end of 2024 (telehealth was temporarily extended when the PH emergency ended).

The question before congress isn’t just whether telehealth should remain a part of Medicare – but how it can be structured to improve care and ensure long-term sustainability.

The Pandemic’s Lessons:
Improved Access Through Telehealth

The expansion of telehealth during the pandemic showed remarkable improvements in access to care. As documented in a Kaiser Family Foundation report, before the pandemic, Medicare’s telehealth coverage was limited.

Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology. The public health emergency lifted these barriers, enabling all Medicare beneficiaries to use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits.

A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions benefitted the most.

Telehealth made it easier for patients to stay connected with their providers, avoiding travel, and waiting times. Patient and provider satisfaction surveys showed a high level of approval for telehealth, with many beneficiaries preferring virtual visits for routine care.

A Crucial Moment for Telehealth Policy

Before the end of the telehealth extension is here (12/31/24) Congress will need to decide whether to again temporarily extend telehealth or make permanent the telehealth flexibilities enacted during the pandemic.

There’s a current proposal for a two-year extension of these flexibilities, which would provide a temporary solution but falls short of addressing long-term needs.

A two-year extension is better than allowing the COVID-era policies to expire altogether, but it’s only a stopgap.

But… the bipartisan CONNECT for Health Act offers a more comprehensive and forward-looking solution. This bill proposes permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and eliminates in-person visit rules for behavioral health.

Importantly, it also includes critical measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.

The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.

Not all medical issues are suited for telehealth, but many conditions—particularly in behavioral health—benefit greatly from continued virtual access. The CONNECT Act emphasizes this distinction, ensuring that telehealth is used where it can be most effective without undermining the need for in-person care.

The Stakes: What Happens If Congress Fails to Act

If Congress doesn’t at least extend the current Medicare telehealth policies seniors could lose access to a vital service -especially for behavioral health services and in rural areas, erasing the gains in access achieved in the last 4 years.

While a two-year extension would temporarily keep access, it doesn’t provide the certainty needed to build sustainable, long-term solutions for telehealth in Medicare.

A Call to Action

Congress needs to act by December 31 to prevent the rollback of important Medicare telehealth services. While a two-year extension is a start, it really just kicks the can down the road.

Passing the CONNECT for Health Act would ensure that telehealth stays a permanent and sustainable part of the Medicare program.

 

Far Out: Cannabis in Rural Healthcare

Thursday, October 17, 2024

12:00 – 1:00 pm MST

Far Out: Cannabis in Rural Healthcare

A webinar series focused on providing technical assistance to rural stakeholders to issue research findings, policy updates, best-practices and other rural health issues to statewide rural partners and stakeholders throughout the state.

Learning objectives:

  • Identify how recreational and medical marijuana laws interact with rural communities.
  • Reflect health equity concerns for rural communities as it relates to cannabis access and safety.
  • Engage with harm reduction resources for responsible adult cannabis use.

Meeting Registration – Zoom

AHCCCS Addressing Social Determinants of Health Via Community Reinvestment

AHCCCS continues to innovate in its approach to healthcare. In their latest move, they’re focusing on the broader social factors that affect health.

For example, their recently updated ACOM Policy 303 – Community Reinvestment is looking to require their contractors to reinvest a portion of their net profits into initiatives that directly address the social determinants of health across Arizona.

AHCCCS has had a community reinvestment requirement for many years – but this is the first time the agency has proposed that their contractors invest specifically in the social determinants of health.

For AHCCCS contractors, this means that up to 10% of net profits must be spent on community reinvestment projects. The proposal includes a sliding scale so that the contractors with lower net after tax profits are expected to invest a lower percentage of that profit.

By targeting factors like housing, education, employment, and food security, AHCCCS is taking concrete steps to address the root causes of poor health outcomes, not just the symptoms.

This policy shows the agency’s commitment to improving the health of vulnerable populations while building stronger, healthier communities.

What’s exciting is that AHCCCS leadership is not just focusing on healthcare within clinic walls. They’re acknowledging that factors like stable housing, access to nutritious food, and a supportive community are critical to health outcomes.

This forward-thinking (and evidence-based) policy recognizes that social determinants are key in creating healthier lives for Arizonans.

See alsoAHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association

AHCCCS is currently seeking public feedback on this proposal, with the comment period open until October 15. You can share your thoughts and help shape this critical policy by submitting comments online at: https://ahcccs.commentinput.com/?id=iePSEUFNp.

This initiative is a great step forward, and we commend AHCCCS leadership for addressing health from a broader perspective.

FDA: Adolescent E-Cigarette Use Declines Nationally

The FDA announced this week that youth e-cigarette use in the US has dropped to its lowest level in a decade! This decline is encouraging news and, according to the FDA, largely attributed to ‘comprehensive federal and state efforts to reduce tobacco use among adolescents, including education campaigns and regulations that limit access to e-cigarettes’.

Nationally, the percentage of high school students who reported current e-cigarette use dropped from 14% in 2022 to 10.6% in 2023… inching closer to the Healthy People 2030 goal of reducing adolescent e-cigarette use to 10% or lower.

Results from the Annual National Youth Tobacco Survey | FDA

In Arizona, about 16% of high school students reported using e-cigarettes in 2023’ Youth Risk Behavior Survey. The downward national trend is a step in the right direction, reflecting the impact of ongoing state and local measures, including tobacco-free policies and youth prevention initiatives.

To continue this progress, it’s crucial to support policies that limit the availability of e-cigarettes and educate young people about the risks by focusing on comprehensive tobacco control policies and community education initiatives.

FDA Conditionally Approves At-Home FluMist Vaccine

The FDA recently approved the at-home administration of FluMist, an intranasal influenza vaccine, for individuals aged 2 to 49 years. This new option is intended to be available for the next flu season (2025-2026) – allowing either self-administration or caregiver administration.

The FDA’s approval for at-home use is subject to several conditions, including meeting stringent storage and administration requirements. For example, patients or caregivers must follow detailed instructions for proper handling to ensure safety and efficacy, which may present challenges for many individuals due to the regulatory complexities involved.

Still, caregiver administration could be a practical alternative, especially for patients who find it challenging to access healthcare facilities, making this a potentially reasonable way for those who need flexibility in getting vaccinated.

To access the at-home vaccine, individuals would need to discuss eligibility with their healthcare provider, who will decide whether they meet the criteria and can properly store and administer the vaccine.

See FDA Approves Nasal Spray Influenza Vaccine for Self- or Caregiver-Administration | FDA for more info.

Protect Adolescents: Keep Meningitis Vaccinations on Track

The Advisory Committee on Immunization Practices is considering changes to the meningococcal vaccine schedule that could have serious negative consequences for adolescents. The ACIP is considering three different options to alter the current recommendations for meningococcal disease, one of which is dangerous and administratively damaging.

Option 3 is the worst option ACIP will be considering. It would end the recommendation for adolescents to get their first dose of the meningococcal vaccine (MenACWY) at 11-12 years old and shift that to 16 years old, followed by a second dose at 18.

The 11–12-year age range is the last good opportunity for routine doctor visits for many young people before they enter the more tumultuous teenage years. Many parents stop bringing their kids to the doctor for annual checkups once they hit high school (except for sports physicals that often don’t include vaccine opportunities).

Option 3 would also upend school attendance vaccine requirements already in place in most states, including Arizona. These school vaccination requirements are designed to keep our communities safe by ensuring widespread immunization.

If Option 3 is adopted, health insurers would likely stop covering the vaccine at 11-12 years old, making students ineligible for insurance-covered vaccination until they turn 16.  This would force states (like Arizona) to choose between either repealing their vaccination requirements for younger adolescents or facing widespread noncompliance due to the lack of insurance coverage at the 11–12-year-old visit.

We can’t afford to take this risk. Vaccine coverage at age 11-12 not only protects against meningococcal disease when kids are at risk but also keeps our schools safe, health systems functioning smoothly. It also gets the vaccine on board before kids are lost to follow up.

The ACIP will likely make its final recommendation in February 2025. AZPHA will urge them to reject Option 3 when public comment starts because it’s a dangerous step backward that undermines adolescent health and the proven protections that the current vaccination schedule provides.