New York has expanded the list of originating sites for telehealth to include schools, giving Empire State children virtual access to doctors, dentists and mental health counselors.
Governor Andrew Cuomo’s signature last week on A4703 expands the list of state-sanctioned delivery sites for telehealth to public, private and charter elementary and secondary schools, child care programs and day care centers. The legislation opens those programs to reimbursement from Medicaid and private payers.
“This is another important step in expanding health care access for New York State residents,” New York Assemblywoman Addie A.E. Jenne, who submitted the bill, said in a press release. “It will be extremely beneficial for areas of the state, including the North Country, that struggle with healthcare provider shortages.”
“It also ties in nicely with the community schools model that seeks to expand services to meet all of our students’ needs,” she added. “We know it’s hard to focus on learning if a student is sick or suffering from dental or mental health issues. The expansion of telehealth offers the potential to address the health issues more quickly.”
The bill follows another telehealth-friendly bill – also sponsored by Jenne - that recently passed the governor’s desk. Cuomo’s signature last month on A1464, extended the list of originating sites to include certain adult day care centers.
"Some patients in the North Country are travelling two, three and even four hours to meet with specialists on a regular basis,” Jenne said in a press release announcing that bill’s signing. “Those trips are often difficult for patients in good weather, and I know those trips are even more challenging in the winter months.”
At that time, Jenne said the still-pending school telehealth bill would give schools and school districts more flexibility to develop telehealth and telemedicine programs on their own.
"When schools are unable to bill for these services, it often means the use of the service is not financially feasible,” she said. “By adding schools to the list of originating sites, schools will have a greater ability to consider telehealth services when needed for their students.”
Telehealth programs in schools are increasingly popular but also tricky, relying on community and administrative support that may shift from year to year.
Funding is also tenuous, with most districts across the country relying on Medicaid and private payers or having the students’ parents foot the bill, either out-of-pocket or through their insurance. Some have been able to partner with health systems that foot most of the bill, at least for the short term.
That reliance on Medicaid comes with its own dangers. Current debate in the nation’s capital over an Obamacare repeal includes proposals to slash Medicaid funding, or shift it to a per capita cap or block grant. If cuts are made, many experts say school-based services would be among the first to take the hit.
“If the Medicaid reimbursement isn’t there, you’re not going to make it,” Steve North, medical director and founder of the North Carolina-based Center for Rural Health Innovation, told Politico in July. “You’re not even going to come close.”
“If we continue to weaken access points for low-income kids, then the schools are going to be having to figure out a way to meet those needs,” added John Schlitt, president of the School-Based Health Alliance, billed as the nation’s leading advocate of school-based clinics. “There’s only so many ways in which states are going to be able to absorb that kind of a financial cut.”
According to a 2017 report from the American Telemedicine Association, only 23 states and Washington D.C. mandate Medicaid reimbursement for school telehealth services, while a few more require private insurers to cover those services. Those mandates, however, don’t prevent states or health plans from setting restrictions that hinder schools from taking full advantage of telehealth.
School districts around the nations could also get some from Congress. The Hallways to Health Act, introduced in February and currently before the Senate, would create reimbursement opportunities and open more schools to telehealth programs by combining them with community health centers.
“School-based healthcare centers provide quality healthcare services to thousands of underserved students,” Michigan Sen. Gary Peters, who submitted the bill with fellow Michigan Sen. Debbie Stabenow, said earlier this year. “The Hallways to Health Act will better connect school-based health centers with skilled professionals, enhancing students’ wellness and encouraging healthy behaviors.”
While debate continues in Washington, rural school districts are finding ways to bring telehealth to their students and teachers. In her announcement that her bill had passed the governor’s desk, Jenne noted the success of the University of Rochester Medical Center’s Health-e-Access program with the Rochester City School District.
“This offers an opportunity to overcome distance barriers that create so many challenges for North Country families seeking health care, improves access to healthcare and reduces the amount of time students spend out of school,” she said.