NH Health Care Consumers & Providers COVID-19 Coalition

The NH Providers Association is a working partner in the NH Health Care Consumers & Providers COVID-19 Coalition, comprised of health care and social service advocates and providers who came together at the outset of the COVID-19 pandemic to address the challenges this crisis has created for the health care sector in NH. The coalition represents a broad spectrum of organizations and health care systems with a history of developing solutions collaboratively on impactful health care issues such as Medicaid Expansion and advancing the health care workforce, both in the Legislature and before the Executive branch. Our shared mission is to ensure that all New Hampshire citizens have access to quality, timely, and appropriate health care and associated services, such as housing, peer support and child care.

The coalition partners strongly support a permanent continuation of the interim telehealth guidance established in Executive Order # 2020-08. We support legislation that is being developed now by a bipartisan group of legislators, to put into law the basic premise of the order. The bill – HB 1623, as amended by #2020-1317s – also seeks to:

I. Ensure coverage and reimbursement parity, expand site of service, and enable all providers to deliver services through telehealth for Medicaid and commercial health coverage.
II. Enable access to medication assisted treatment (MAT) in specific settings by means of telehealth services.
III. Amend the Physicians and Surgeons Practice Act to expand the definition of telemedicine.
IV. Amend the Nurse Practice Act to expand the definition of telemedicine.
V. Enable the use of telehealth services to deliver Medicaid reimbursed services to schools.

The current pandemic required providers to rapidly switch the delivery of services from an in-person modality to telehealth, with the goals of ensuring no gaps in care and enhancing existing services. It is safe to say that this has been both transformative and successful, with the majority of patients surveyed to date reacting favorably to their experiences with telehealth.

The hard work and ability of thousands of clinical, administrative, and IT staff at hospitals, community health centers, community mental health centers, area agencies, and other facilities, to so quickly change over to a whole new model of care is a testament to their dedication to their patients and their fellow NH citizens. There are areas of physical and behavioral health care services that are not appropriate for telemedicine, and we know that it will not replace all in-person care, but it is clear telehealth has been a bright spot among a sea of change and is a tool that should become a standard element available for those who can benefit from it.

Telehealth offers convenience, frees up time in patients’ busy schedules, and breaks down transportation barriers to care. During COVID-19, telehealth helps keep patients and staff safe and allows health care organizations to reserve their personal protective equipment (PPE) for testing patients who may be COVID-positive and testing staff when they return after vacation or quarantine. For dental providers, who are at high risk because of exposure to aerosols and droplets and who must thoroughly disinfect the operatory between patients, teledentistry can save an abundance of time and PPE.
Telehealth has also resulted in expansion of behavioral health services, alleviating obstacles to receiving care, including trauma and anxiety that can be triggered when entering a medical office: Many organizations, for the first time, are seeing a 0% no-show rate for behavioral health. Patients who come in every week or month, like cancer patients or those receiving Medication-Assisted Treatment, have shared that telehealth means they do not miss as much time from work. Providers note it is critical for caring for elderly patients, especially in rural areas, who do not have transportation or have trouble ambulating. For these reasons and many more, health care providers are making changes in their offices to accommodate for telehealth as the way of the future. It is our duty to ensure that it continues to be available to patients and so that providers in our state can do their jobs effectively.

Telemedicine laws were first enacted in NH in 2009 and have been on the forefront of health care for several years. Last year, New Hampshire lawmakers and the Governor’s Office demonstrated foresight by expanding telemedicine access in legislation that allowed primary care providers to bill Medicaid and private insurance for telemedicine visits. Efforts to expand some provisions of the law have encountered some resistance over the past decade, but there has always been forward motion. We believe that the current situation provides the urgency, the rationale, and the framework for improving and expanding our use of this technology for our health care needs.