Telemedicine & Other Capacity Building Services
Telemedicine is an important new capacity-building service that is of particular benefit in geographic areas where pediatric subspecialty care is unavailable or difficult to access. A growing number of states make extensive use of telemedicine.
In Arizona, the state uses telemedicine in collaboration with the Indian Health Service and rural primary care clinics to improve access to providers.
In Nebraska, the Title V program contracts with the University of Nebraska Medical Center to operate a “telehealth” network with all hospitals in the state. This network is used to enhance access to providers, improve the coordination of transition services for youth with special health care needs (YSHCN), and coordinate services with the Department of Education for children who have an Individualized Family Service Plan.
In Hawaii, where pediatric sub-specialty services are not available on all the islands, telemedicine is available for some sub-specialties. Telehealth is a reimbursable service; by law, face-to-face contact between a health care provider and patient is not a prerequisite for payment. Hawaii also participates in a regional collaboration with Alaska, California, Oregon, Idaho, Washington State, and Guam to improve access to genetic services and education. The sharing of resources allows underserved communities to receive care via telehealth or outreach clinics.
The Hawaii Revised Statutes (HRS) on telehealth are HRS § 431:10A-116.3, 432:1-601.5 and 432D-23.5. The HRS can be found on the Hawaii State Legislature website at http://www.capitol.hawaii.gov/site1/hrs/default.asp
Children’s Medical Services in Florida (Title V program) operates an extensive telemedicine program to facilitate access to specialists for CYSHCN, and the Florida Medicaid program pays for this service. Though not technically telemedicine, the Illinois Title V program contracts with 24 pediatric specialists around the state to provide telephone consultation to any of the 75 Title V-approved medical home providers in the state.
Several states are using telehealth to address the critical shortage of child and adolescent psychiatrists. In Iowa, pediatric psychiatric services are limited, and the state operates a telehealth behavioral health program out of thirteen Title V Children with Special Health Care Needs Regional Centers across the state. The Regional Centers utilize HIPAA compliant video conferencing technology that connects children and families to pediatric psychiatrists. The telehealth services are reimbursed through many of the state’s health plans. There is an enhanced care coordination reimbursement through the state Medicaid program for this service.
The Massachusetts Child Psychiatry Access Project addresses the critical shortage of child-trained psychiatric clinicians in the state by providing primary care practices (pediatricians and family practices) access to consultations with child psychiatrists who can immediately respond to questions about psychiatric medications, help assess the need for specialized mental health referrals and assist in making those referrals. An in-person appointment with the child can be arranged within 48 hours if necessary. The program is administered by the mental health carve out for the state’s Medicaid PCC plan, however, services are available for all children regardless of their insurance status or carrier. Seventy-eight percent of the state’s family practice and pediatric practices are enrolled (243 practices), serving over 1,170,000 children. This project improves mental health care in primary care, facilitates access to specialized mental health services, and reduces both under- and over-prescribing of psychiatric medication for children.
