Telehealth Archives - Page 2 of 34

Trending in Telehealth: September 17 – 30, 2024

by Patrick Zanayed, Lauren Ellison and Grayson Dimick | Oct 1, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Insurance and Medicaid reimbursement
Professional standards

A CLOSER LOOK

Proposed Legislation & Rulemaking:

The California governor vetoed AB 2339, which would have expanded the definition of “asynchronous store and forward” for Medicaid purposes to include asynchronous electronic transmission initiated directly by patients, including through mobile apps. The bill would have allowed Medicaid providers to establish a provider-patient relationship using asynchronous store and forward when the visit related to sensitive services.

The District of Columbia gave notice of a proposed Medicaid state plan amendment. The amendment would allow DC Medicaid to cover and reimburse for new remote patient monitoring (RPM) preventive services for eligible pregnant and postpartum individuals who are at risk of experiencing pregnancy-related morbidity or mortality issues. This amendment would include coverage for medically necessary monitoring devices, initial set-up and patient education on such devices, and collection and interpretation of the results by a healthcare professional.

The Texas Medical Board proposed repealing and replacing its telemedicine regulations. The proposed regulations are pared down from the current regulations, addressing only licensure and requirements for prescribing, and affirming that telemedicine medical services, including supervision, delegation, and posting of notices regarding filing a complaint, must be in compliance with Tex. Occ. Code C 111 and the Medical Practice Act.
At the federal level, the US House of Representatives approved the bipartisan HR 6033, which would create a task force focused on access to healthcare information technologies for non-English speakers. The bill would create best practices for:
- Facilitating and using interpreters during telemedicine visits.
- Providing accessible instructions for how to use telecommunication systems.
- Improving digital patient portals for non-English speakers.
- Integrating the use of video platforms that enable multi-person video calls via telecommunications.
- Providing patient materials, communications, and instructions in multiple languages. This would include text message appointment reminders and prescription information.

The bill defines “health information technology service providers” to include electronic medical record companies, RPM companies, and telehealth and mobile health vendors.

Finalized Legislation & Rulemaking:

Delaware enacted SB 301, which requires public universities to provide access to medication for the termination of pregnancy and emergency contraception. Although the medication and contraception must be provided onsite, the consultation to provide them may be performed through telehealth services.
Illinois enacted HB 4475, which amends the Insurance Code to address mental health and substance use parity requirements. The act provides that insured individuals have the right to select the provider or facility of their choice and modality, whether the care is provided via in-person visit or telehealth, for medically necessary mental health and substance use care.
The US Senate issued a joint resolution,
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Trending in Telehealth: August 26 – September 17, 2024

by Amanda Enyeart, Jessica Vishny and Grayson Dimick | Sep 20, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Out-of-state telehealth providers
Interstate compacts
Reimbursement requirements

A CLOSER LOOK

Proposed Legislation & Rulemaking:

California’s AB 2339 was approved by both chambers and sent to the governor for signature. The bill would expand the definition of “asynchronous store and forward” for the state’s Medicaid program, Medi-Cal, to include asynchronous electronic transmission initiated directly by patients, including through mobile apps. Existing law prohibits a healthcare provider from establishing a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, audio-only, remote patient monitoring, or other virtual communication modalities, except as specified. Among those exceptions, existing law authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services (e.g., mental or behavioral health, sexual and reproductive health, substance use disorder treatment, gender affirming care) and when established in accordance with Medicaid-specific requirements. AB 2339 would expand this exception to the use of asynchronous store and forward when the visit is related to sensitive services. Existing law also authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests that they do not have access to video. AB 2339 would remove from that exception the option of the patient attesting that they do not have access to video, and would add a parallel exception to permit the use of an asynchronous store and forward modality when the client requests.
The North Dakota Board of Medicine proposed regulations that would provide exceptions to physician licensure for telehealth providers licensed in another state, including for continuation of care received outside of the state, temporary care while the patient is located within the state temporarily, preparation for a scheduled in-person visit, practitioner-to-practitioner consultations, and emergency circumstances.

Finalized Legislation & Rulemaking:

Delaware enacted SB 331 into law. Under the act, out-of-state practitioners who wish to prescribe controlled substances in Delaware, including those who have privilege based on a telehealth registration or compact license, must obtain a Delaware controlled substance registration.
Alaska enacted SB 75 into law, entering the state into the Audiology and Speech-Language Pathology Interstate Compact.
Alaska enacted SB 91 into law. The act updates the telehealth licensure exceptions (which currently allow physicians licensed in another state to provide telehealth services in Alaska without Alaska licensure under certain circumstances) to include exceptions for members of a physician’s multidisciplinary care team. “Multi-disciplinary care team” is defined to include nurses, advanced practice registered nurses, physician assistants, social workers, psychologists, licensed professional counselors, marriage and family therapists, physical therapists, occupational therapists, and other provider types. The exception applies when such services provided are not reasonably available [...]

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Trending in Telehealth: August 13 – 26, 2024

by Amanda Enyeart and Angela Irene Theodoropoulos | Sep 4, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past two weeks:

Licensing requirements
Substance use disorder
Teleoptometry

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Maine¸ the comment period deadline passed for a Department of Professional and Financial Regulation proposed rule, which, in part, implements the legislation to establish telehealth standards, uses, and limitations for the practice of optometry. The proposed rule would establish a comprehensive framework of virtual care delivery, imposing guidelines around scope of practice, underscoring the importance of identity verification, and providing a necessary reminder about the importance of informed consent for telehealth providers. If adopted, the rule would prohibit prescribing to a patient based solely on a static questionnaire and defines telehealth to exclude the provision of optometric services exclusively through an audio-only telephone, email, text messaging, instant messaging or US mail or other parcel service. While the proposed rule states that eye examinations should generally be performed in-person, it allows for a remote interview and examination “if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis” as though care had been delivered in person.
In Nevada, the Board of Psychological Examiners adopted a final rule relating to the supervision of psychological assistants, psychological interns, and psychological trainees. The regulation imposes additional duties on the supervisor to ensure that “a psychological trainee receives at least 1 hour of individual supervision for each 10 hours of service delivery per week.” Notably, the regulation specifies that “service delivery” means “activities that involve direct contact with a client in-person or through telehealth.” Nevada currently defines “telehealth” as “the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including standard telephone, facsimile or electronic mail.”
The Oregon Criminal Justice Commission adopted a final rule to administer the state’s Jail-based Medications for Opioid Use Disorder Grant Program. The program will provide $10 million in funding to develop substance-abuse recovery programs to adults in custody. Under the rule, applicants for the grant must describe how the funds will be used to meet one of four requisite aims, including the provision of “medication, telemedicine, or any other reasonable treatment to persons in custody with an opioid disorder.”

Why it matters:

Regulators are adapting to the evolving healthcare delivery landscape. States continue to authorize telehealth care delivery for a wider range of practitioners. As evident from the proposed rule in Maine, however, such new authorizations can come with a myriad of compliance considerations, including obtaining informed consent, restrictions around prescribing, as well as heightened privacy and security concerns.
Regulators disavow a one-size-fits-all approach for virtual care delivery. As legislators and regulators become increasingly sophisticated as to the various telehealth modalities, they [...]

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Trending in Telehealth: July 30 – August 12, 2024

by Stacey Callaghan, Patrick Zanayed and Angela Irene Theodoropoulos | Aug 16, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past two weeks:

Community health
Interstate compacts
Teledentistry

A CLOSER LOOK

Finalized Legislation & Rulemaking:

The Illinois governor signed into law SB 2586. While the bill imposes certain restrictions on the practice of teledentistry, it expands patient access to care in other ways, including allowing a dentist to treat a “patient of record” to provide emergent care, or conduct an initial consultation using teledentistry for the purpose of treating or assessing acute pain, infection, injury, or certain other conditions. A “patient of record” is defined as a patient for whom the patient’s most recent Illinois-licensed dentist has obtained a relevant medical and dental history and on whom the dentist has performed a physical examination within the last year; obtained relevant records that are appropriate for the type of teledentistry service being provided from an in-person examination within the previous 12 months, including a review of the patient’s most recent x-rays; or established a relationship with the patient through an exchange of protected health information for the purpose of providing emergency care, treatment, or services. The bill expands the definition of “teledentistry” to encompass diagnosis and treatment planning. The act also prohibits a teledentistry provider from requiring a patient to sign an agreement that limits in any way the patient’s ability to write a review of services received or file a complaint with a regulatory agency.
In New Hampshire, the governor signed into law SB 403. This bill specifies that certified community health workers are permitted to provide services through telemedicine. The state defines “telemedicine” as “the use of audio, video, or other electronic media for the purpose of optimizing individual and family health outcomes.”
In Ohio, SB 90 went into effect. Passed in April of this year, this bill enacts the Social Work Licensure Compact with the purpose of facilitating interstate practice of regulated social work by improving public access to competent social work services.

Why it matters:

States are continuing to recognize the value of teledentistry. As more states develop the role of teledentistry, many are taking measures to ensure this mode of care increases access as intended while not displacing critical in-person services. For example, the latest Illinois legislation limits the practice of teledentistry to “patients of record” but allows for the use of teledentistry to provide emergent care.
State legislatures are recognizing the utility of virtual care delivery. In the past two weeks, we saw this through New Hampshire’s allowing community health workers to practice via telehealth, broadening the types of providers permitted to do so.
Interstate compacts are becoming increasingly popular alongside the adoption of telehealth. The pandemic witnessed a rise of multijurisdictional behavioral health practices which have proved to be enduring. Such multistate compacts have great [...]

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Trending in Telehealth: July 23 – 29, 2024

by Marshall E. Jackson, Jr. and Jae Hyun Lee | Aug 1, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Teleoptometry
Supervision
Naturopathic doctors

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Michigan, the governor signed SB 747 with line-item vetoes. This appropriations bill allocates money from the behavioral health initiative to nonprofit organizations to, among other things, increase the use of telehealth for behavioral health services. This bill further requires at least the same rate of reimbursement for telehealth services as services involving face-to-face contact for behavioral and physical health services provided through managed care or the fee-for-service program.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

Oklahoma proposed a rule that requires optometrists practicing telemedicine to provide services to patients located in Oklahoma consistent with their obligations under statutes and Board rules for in-person consultations, including meeting patient confidentiality requirements under HIPAA. However, the proposed rule makes clear that telemedicine encounters shall not be used to establish a valid provider-patient relationship for prescribing contact lenses and or spectacles.
Oregon adopted a rule that amends the definitions regarding supervision for occupational therapists to allow for supervision via telehealth.
Wisconsin adopted a final rule that allows for the licensure, discipline and practice of naturopathic doctors which also allows for telehealth practice.

Why it matters:

States are expanding telehealth to more healthcare professionals. Oklahoma, Oregon, and Wisconsin adopted rules expanding telehealth permissibility to various healthcare professionals including optometrists, occupational therapists and naturopathic doctors.
Legislation remains slow for the summer. As typical during the mid-to-late summer, legislative activity has slowed down, including as related to telehealth.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.

Trending in Telehealth: July 16 – 22, 2024

by Dale C. Van Demark and Jae Hyun Lee | Jul 26, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Professional standards
Hospice services
Teledentistry

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Alaska, the governor signed SB 91 that impacts out-of-state members of a multi-disciplinary team providing services to a patient located within the state. SB 91 clarifies that the out-of-state members of a multi-disciplinary team are treated the same as out-of-state physicians and it addresses the disciplinary actions that may be imposed.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

In New Hampshire, the House passed HB 1095, which standardizes the definition of telemedicine across multiple professions.
Ohio proposed two separate substantive rules eliminating the availability of services provided via telehealth. The summaries of the rule changes reference changes in federal policy since the end of the COVID public health emergency as justification for the roll-back, but do not specify the specific policy changes:
- The first rule relates to Medicaid covered services that hospice providers may or must furnish to the extent specified by the individual’s plan of care. Among the changes to the rule is the removal of language that allows core and non-core services to be provided through a combination of contracting services and telehealth services as necessary.
- The second rule addresses hospice services and includes among the changes the removal of language that allowed for the reimbursement of telehealth services where in-person visits were otherwise mandated.
Washington issued a proposal statement of inquiry regarding a possible rule implementing recent legislation which updated supervision requirements and the scope of practice for medical assistants. The bill lowered the supervision level required for the medical assistant-certified (MA-C) credential and the medical assistant-registered (MA-R) credential to provide treatment for known or suspected syphilis infections from “immediate or direct visual” supervision to “telemedicine” supervision.
Nevada proposed a rule establishing permissible services to be provided via teledentistry.

Why it matters:

States are focusing on ensuring professional standards for telehealth services. Ohio and Washington are considering proposed rules to adopt additional professional standards and scope of practice regulations concerning various healthcare professionals. Alaska also passed a bill that imposes certain disciplinary guidelines for the improper provision of telehealth services.
Teledentistry continues to be adopted by more states. Nevada is considering a proposed rule establishing provisions on teledentistry.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.

Trending in Telehealth: July 9 – 15, 2024

by Amanda Enyeart and Jae Hyun Lee | Jul 16, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Insurance and Medicaid reimbursement
Speech-language pathology and audiology
School-based health services

A CLOSER LOOK

Finalized Legislation & Rulemaking:

Florida finalized a rule updating the disciplinary guidelines for the Florida Board of Speech-Language Pathology and Audiology to describe potential disciplinary actions for certain violations by out-of-state telehealth registrants.
In Pennsylvania, Senate Bill 74, which was enacted on April 18, 2024, became effective as of July 15, 2024. The bill requires Medicaid coverage for maternity services and health insurance coverage for telehealth and in-home program services for pregnant and postpartum women.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

Oregon issued a proposed rule that would update school-based health services to add services and health plans approved by Oregon’s Medicaid State Plan Amendment, including telehealth.

Why it matters:

States are increasing access to and coverage for telemedicine services. Pennsylvania expanded access to and coverage of telehealth services for pregnant and postpartum women seeking maternity services. Additionally, Oregon is considering a rule to expand telehealth coverage for school-based health services.
Legislation is slowing down for the summer. As typical during the mid to late summer, legislative activity has slowed down across the board, including as related to telehealth.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.

Trending in Telehealth: July 2 – 8, 2024

by Amanda Enyeart and Jae Hyun Lee | Jul 12, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Insurance and Medicaid reimbursement
Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Pennsylvania, the governor signed SB 739, which amends Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to require health insurers and Medicaid and CHIP managed care programs to provide coverage for healthcare services delivered through telemedicine using a HIPAA compliant technology. This bill establishes definitions related to telemedicine, as well as requirements for health insurance and Medicaid coverage of telemedicine services.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

Delaware issued a proposed rule to amend the Delaware Administrative code concerning professional counselors of mental health and chemical dependency professionals to clarify that face-to-face supervision or counseling includes live video conferencing.
Arizona issued a notice of rulemaking to notify of its intent to amend the Arizona Board of Behavioral Health Examiners rules to make them consistent with statutory changes including: (1) amending the definition of direct client contact to include therapeutic or clinical care via telehealth; (2) registration of out-of-state providers of telehealth services; (3) removing the requirements for evidence of indirect client hours obtained during training for social workers, counselors, marriage and family therapists, and addiction counselors; and (4) implementing the interstate compact for licensed professional counselors.

Why it matters:

States are increasing access to and coverage for telemedicine services. Pennsylvania expanded access to and coverage of telehealth services across insurance providers and across the state. Additionally, Delaware and Arizona are considering rules to include live video conferencing under the definition of direct patient care.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.

Trending in Telehealth: June 25 – July 1, 2024

by Lisa Mazur and Jae Hyun Lee | Jul 2, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Interstate compacts
Medicaid reimbursement
Teledentistry
Professional standards
Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

Rhode Island entered into the following compacts:
- Social Work Licensure Compact (SB 2184)
- Counseling Compact (SB 2183)
- Speech-Language Pathology Interstate Compact (SB 2173)
- Occupational Therapy Licensure Compact (SB 2623)

Louisiana enacted HB 888 which enters the state into the Social Work Licensure Compact.
In New Hampshire, the governor signed SB 411 which requires coverage of behavioral health or mental health crisis assessments, including both in-person and telehealth services for children and youth 21 years of age and younger.
In Illinois, the governor signed SB 1 which creates the Department of Early Childhood and transfers to it certain rights, powers, duties and functions currently exercised by various state agencies. The bill makes for provision of certain programs that have the ability to utilize telehealth as an option.
Ohio adopted a final rule that provides guidance from the Chemical Dependency Professional Board regarding the ethics and professional conduct of practice for certificate holders and licensees when using telehealth.

Legislation & Rulemaking Activity in Proposal Phase: 17

Highlights:

The Ohio Senate passed SB 211 that would enroll the state in the Dietitian Licensure Compact.
The Pennsylvania Senate passed SB 739 which would amend Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to provide for telemedicine. This bill updates definitions related to telemedicine and requirements for health insurance and Medicaid coverage of telemedicine services.
The lower chamber in Pennsylvania passed HB 2268 which defines telehealth for speech language pathology and requires coverage by payors.
The upper chamber in Pennsylvania passed SB 913 which would require parental consent for virtual mental health services provided by a school entity.
The Delaware House passed SB 301 which would require public universities to provide access to medication to terminate pregnancy and emergency contraception, including requirements for accommodating a student’s request for a telehealth appointment if the student health center is not equipped or staffed to provide the medication.
In Puerto Rico, the Senate passed PS 1136 which would establish the Dental Examining Board of Dentists, Hygienists, Dental Assistants, Dental Technicians or Technologists and, among other things, develop a framework for teledentistry. The bill includes items on consent, patient information protection, definitions and other items related to teledentistry.
Mississippi published a proposed rule that amends the Department of Mental Health’s rules concerning assessments for persons receiving mental health services and/or substance use services to allow initial and subsequent visits to be provided [...]

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Trending in Telehealth: June 18 – 24, 2024

by Patrick Zanayed and Abby Higgins | Jun 28, 2024 | Telehealth

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

Interstate compacts
Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

Arizona enacted SB 1036, entering into the Social Work Compact. Arizona is the 19th state to enact this compact.
Arizona also signed SB 1267 into law, which revises the definition of “general supervision” to include supervision through telehealth for physical therapy services provided by physical therapist assistants.
In Louisiana, the governor signed HB 896, the Louisiana Remote Patient Monitoring Program Law, which establishes a patient monitoring program including definitions, eligibility, and reimbursement requirements under Medicaid. It also addresses equipment and network requirements and availability, and is aimed at patients with costly, chronic illnesses. The act goes into effect August 1,
Nevada adopted a final rule that revises social work regulations, and now clearly states that licensed social workers are not allowed to provide telehealth services to a client outside of Nevada, unless authorized under that state’s laws.
Ohio partially adopted a rule regulating the provision of personal care activities, which includes documentation requirements when the care is provided by telehealth.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

New Hampshire passed to enter into the Social Work Compact. The bill heads to the governor’s desk.
Nevada proposed a rule that would revise optometry regulations and what is required of an optometrist before providing optometry services via telehealth, such as reviewing the patient’s chart and, if prescribing ophthalmic lenses, performing a manifest refraction.
Although not a formal rule, the Washington Insurance Commissioner is seeking feedback on amending telehealth-related rules. Specifically, the Office of the Insurance Commissioner (OIC) is considering consolidating healthcare regulations be consistent with state and federal changes. This would include amending definitions related to “established relationship” as it applies to audio-only telemedicine services. Interested parties can reach out to the OIC.

Why it matters:

Interstate compacts continue to grow. As we’ve seen consistently, states continue to join interstate compacts. This week, Arizona became the 19th state to enact the Social Work Compact, which New Hampshire introduced legislation to enroll into. Three other states have also introduced or fully enacted legislation to enroll in the Social Work Compact this year so far.
States are expanding the use of technology related to telehealth. Multiple states have legislation and regulations that account for difference in documentation when using telehealth or other technology, versus traditional in-person care. This week, Nevada a proposed rule that establishes standards of care specifically for providing optometry services via telehealth, and Ohio partially adopted a rule which factors in the automatic record creation of certain technologies. This push to incorporate technology is also evident in Louisiana’s passing of the Remote Patient Monitoring [...]

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