Telehealth Archives - Page 6 of 33

Telehealth

Trending in Telehealth: September 26, 2023 – October 10, 2023

by Purnima Boominathan and Ashley Ogedegbe | Oct 13, 2023 | 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:

Reproductive Health
Telehealth Practice Standards
Interstate Compact
Disciplinary Guidelines
Regulatory Licensing

A CLOSER LOOK
Finalized Legislation and Rulemaking

California signed into law SB 345, which goes into effect on January 1, 2024. The legislation states that California law applies to any civil, administrative or criminal proceeding involving individuals (that is, patients) located inside and outside of California engaged in providing, receiving, supporting, or attempting to provide or receive reproductive health and gender-affirming healthcare services via telehealth or other means. This “shield law” also provides legal protections for healthcare practitioners located in California who provide or dispense medication or other services for abortion, contraception or gender-affirming care to out-of-state patients. These protections apply regardless of the provider’s location during the activity. This law also prohibits California law enforcement, government officials or government contractors from cooperating with out-of-state prosecutions related to abortion, contraception or gender-affirming care. The law prohibits California-based corporations, including social media and tech companies, from disclosing to law enforcement any private patient communication regarding healthcare that is legally protected in the state.
New Hampshire enacted legislation effective October 7, 2023, that amends the prior law to permit out-of-state healthcare professionals to treat patients in the custody of the Department of Corrections via telemedicine, without a New Hampshire license, as long as the professionals are licensed in the state where they provide services. The prior law required all out-of-state healthcare professionals providing telehealth services to be licensed in New Hampshire, regardless of the patient’s location.

Legislation and Rulemaking Activity in Proposal Phase
(more…)

How Not to Lose $1 Million: Preparing for OIG’s Information Blocking Enforcement

by James A. Cannatti III and Alya Sulaiman | Oct 4, 2023 | Consumer Protection, Data Privacy, Data Transfers/Safe Harbor/Privacy Shield, Telehealth

OIG’s long-awaited final rule on investigating and imposing penalties for information blocking dropped in July 2023 and is effective as of Sept. 1, 2023 – almost three years after OIG released its proposed rule (April 2020) and two years after the start of information blocking compliance on April 5, 2021. The final rule codifies OIG’s authority to investigate information blocking complaints, including against developers of certified health IT and health information networks/health information exchanges (HIN/HIEs), and assess CMPs of up to $1 million per violation.

OIG defined a “violation” as a practice that constitutes information blocking as set forth in ONC’s information blocking regulations—a broad definition that is important because each distinct act or omission could be subject to a separate $1 million CMP. OIG also provided examples of what it would consider constituting a single violation versus multiple violations subject to multiple CMPs:

Single Violation: A certified health IT developer denies a single request by a healthcare provider to receive multiple patients’ EHI via an API and no legal requirement or information blocking exception applies. OIG would consider this a single violation even though it would result in preventing access to multiple patients’ EHI.
Multiple Violations: A certified health IT developer takes multiple separate actions to improperly deny multiple individual requests by a healthcare provider for EHI through an API. Each separate action would be considered a separate violation.

OIG has stated that while it does not intend to impose CMPs on conduct that occurred before Sept. 1, 2023, it may consider a regulated entity’s behavior from the April 2021 compliance date onwards in deciding if alleged information blocking conduct was part of a pattern of behavior. Other factors OIG anticipates considering when deciding penalty levels include the nature, circumstances, and extent of the information blocking and resulting harm, including the number of patients and/or providers affected and the number of days the information blocking persisted. OIG will also consider other factors, such as the degree of culpability, history of prior offenses, and other wrongful conduct.

When deciding whether to pursue a particular information blocking allegation, OIG indicated that it plans to prioritize enforcement for actions that:

Resulted in/had the potential to cause patient harm;
Significantly impacted providers’ ability to care for patients;
Are of long duration;
Caused financial loss to Medicare, Medicaid, or other federal healthcare programs or private entities; and
Were performed with actual knowledge.

Each allegation will require a facts and circumstances analysis, which OIG will conduct in coordination with ONC and other federal agencies as appropriate. Further, while OIG’s enforcement priorities may inform its decisions about which allegations to investigate, OIG states that the priorities are not dispositive, meaning it can investigate any allegations it chooses.

READ THE FULL ARTICLE ON THE HIMSS ELECTRONIC HEALTH RECORD ASSOCIATION BLOG HERE.

Weight-Loss Programs in Florida: State Law Considerations for GLP-1 Telehealth Providers

by Purnima Boominathan and Jayda Greco | Sep 29, 2023 | Telehealth

As more telehealth providers offer weight-loss programs, they should be aware of the potential impact of state laws and regulations. In this blog post, we take a closer look at Florida’s consumer protection laws regarding weight-loss programs.

OVERVIEW

While many providers are familiar with Florida’s Standards for the Prescription of Obesity Drugs (Fla. Admin. Code 64B8-9.012, see Final with ID: 26115424), providers may not be as familiar with the Florida Commercial Weight-Loss Practices Act. The Commercial Weight-Loss Practices Act, enacted in 2000 (Fla. Stat. 501.057 – Fla. Stat. 501.0581) broadly applies to weight-loss providers, which includes any person engaged in the business of offering services to consumers to assist them in losing weight and making oral or written statements, visual descriptions, advertisements or other representations that have the capacity, tendency or effect of leading consumers to believe that participation in a weight-loss program will result in weight loss. See Fla. Stat. 501.0571(5). Additionally, weight-loss providers are required to:

Provide to a consumer a written, itemized statement of the fixed or estimated cost of the weight-loss program that is being recommended, including all additional products, services, supplements, examinations or laboratory tests the consumer may be required to purchase from the weight-loss provider as part of such program
Disclose the actual or estimated duration of the recommended weight-loss program
Provide, upon request, a copy of the educational and professional experience of the weight-loss provider’s staff
Provide the name, address and qualifications of the person who has reviewed and approved the weight-loss program, according to section 468.505(1)(j)
Produce and distribute to all consumers who inquire about their weight-loss program a palm-sized card with the Weight-Loss Consumer Bill of Rights printed on it
Post conspicuously the Weight-Loss Consumer Bill of Rights at the front registration desk in each weight-loss program location and require every agent, representative, franchisee or independent contractor to post such a bill of rights in a prominent place in every room in which a presentation or sale of a weight-loss program is made or in which a product or treatment is offered for sale

See Fla. Stat. 501.0573.

Notably, the Weight-Loss Consumer Bill of Rights is a required, separate consumer-facing document that requires disclosure that “rapid weight loss may cause serious health problems,” among other safety disclosures and protections intended for disclosure before beginning a weight-loss program.

KEY TAKEAWAYS

Florida’s Commercial Weight-Loss Practices Act is a reminder that telehealth providers should look beyond the telehealth and prescribing regulations in each state. For telehealth providers operating in a number of states, an in-depth review of all of the relevant state laws and regulations is critical to capture the framework of applicable laws and regulations across the spectrum of health and consumer protection. For providers without in-person practice locations, there are often other strategies that meet the relevant requirements and can ensure compliance with these laws.

Telehealth is an important development in care delivery, but the [...]

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Trending in Telehealth: September 19 – 25, 2023

by Patrick Zanayed and Jayda Greco | Sep 28, 2023 | 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 Coverage
Telehealth Practice Standards
Telehealth Access

A CLOSER LOOK

Finalized Legislation and Rulemaking

New Hampshire enacted HB 409, which enacts the Social Worker Licensure Compact.
Louisiana adopted rulemaking regarding Medicaid coverage for physician-directed treatment-in-place ambulatory services. The rule allows such services to be provided via telehealth when the provider meets certain requirements, such as enrollment and notification to the Department of Health.
Alaska adopted rulemaking that provides eligibility requirements and defines the scope of services for delivering psychological care through electronic means while physically separate from the recipient. The regulations require applicants for a courtesy license to be licensed in another jurisdiction where the licensing requirements are at least equivalent to those in Alaska.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

As mentioned in last week’s update, California progressed two bills that are now awaiting the governor’s signature.
- AB 1478 was presented to the governor on September 20, 2023. The bill would require the State Department of Public Health to maintain, on its website, a database of referral networks for community-based mental health providers and support services addressing postpartum depression and prenatal care, and information on mental health providers and support groups that allow patient-driven care access, including telehealth and virtual care.
- AB 48 also was presented to the governor on September 20. The bill would require the State Department of Public Health, in consultation with interested stakeholders, to develop a standardized informed consent form which would then need to be available to skilled nursing facilities and intermediate facilities by December 31, 2025. Additionally, the bill would permit prescribers to use remote technology, including telehealth, to examine patients and obtain the above mentioned informed written consent.
Ohio proposed rulemaking specifying the requirements for delivery of services by speech-language pathologists and audiologists via telehealth, such as licensure and encryption requirements and guidelines for assessing whether telehealth is appropriate based on the patient’s condition.

Why it matters:

Increased activity in California continues. California continues to move forward with legislation to address access to healthcare services via telehealth. While they increase access, these bills are addressed to specific sites of care, such as nursing facilities, reflecting an openness to telehealth under specific circumstances.
States are focused on Medicaid reimbursement for telehealth services. This week, we saw Louisiana adopt rulemaking regarding Medicaid coverage for physician-directed treatment-in-place ambulatory services.
Telehealth practice standards remain a focus. Alaska and Ohio’s enacted and proposed rulemaking, respectively, continue the trend of states expanding on telehealth practice standards for non-physician licensees.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott digital health team [...]

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Trending in Telehealth: September 5 – 18, 2023

by Amanda Enyeart and Jayda Greco | Sep 22, 2023 | Telehealth

Trending in the past week:

Medicaid Coverage
Broadband Access
Behavioral Health and Substance Use Disorder Treatment
Practice Standards Across Licensee Types

A CLOSER LOOK

Finalized Legislation and Rulemaking

California enacted AB 1241, which was presented for signature last week. As noted in our prior updates, the bill will loosen certain requirements related to the virtual delivery of care within the Medi-Cal program.
Maryland made effective a host of non-substantive rulemaking updates related to professional standards for telehealth across a variety of licensee types, including optometrists, massage therapists, social workers, dietitians, chiropractors, audiologists, speech language pathologists, hearing aid dispensers, music therapists, physical therapists, occupational therapists and professional counselors. The final rules provide clarity by removing language regarding the physical location of a practitioner or patient when providing telehealth and by removing ambiguous and other language to be consistent with telehealth regulations adopted by other health occupations boards.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

California progressed several bills to the engrossing and enrolling stage and to the governor for signature.
- AB 965 moved from the second committee to the governor for signature. The bill is an amendment to the Permit Streamlining Act that would require local agencies that process applications for the construction of broadband projects to simultaneously process multiple broadband permit applications for substantially similar projects under a single permit (so-called batch broadband permit processing), with the goal of ensuring a more efficient broadband approval process.
- AB 1369 also progressed from the second committee to the governor for signature. This legislation provides that a person licensed as a physician and surgeon in another state would be authorized to deliver healthcare via telehealth to a patient who, among other requirements, has a disease or condition in which there is a reasonable likelihood of death within a matter of months.
- AB 1478 was enrolled on September 14, 2023. The bill would require the State Department of Public Health to maintain, on its website, a database of referral networks of community-based mental health providers and support services addressing postpartum depression and prenatal care, information on mental health providers and support groups that allow patient-driven care access, including telehealth and virtual care.
- AB 912 was enrolled on September 16, 2023. The bill would authorize school-based health centers to provide primary medical care, behavioral health services or dental care services on site or through mobile health or telehealth.
- AB 48 was sent to engrossing and enrolling on September 13, 2023. The bill would add nursing [...]
  
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Trending in Telehealth: August 29 – September 5, 2023

by Dale C. Van Demark and Jayda Greco | Sep 8, 2023 | Telehealth

Trending in the past week:

Medicaid Reimbursement of Behavioral Health Services
Practice Standards for Counselors and Therapists
Technology and EHR access

A CLOSER LOOK

Finalized Legislation and Rulemaking

West Virginia enacted emergency rulemaking, effective October 12, 2023, that establishes the scope of practice for the provision of counseling services via telehealth technologies and the process for licensed professional counselors or licensed marriage and family therapists to obtain an interstate telehealth registration with the West Virginia Board of Examiners in Counseling. This rule ensures continuity of care while existing patients are either transitioning to become a resident of another jurisdiction or temporarily located in another jurisdiction.
Washington, DC, adopted an emergency rule, effective September 1, 2023, that reimburses the use of audiovisual telehealth visits in the Assertive Community Treatment (ACT) program within DC Medicaid.
Mississippi finalized rulemaking, effective October 1, 2023, regarding Medicaid coverage for continuous glucose monitoring services via telemedicine.
Oklahoma finalized rulemaking, effective September 11, 2023, that allows for onsite and mobile crisis intervention services to be provided in person or via telehealth.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

California’s state legislature presented AB 1241 to the governor on August 30, 2023. If signed, the bill will loosen certain requirements related to the virtual delivery of care within the Medi-Cal program. Existing law requires providers that furnish services through video synchronous interaction or audio-only synchronous interaction to also either offer those services in person or arrange for a referral to, and a facilitation of, in-person care. That requirement will go into effect by a date set by the State Department of Health Care Services, but no sooner than January 1, 2024. Under AB 1241, providers will instead be required, in the above-described circumstance, to maintain protocols for patient referral to appropriate in-person care when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.
California’s state legislature progressed AB 965.The bill is an amendment to the Permit Streamlining Act that would require local agencies that process applications for the construction of broadband projects to simultaneously process multiple broadband permit applications for substantially similar projects under a single permit (so-called “batch broadband permit processing”), with the goal of a more efficient broadband approval process.
California also progressed AB 1369 to the Second Committee. This legislation provides that a person licensed as a physician and surgeon in another state would be authorized to deliver healthcare via telehealth to a patient who, among other requirements, has a disease or condition in which there is a reasonable likelihood of death within a matter of months.
Alaska proposed rulemaking to [...]

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Trending in Telehealth: August 22 – 28, 2023

by Stacey Callaghan and Abby Higgins | Aug 30, 2023 | Telehealth

Trending in the past week:

Update to Standards of Care
Youth Programs

A CLOSER LOOK

Finalized Legislation and Rulemaking

Louisiana finalized regulations (beginning on page 21) related to Early and Periodic Screening, Diagnosis and Treatment (EPSDT). The regulations exclude telemedicine as a covered service for consultations but do state that telemedicine is an “applicable service method.” Specifically, the new regulations state that “[w]hen otherwise covered by Louisiana Medicaid, telemedicine/telehealth is allowed for all CPT codes located in Appendix P of the CPT manual. This service is available to all Medicaid individuals eligible for EPSDT.”
Ohio adopted rules related to the use of telehealth by Ohio State Chiropractic Board licensees, amending the practice guidelines for chiropractors in the state. This update includes information on approved modalities, allowing the use of both synchronous and asynchronous technologies. This new rule also explicitly states that an Ohio license is required for practicing within the state.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

California’s state legislature has passed AB 1241, which relates to the Medi-Cal program. Existing law requires providers furnishing services through video synchronous interaction or audio-only synchronous interaction to also either offer those services in-person or arrange for a referral to and facilitation of in-person care by a date set by the department, but no sooner than January 1, 2024. AB 1241 would instead require a provider to maintain protocols for patient referral to appropriate in-person care when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction. This has passed both houses of the California State Legislature, with amendments being accepted by the California State Assembly on August 24, 2023. It now heads to the governor.
Florida has proposed an amendment to the registration regulations for out-of-state providers providing care via telehealth. While not incredibly substantive, the amendment updates the application that out-of-state providers must submit to practice within the state. The updated application is not yet available.
Louisiana has proposed changes (beginning on page 143) to certain regulations related to the provision of care to School-Based Health Centers (SBHCs). This includes a proposed regulation for SBHCs to provide convenient access to preventive and acute care services for students who might otherwise have limited or no access to healthcare, including through telehealth.
New Jersey has proposed adding definitions to regulations related to the home health standards of care for telehealth and telemedicine in order to keep abreast with newer technology. Specifically, the amended N.J.A.C. 8:42-6.7 would permit the telehealth services to be offered in addition to, but not in lieu of, direct patient care.
Tennessee has a fast-moving bill that has passed the state senate and [...]

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Trending in Telehealth: August 15 – 21, 2023

by Purnima Boominathan and Abby Higgins | Aug 25, 2023 | Telehealth

Trending in the past week:

Expansion of Telehealth Services
Broadband Access
Clarity on Supervision Requirements

A CLOSER LOOK

Finalized Legislation and Rulemaking

Colorado moved, but did not amend or modify, the supervising requirements for physician supervisors to 3 CCR 713-1 Rule 1.15 .
The District of Columbia finalized and adopted rules for the practice of professional art therapy, addressing practice standards and licensure relating to the use of telehealth in this area of practice.
Maryland finalized a rule related to participation in the Medicaid program for podiatrists, which includes required compliance with telehealth regulations. Maryland also finalized regulations related to home care for disabled children, allowing care to be provided, under certain circumstances, through “audio-visual telehealth” in accordance with other Maryland telehealth requirements.
New Hampshire’s governor signed a bill that provides an exception to New Hampshire licensing requirements for out-of-state healthcare professionals treating patients in the custody of the state’s department of corrections, provided the out-of-state healthcare professionals are licensed, certified or registered by and are in good standing with the appropriate licensing body within the professional’s state of practice. The bill goes into effect on October 7, 2023.
New Hampshire also amended an existing parentage-related law to permit a mental health consultation to be conducted via telehealth. This amendment went into effect on August 19, 2023.
Oklahoma adopted emergency regulations related to reimbursement by the state Medicaid program, including a new section for definitions and standards for audio-only health services.
Oregon permanently repealed a rule addressing COVID-19 workplace risks, which in part included telehealth information. This rule had previously been temporarily suspended, so no significant impact is expected.
South Dakota adopted changes to the licensure regulations for speech-language pathologists, which removes the definition of “telepractice.” The rule now refers to the definitions section of South Dakota codified laws §36-37-1 and §36-37-2.
Tennessee finalized rules related to healthcare facility licensing, specifically requiring rural emergency hospitals to include a description of additional services provided within the licensing application, citing telehealth services as an example of additional services to be included.
Texas amended the telemedicine, telehealth and teledentistry rule (§133.30) within the Texas Administrative Code. The amended section implements §413.011 of the state’s Labor Code, which requires the Texas Department of Insurance to adopt healthcare reimbursement policies and guidelines related to workers’ compensation that reflect the standardized reimbursement structures found in other healthcare delivery systems. Interestingly, §413.011 requires the commissioner of workers’ compensation to adopt the current reimbursement methodologies, models and values or weights used by the federal Centers for Medicare & Medicaid Services.
Washington finalized two rules [...]

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Trending in Telehealth: August 8 – 14, 2023

by Lisa Mazur and Abby Higgins | Aug 17, 2023 | Telehealth

Trending in the past week:

Expansion of Telehealth Services
Jurisdictional Clarifications for Providers

A CLOSER LOOK
Finalized Legislation and Rulemaking

Maryland amended the requirements for participation in the state’s medical assistance program for advanced practice registered nurses to explicitly require compliance with the state’s telehealth rule in COMAR 10.09.49.
Oregon has finalized a rule related to the licensing of optometrists in either a public health emergency or state emergency, incorporating telehealth licenses into the relevant provisions.
Wisconsin adopted regulations that would expand reimbursement under the state’s medical assistance program for certain services provided via telehealth. This rule, which focuses on mobile crisis units, is a result of a directive by the Wisconsin legislature to determine which services provided via telehealth should be reimbursed under the medical assistance program. This was only a partial adoption of rules proposed earlier this year.

Legislation and Rulemaking Activity in Proposal Phase
Highlights:

Illinois has proposed a rule (page 234) that expands and clarifies the definition of telemedicine in the context of hospital licensing to include provider-to-provider consultations with physicians licensed in the United States.
Illinois has also signed into law its enrollment into the Counseling Compact through an amendment to the Professional Counselor and Clinical Professional Counselor Licensing and Practice Act. Illinois joins more than 30 other states that are part of this intrastate compact.
Massachusetts has proposed regulations related to the provision of doula services, which includes defining the standard of care in terms of telehealth.
West Virginia has proposed regulations (page 20) for best practices related to the provision of sexual assault care. This includes providing the initial evaluation via a telehealth service called teleSANE, which would require additional training for relevant providers.

Why it matters:

States are expanding services that can be provided via telehealth. States continue to identify new service areas in which telehealth can be utilized. Examples include the newly proposed bills related to sexual assault examinations in West Virginia and doula services in Massachusetts. As telehealth has become more common, states have expanded opportunities for telehealth services into more specialized fields.
Jurisdictional questions are being more clearly defined in state regulations. Some states have recently provided clarification for providers who are not physically present in the state, clearing up questions regarding what it means to be practicing within a state. For example, although only applicable in an emergency, the Oregon optometry licensing change specifically addresses physical location. Additionally, Illinois’s enrollment in the Counseling Compact expands and standardizes out-of-state practice for certain provider types.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott digital health team works alongside the [...]

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Trending in Telehealth: August 1 – 7, 2023

by Patrick Zanayed and Abby Higgins | Aug 14, 2023 | Telehealth

Trending in the past week:

Professional Practice Standards

A CLOSER LOOK
Finalized Legislation & Rulemaking

A law creating the Continuum of Care Program in Arkansas went into effect on July 31, 2023, permitting care coordination of certain reproductive health services to be conducted via telemedicine.
Illinois updated the Hearing Instrument Act, allowing patients 18 years or older to be evaluated for a hearing aid prescription via telehealth. Patients who are 17 years or younger still must have an in-person visit to obtain a prescription. These updates are not effective until January 1, 2024.
The Medical Care Program in Maryland adopted updated standards for physical therapy services provided via telehealth. This update generally aligns those requirements with broader telehealth standards in the state.
Massachusetts passed an emergency rule permitting mobile crisis intervention care to be provided via telehealth and still be eligible for reimbursement under government health care programs. These emergency measures went into effect on August 1, 2023, and will be made permanent pending federal approval.
Oklahoma revised the standards surrounding community mental health centers (CMHCs) and certified community behavioral health clinics to add telehealth encounters to the definition of “face to face” visits. This term is used to determine psychotherapy or therapy services provided by CMHCs, which provide certain assessments and emergency services throughout the community.
The Kentucky Board of Optometric Examiners updated telehealth standards for optometrists, including regulations permitting the provision of services by optometrists physically located outside of Kentucky, via telehealth in certain situations.
Kentucky also passed an emergency rule to address the shortage of social workers. Unlike optometrists, social workers must be physically located within the Commonwealth to use telehealth to care for Kentucky patients.
Texas passed an amendment to the physical therapy practice standards for early childhood intervention care, which permits certain previously onsite-only care to be conducted via telehealth.
New standards related to the use of telemedicine within the practice of occupational therapy in Wisconsin have gone into effect as of August 1, 2023. To note, the initial regulations proposed were not fully accepted, the Wisconsin Occupational Therapists Affiliated Credentialing Board adjusted the regulations after the public comments.