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Corporate Transparency Act: Key Considerations for Virtual Care Providers

by Lisa Mazur, Stacey Callaghan and Grayson Dimick | Mar 12, 2024 | Telehealth

As of January 1, 2024, the US Corporate Transparency Act (CTA) requires corporations, limited liability companies, limited partnerships and other similar entities to disclose beneficial ownership information to the Financial Crimes Enforcement Network (FinCEN), a bureau within the US Department of the Treasury. Although the US District Court for the Northern District of Alabama declared the CTA unconstitutional in March 2024, the decision in the underlying case is limited to the plaintiff. Therefore, all other entities – including virtual care providers – are still required to comply with the CTA.

Following are key considerations for virtual care providers utilizing friendly PC structures.

Are professional entities (i.e., PCs, PLLCs, PAs) subject to CTA reporting requirements? Yes. The CTA includes certain exemptions, but these are unlikely to apply to a professional entity formed to provide virtual care services.
To whom do CTA reporting requirements apply? The reporting obligation is on the reporting company (i.e., the entity formed by a filing in a US state) – not on the beneficial owners or the person or entity assisting with the formation of the reporting company (i.e., the company applicant, defined as the individual who directly files the document that forms the reporting company and the individual who is primarily responsible for directing or controlling such filing if more than one individual is involved in the filing, with no more than two company applicants). However, individuals and entities other than the reporting company can be held liable for willful violations of the CTA (e.g., an individual who willfully fails to report complete beneficial ownership information or an individual who files – or causes the filer to file – false information with FinCEN).
What reporting is required? The reporting company must visit FinCEN’s Beneficial Ownership Information (BOI) website to complete and file a beneficial ownership information report (BOIR). Reporting companies formed before January 1, 2024, have until January 1, 2025, to file a BOIR; those formed during 2024 must file a BOIR within 90 calendar days of the effective date of formation; and those formed on or after January 1, 2025, will have 30 calendar days to file a BOIR.
Who are beneficial owners? Are friendly physician owners beneficial owners? Reporting companies must identify each of their beneficial owners, defined as any individual who, directly or indirectly, exercises substantial control over the reporting company or who owns or controls at least 25% of the ownership interests in a reporting company. Individuals with substantial control include senior officers (e.g., president, chief executive officer, chief operating officer, chief financial officer and general counsel), as well as anyone who can make important decisions on behalf of the reporting company, including the power to appoint and remove senior officers or a majority of the board of directors (or similar governing body). Accordingly, friendly physician owners are likely to be beneficial owners.
What information must be reported in a BOIR? Reporting companies must provide the following information:

How to Prepare for New State Health Privacy Laws

by McDermott Will & Emery | Mar 8, 2024 | Data Privacy

New state privacy laws regulating health data impose significant obligations and heightened risks. In addition to existing laws in California, Colorado and other states, Washington State’s My Health My Data Act and Nevada’s Consumer Health Data Privacy Law take effect in March 2024 and will require new or updated privacy notices, enhanced consent and many other compliance steps. Increasing regulator scrutiny of these issues and a new private cause of action in Washington make these laws top compliance priorities.

These laws impact entities ranging from healthcare providers and plans handling non-HIPAA health information online to pharmaceutical, fitness, wellness, identity verification and consumer goods companies. Join our health information privacy lawyers Elliot Golding and Sam Siegfried on March 12 to understand how these laws apply to your company and what you need to do now to prepare.

Discussion topics include:

The scope, applicability and requirements under state privacy laws related to health data
A deep dive into complex issues arising under these laws, such as the use of cookies and online tracking technologies
Benchmarking and practical recommendations for complying with these new requirements and building a harmonized compliance program

RESERVE YOUR SPOT

Trending in Telehealth: February 27 – March 4, 2024

by Amanda Enyeart and Nathan Gray | Mar 7, 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
Expanding telehealth
Regulation of teledentistry

A CLOSER LOOK

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

In Arizona, HB 2446 passed the first chamber. If enacted, the bill would establish licensing requirements for dietician nutritionists and nutritionists, which would allow for the delivery of dietetic and nutrition services via telehealth.
In Florida, HB 849 passed both chambers. If enacted, the bill would establish requirements for the delivery of veterinary telehealth services by Florida-licensed veterinarians.
In Florida, HB 855 passed both chambers. If enacted, the bill would, among other changes, require dental practice to designate a dentist of record with the Florida Board of Dentistry. It would also require dentists to perform an in-person examination of a patient or to obtain records of an in-person evaluation before initiating orthodontic treatment. The proposal would also require that dentists placing advertisements of dental services provided through telehealth include a disclaimer recommending an in-person examination for each of the following services: an impression or digital dental scan, denture services, placement of an appliance or other structure, and orthodontic treatment. Under the proposal, failure to comply with the evaluation requirement and failure to provide patients with contact information of each dentist who is providing dental services to a patient would be grounds for discipline.
In Georgia, HB 844 passed the first chamber. If enacted, the bill would establish licensing requirements for dietician nutritionists and nutritionists, which would allow for the delivery of dietetic and nutrition services via telehealth.
In Georgia, HB 441 passed the first chamber. If enacted, the bill would, among other requirements, require a dentist intending to provide care via teledentristry to notify the Georgia Board of Dentistry and to provide documentation that the dentist had established a referral relationship with a dentist capable of providing in-person dental care at a location within the state meeting certain geographic requirements. A dentist providing teledentistry would be permitted to authorize dental hygienists to perform certain dental hygiene functions, prescribe noncontrolled prescriptions and authorize the performance of digital scans and the transmission of patient records to the dentist. The proposed bill would require dentists to perform an initial in-person examination and an in-person exam at least once every 12 months to provide teledentistry services to a patient, except for patients seen in certain specified settings. It would also require dentists to obtain written authorization to a patient with information about the treating dentist and dental hygienist and obtain informed consent after providing a written statement advising the patient that teledentistry was not equivalent to an in-person clinical exam and that the dentist would not physically be present. The bill would prohibit an insurer from excluding coverage for a service [...]

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Trending in Telehealth: February 12 – February 26, 2024

by Amanda Enyeart, Dale C. Van Demark and Grayson Dimick | Mar 7, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

South Dakota enacted the Counseling Compact, making it the 33rd state to ratify the compact.
South Dakota also adopted HB 1029, which specifies that licensed hearing aid dispensers and audiologists can deliver services via telehealth provided they are of the same quality as services delivered face-to-face.
In Texas, the Commission of Licensing and Regulation adopted rules that reorganize and revise telehealth standards for behavioral analysts. The changes include better aligning the telehealth practice standards with those for other professions regulated by the Department of Licensing and Regulation. Similarly, the Commission of Licensing and Regulation adopted a rule addressing supervision for behavioral analysts, which includes provisions addressing supervision via telehealth.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

In Arizona, SB 1036 passed the first chamber. If enacted, the bill would enact the Social Work Licensure Compact.
In Florida, SB 7016 passed both chambers. If enacted, the bill would enter Florida into the Interstate Medical Licensure Compact.
In Louisiana, the Behavior Analyst Board proposed rules governing behavioral analyst practice, including establishing telehealth practice standards.
In Oklahoma, the Board of Examiners in Optometry proposed rule 505:10-5-19 that would address telemedicine practice by optometrists and, among other things, prohibit an optometrist from prescribing contact lenses or spectacles via a telemedicine encounter. The rule would also establish requirements for informed consent and practice requirements associated with a telemedicine visit.
In Tennessee, SB 2134 and HB 2405 each passed one chamber. If enacted, the bills would enact the Social Work Licensure Compact.
In Utah, SB 24 passed both chambers. If enacted, the bill would require Medicaid reimbursement for telepsychiatric consultations between a physician assistant and a psychiatrist. The law currently requires reimbursement only for telepsychiatric consultations between a physician and a psychiatrist.
In Virginia, HB 326 passed the first chamber. If enacted, the bill would enter Virginia into the Counseling Compact.
In West Virginia, HB 4110 passed the first chamber. If enacted, the bill would authorize the state’s Board of Licensed Dietitians to promulgate a legislative rule relating to telehealth practice, requirements and definitions.
In Wisconsin, SB 158 passed both chambers and awaits the governor’s signature. If enacted, the bill would enact the Social Work Licensure Compact.

Why it matters:

States continue to increase activity surrounding licensure compacts for a variety of health professionals. These state efforts ease the burdens of the licensing process and demonstrate a desire to facilitate multijurisdictional practice without giving up [...]

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Trending in Telehealth: February 5 – 12, 2024

by Amanda Enyeart and Grayson Dimick | Feb 15, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Facilitation of connectivity and data exchange
Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

South Dakota enacted the Social Work Licensure Compact, becoming the second state to enact the compact. Missouri enacted the compact in July 2023. The compact will become active once enacted by seven states. According to the National Center for Interstate Compacts, 24 other states have introduced the compact.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

In Idaho, HB 393 passed the first chamber. If enacted, it would enter Idaho into the Counseling Compact.
In Indiana, SB 132 passed the first chamber. Currently, Indiana law provides that an out-of-state provider licensed in Indiana may not provide telehealth services in Indiana until the provider and their employer/contractor have filed a certification with the Indiana Professional Licensing Agency that the provider and employer/contractor agree to be subject to Indiana jurisdiction and Indiana substantive and procedural laws. If enacted, the bill would remove the requirement to file the certification, though providers would still be subject to Indiana jurisdiction and Indiana substantive and procedural laws, and the provision of health services (rather than the filing of the certification) would constitute a voluntary waiver of other jurisdictional rights.
In West Virginia, HB 5310 passed the first chamber. If enacted, the bill would enact the Remote Patient Outcome Improvement Act to authorize insurers and providers to partner with internet service providers to facilitate the transmission and analysis of vital signs and medical device data.
In Wisconsin, the Marriage and Family Therapy, Professional Counseling and Social Worker Examining Board proposed a rule that would update telehealth practice standards by defining telehealth, creating of a new subsection that establishes standards of telehealth practice, amending the definitions of “face-to-face” and “supervision” to include telehealth practice, and amending of unprofessional conduct provisions to incorporate telehealth practice.

Why it matters:

States continue to increase activity surrounding licensure compacts for a variety of health professionals. These state efforts ease the burdens of the licensing process and demonstrate a desire to facilitate multijurisdictional practice without giving up authority over professional licensure.
Measures emphasizing connectivity and infrastructure complement the increasing availability of reimbursement for remote monitoring and other virtual care modalities. States propose measures such as West Virginia’s Remote Patient Outcome Improvement Act with the expectation that they will help reduce costs of avoidable emergency room and other medical visits when paired with remote monitoring programs.
States continue to amend and clarify professional practice standards for telehealth. With the increase in the delivery of care through virtual modalities, professional boards are adopting standards governing telehealth practice across multiple health professions and revising [...]

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Trending in Telehealth: January 29 – February 5, 2024

by Lisa Mazur and Grayson Dimick | Feb 9, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Medicaid coverage
Private payor coverage

A CLOSER LOOK

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

In Michigan, HB 4579 and HB 4580 passed both chambers. If enacted, the bills would require coverage parity of telehealth services in health plans and Medicaid, respectively.
In New Hampshire, SB 318 passed the first chamber. If enacted, the bill would enter New Hampshire into the Social Work Licensure Compact.
In South Carolina, H 4159 passed both chambers. If enacted, the bill would create a new “South Carolina Telehealth and Telemedicine Modernization Act,” which would regulate all licensees providing services via telehealth. The bill would also revise the Medical Practice Act statutes related to telehealth, including addressing ongoing care provided by an out-of-state physician not licensed in telehealth, as well as implementing standards for licensees solely providing services via telehealth (including evaluation, recordkeeping, follow-up care and prescribing standards).
In South Dakota, HB 1012 and HB 1015 passed the first chamber. If enacted, the bills would enter South Dakota into the Counseling Compact and Social Work Licensure Compact, respectively.
In Tennessee, SB 1862 and HB 1863 passed the first chamber. If enacted, the bills would enter Tennessee into the Dietitian Licensure Compact.
In Tennessee, HB 2461 and SB 1674 passed the first chamber. If enacted, the bills would allow for Tennessee’s Medicaid program to reimburse qualifying remote ultrasound procedures and remote fetal nonstress tests when the patient is in a residence or other off-site location that is separate from the patient’s provider and the same standard of care is met.
In Utah, HB 44 passed both chambers. If enacted, the bill would enter Utah into the Social Work Licensure Compact.
In Utah, SB 24 passed the first chamber. If enacted, the bill would amend the statute providing for Medicaid reimbursement for telepsychiatric consultations to require coverage for telepsychiatric consultations conducted by physician assistants.
In Virginia, SB 2500 passed the first chamber. If enacted, the bill would require the Virginia Department of Medical Assistance Services to modify the state plan for medical assistance to include a provision allowing for reimbursement for remote ultrasound procedures and remote fetal nonstress tests under certain conditions.

Why it matters:

There continues to be an increase in activity surrounding licensure compacts. This includes established compacts, such as the Counseling Compact and Social Work Licensure Compact, as well as the Dietician Licensure Compact, which recently finalized its model legislation and has not yet been enacted in any states. In general, these state efforts ease the burdens of the licensing [...]

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Trending in Telehealth: January 22 – 29, 2024

by Patrick Zanayed and Adetoro Olugbemi | Feb 2, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Scope of practice
Medicaid reimbursement

A CLOSER LOOK

Finalized Legislation & Rulemaking

Arkansas passed final rule, which provides Medicaid coverage for ambulance telemedicine triage services. Specifically, an ambulance service may triage and transport a beneficiary to an alternative destination or treat in place if the ambulance service is coordinating the care of the beneficiary through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Florida proposed a rule to clarify the Board of Psychology’s supervised experience requirements in light of recent statutory changes involving telehealth.
Iowa proposed rules to clarify the scope of practice including recordkeeping, ethical practice standards, and use of telehealth visits for occupational therapists and occupational therapy assistants and physical therapists and physical therapist assistants.
Nevada proposed a rule to define a social workers’ scope of practice and licensure requirements and clarify when services may be provided through telehealth to a client outside the State of Nevada, among other things.
South Carolina progressed H 4159 in the second chamber to enact the South Carolina Telehealth and Telemedicine Modernization Act. The bill defines necessary terms and provides requirements for certain regulated healthcare professionals who provide healthcare by means of telehealth; amends definitions in the medical practice act to define “telehealth”; and amends law relating to the practice of telemedicine to revise requirements for the practice of telemedicine and to include provisions concerning telehealth.
South Dakota progressed HB 1015 in the second chamber to adopt the social work licensure compact.
Utah progressed SB 24 in the first chamber. The bill clarifies the scope of practice of physician assistants to include telepsychiatry services.

Why it matters:

States continue to progress laws clarifying the use of telehealth within a practitioners’ scope of practice. This week, Florida, Iowa, Nevada and Utah proposed rules or progressed legislation clarifying that several healthcare practitioners’ scope of practice include the use of 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. Are you working to make healthcare more accessible through telehealth? Let us help you transform telehealth.

Trending in Telehealth: January 16 – 22, 2024

by Stacey Callaghan and Ashley Ogedegbe | Jan 24, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Behavioral health
Expanding telehealth

A CLOSER LOOK

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Florida progressed SB 7016, which expands the telehealth minority maternity care pilot program to a statewide program; enacts the interstate medical licensure compact; and enacts the audiology and speech-language pathology interstate compact.
Oklahoma proposed a rule to include the use of telemedicine within the optometrist’s scope of practice under certain circumstances and clarify medication dispensation and storage requirements.
South Dakota progressed HB 1015 to adopt the social work licensure compact.
Texas proposed rule to expand the existing Department of Health’s Emergency Medical Care rules by providing telemedicine options in non-rural counties and expanding the use of telemedicine in rural counties, by integrating the use of telemedicine by Advanced Practice Provider (APP) in Rural Level IV trauma facilities under certain circumstances.
Utah progressed HB 44 to adopt the social work licensure compact.
Wisconsin proposed a rule to amend current standards of practice for supervising physical therapist assistants to incorporate new telehealth practices. Specifically, the current supervision rules require supervision physical therapists to provide on-site assessment and reevaluation of each patient at least once each calendar month or every 10th treatment day, whichever is sooner, while new telehealth practices permit patients to receive treatments using telehealth. The new rule will resolve the conflict between the on-site assessment and reevaluation requirements for supervision and patients’ ability to schedule telehealth visits.
Wisconsin progressed AB 573 and AB 541to the second chamber. AB 573 directs the Department of Health Services to establish a pilot program to implement virtual behavioral health crisis care services for use by county or municipal law enforcement agencies in the field to connect law enforcement officers who encounter persons in crisis to behavioral healthcare services. AB 541 provides that no mental health care provider may be required to be licensed, registered, certified, or otherwise approved to practice in the state to provide mental health services by telehealth to patients located in the state unless mental health care provider satisfies certain conditions.

Why it matters:

There continues to be elevated activity surrounding licensure compacts. This week, Florida, South Dakota and Utah progressed laws to adopt interstate licensure compacts.
States continue to progress laws to incorporate the use of telehealth in practitioners’ scope of practice. This week, several states progressed legislation expanding practitioners’ scope of practice to include telehealth services under certain circumstances.

Trending in Telehealth: January 4 – 15, 2024

by Marshall E. Jackson, Jr. and Adetoro Olugbemi | Jan 23, 2024 | Telehealth

Trending in the past week:

Econsults
Medical cannabis
Out-of-state practitioners

A CLOSER LOOK

Finalized Legislation & Rulemaking

Alaska adopted a final rule, which updates the Board of Professional Counselors regulations related to distance professional services to clarify supervision requirements for distance professional services.
Colorado passed a final rule amending the Medical Assistance Act’s corresponding rules to authorize reimbursement of Electronic Consultation (eConsults) performed through Medicaid’s authorized eConsult platform.
New Jersey enacted SB 3604, which authorizes the use of healthcare platforms that provide discounted prices for payment of prescription and non-prescription drugs or devices and for telehealth and telemedicine services.
Oregon adopted a final rule, which amends Oregon Medical Board Rules (OAR 847-025-0020) to align the rules with the Oregon 2023 Law (SB 232). The amended rule allows out-of-state physicians and physician assistants who have an established relationship with a patient to provide continuity of care via telemedicine on a periodic or intermittent basis when the patient is located in Oregon.
Virginia adopted a final rule establishing applications, licenses, permits, and registrations for its Medical Cannabis Program. The final rule permits practitioners to provide patient care and evaluation using telemedicine, provided that the use of telemedicine follows certain parameters.
Utah adopted a final rule, which moves content governing the Human Services Program Licensing Office’s processes to a new division-wide rule. While the definition of telehealth remains the same, the relevant sections of the law have a new citation.

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

Iowa Board of Speech Pathology and Audiology proposed a rule to rescind Chapter 301, Practice of Speech Pathologists and Audiologists, Iowa Administrative Code, and adopt a new chapter with the same title. The proposed rule will provide definitions relevant to the practice of speech pathologists and audiologists and requirements for telehealth appointments. Further, the rule will articulate practice standards and provide a scope of practice for the profession. Comments are due by January 31, 2024.
Nevada proposed a rule to amend the Board of Examiners for Social Workers rules to prohibit a licensee from providing services through telehealth to a client located outside the State of Nevada unless the licensee is authorized to do so under the laws of the jurisdiction where the client is located.
New Jersey progressed AB 5311 in the second chamber. If passed, the legislation would enact the Counseling Compact in New Jersey.
Tennessee progressed SB 1674, which would amend existing TennCare rules, or promulgate new rules, on fee-for-service and Medicaid managed care plans to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests that utilize established CPT codes for [...]

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2024: The Year of the Telehealth Cliff

by Lisa Mazur, Rachel Stauffer, Debra Curtis and Leigh Feldman | Jan 12, 2024 | Telehealth

What does December 31, 2024, mean to you? New Year’s Eve? Post-2024 election? Too far away to know?

Our answer: December 31, 2024, is when we will go over a “telehealth cliff” if Congress fails to act before that date, directly impacting care and access for Medicare beneficiaries. What is this telehealth cliff? Let’s back up a bit.

TELEHEALTH COVERAGE POLICIES

Current statute (1834(m) of the Social Security Act) lays out payment and coverage policies for Medicare telehealth services. As written, the provisions significantly limit Medicare providers’—and therefore patients’—ability to utilize telehealth services. Some examples:

If the patient is in their home when the telehealth service is being provided, telehealth is generally not eligible for reimbursement.
Providers cannot bill for telehealth services provided via audio-only communication.
There is a narrow list of providers who are eligible to seek reimbursement for telehealth services.

COVID-19-RELATED TELEHEALTH FLEXIBILITIES

When the COVID-19 pandemic hit in 2020, a public health emergency (PHE) was declared. Congress passed several laws, and the administration acted through its own authorities to provide flexibilities around these Medicare telehealth restrictions. In general, nearly all statutory limitations on telehealth were lifted during the PHE. As we all know, utilization of telehealth skyrocketed.

The PHE ended last year, and through subsequent congressional efforts and regulatory actions by the Centers for Medicare and Medicaid Services (CMS), many flexibilities were extended beyond the end of the PHE, through December 31, 2024. Congress and CMS continue to grapple with how to support the provision of Medicare telehealth services for the future.

CMS has taken steps through the annual payment rule, the Medicare Physician Fee Schedule (MPFS), to align many of the payment and coverage policies for which it has regulatory authority with congressional deadlines. CMS has also restructured its telehealth list, giving more clarity to stakeholders and Congress as to which pandemic-era telehealth services could continue if an extension is passed. But CMS can’t address the statutory limitations on its own. Congress must legislate. CMS highlighted this in the final calendar year (CY) 2024 MPFS rule released on November 2, 2023, noting that “while the CAA, 2023, does extend certain COVID-19 PHE flexibilities, including allowing the beneficiary’s home to serve as an originating site, such flexibilities are only extended through the end of CY 2024.”

THE TELEHEALTH CLIFF

This brings us to the telehealth cliff. CMS generally releases the annual MPFS proposed rule in July, with the final rule coming on or around November 1. If history is any indication, Congress is not likely to act on the extensions much before the current December 31 deadline. This sets up the potential for a high level of uncertainty headed into 2025.

If we go over, this telehealth cliff would directly impact care and access for Medicare beneficiaries. The effects could be felt acutely in rural and underserved areas, where patients have been able to access, via telehealth, medical services that may have been out of reach for them in the past. The telehealth cliff would [...]

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