private payor reimbursement Archives

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
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 is a new series from the McDermott Digital Health team in which we highlight 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 and Private Payor Reimbursement
Prescribing
Health Practitioner Licensing
Behavioral Health

A CLOSER LOOK
Finalized Legislation & Rulemaking:

In Oregon, the Workers’ Compensation Division of the Department of Consumer and Business Services adopted a final rule that updates and incorporates by reference the new medical billing codes and fee schedule for telehealth and telemedicine services published by the American Medical Association. The rule, which becomes effective on April 1, 2023, among other things, specifies that providers should use certain place of service codes to indicate where the provider provides medical services to a patient through telehealth (i.e., place of service code “02” to be used for “Telehealth provided other than in a patient’s home,” and place of service code “10” to be used for “Telehealth provided in a patient’s home.”). The rule also clarifies that modifier 95 should be used when a provider renders synchronous medical services via a real-time interactive audio and video telecommunication system (i.e., technology that permits the provider and patient to hear each other and see each other in real-time).
In Colorado, the Department of Health Care Policy and Financing adopted an emergency rule that aims to expand access to healthcare in rural communities by launching two new projects, the Health Care Access Project and the Health Care Affordability Project. The Health Care Access Project will, among other things, increase access to telemedicine, including remote monitoring support, while the Health Care Affordability project aims to modernize the information technology infrastructure of qualified rural providers through shared analytics and care coordination platforms, enabling technologies, including telehealth and e-consult systems, and funding for qualified rural providers to share clinical information and consult electronically to manage patient care. The projects are currently set to commence no earlier than July 1, 2023 and to conclude no later than December 31, 2026.
Texas passed two rules: the first rule clarifies that during telehealth sessions, chiropractors must conspicuously display a mandatory notice from the Texas Board of Chiropractic Examiners (Board) that provides patients with the Board’s contact information in the event that the patient wants to issue a complaint against the chiropractor, and the second rule clarifies that licensed marriage and family therapists that provide telehealth services must complete two hours of continuing education in technology-assisted services.

Legislation & Rulemaking Activity in Proposal Phase:
Highlights:

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