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Trending in Telehealth: September 30 – October 7, 2024

by Lisa Mazur, Lauren Ellison and Jayda Greco | Oct 17, 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
Teledentistry
Occupational therapy

A CLOSER LOOK

Proposed Rulemaking:

The Florida Nursing Board proposed a set of guidelines that the board must follow when imposing disciplinary penalties upon telehealth registrants. The penalties include reprimand, suspension with a corrective action plan, and revocation of the individual’s license.
New York proposed a rule to update its regulations for personal recovery-oriented services to align with telehealth guidance. The rule would mandate that individuals receiving intensive rehabilitation services be seen at least once in-person or through audio-visual telehealth during the calendar month.

Finalized Rulemaking:

Mississippi enacted a final rule that defines the Department of Mental Health’s certification requirements for community service providers. For all individuals reviewing mental health services and/or substance use services, the initial assessment and subsequent assessments may be provided either in-person or via telehealth.

Ohio adopted a final rule permitting occupational therapists to provide telehealth services. A provider may use synchronous or asynchronous technology during the initial patient visit. A provider also may deny a patient telehealth services and require the patient to undergo an in-person visit if care is continued with that provider.
Maine enacted a final rule permitting dentists to deliver diagnostic services via telehealth in accordance with the MaineCare Benefits Manual and current rules and guidance. The rule states that when delivering services via telehealth, dentists should bill for the underlying service and include the appropriate teledentistry CDT code that indicates a synchronous real-time encounter or an asynchronous encounter in which information is stored and forwarded to the dentist for subsequent review.

Why it matters:

States continue to expand access to telehealth services. Maine expanded access to teledentistry services, while Ohio expanded access to occupational therapy services and clarified the corresponding reimbursement methodology.
Legislation continues to slow as we approach the election, and many states have concluded the year’s legislative sessions. As mentioned in last week’s update, legislative activity has slowed, including legislation related to telehealth. Many legislators prefer to maintain the status quo until after elections, and legislative sessions in several states, such as California, have already concluded.

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: 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 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: June 25 – July 1, 2024

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

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: February 27 – March 4, 2024

by Amanda Enyeart and Nathan Gray | Mar 7, 2024 | Telehealth

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: July 25 – 31, 2023

by Amanda Enyeart and Grayson Dimick | Aug 4, 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:

Professional Practice Standards

A CLOSER LOOK

Finalized Legislation and Rulemaking

Nevada finalized a rule that updates its physical therapy standards. Physical therapists may now provide services via telehealth in accordance with Nevada’s general telehealth statute, Nev. Rev. Stat. § 629.515.
Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Texas proposed a rule that would amend Division of Workers’ Compensation regulations that set telehealth and telemedicine billing requirements for services provided to injured employees in the Texas workers’ compensation system. The proposed rule would add a definition for “teledentistry services” and would add Medicaid payment policies to the list of applicable payment policies that healthcare providers must use to bill for telemedicine, telehealth and teledentistry services.
West Virginia’s Medical Imaging and Radiation Therapy Technology Board of Examiners proposed a rule that would clarify that telehealth practice is inapplicable to the performance of medical imaging and radiation therapy. This proposed rule comes in response to W.V. Code § 30-1-26, which requires all health boards to adopt rules governing telehealth.

Why it matters:

States continue to refine and adopt professional practice standards for telehealth. Some states have recently adopted new or revised professional practice standards that vigorously regulate telehealth. As the latest Nevada and West Virginia rules demonstrate, regulation for certain health professions may be less robust and may simply clarify whether the profession is permitted to practice via 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: May 23 – 30, 2023

by Amanda Enyeart and Taylor Hood | Jun 1, 2023 | Telehealth

Trending in Telehealth is a series from the McDermott digital health team in which we highlight state legislative and regulatory developments that impact healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate virtual care.
Trending in the past week:

Forensic Examinations
Telehealth Flexibilities

A CLOSER LOOK
Finalized Legislation and Rulemaking

Florida passed legislation (SB 218) amending Fla. Stat. Ann. § 456.47 to revise the definition of “telehealth provider” to include persons licensed as genetic counselors. By way of background, in 2021, the Florida legislature created a new licensed and regulated profession—genetic counseling. SB 218 is likely one of several pieces of legislation that will incorporate the newly created profession into existing regulatory frameworks.
Minnesota enacted legislation (SF 2744) allowing telehealth to factor into the network adequacy assessments required to be performed by health carriers under Minnesota’s insurance laws. Minnesota also enacted appropriations legislation (SF 2995) that, among other things, allocates money for a study of telehealth expansion and payment parity in 2024.
Nevada passed legislation (AB 276) amending Nev. Rev. Stat. § 629.515 to authorize a provider who is conducting certain forensic medical examinations on an apparent victim of sexual assault or strangulation to use telehealth to connect to an appropriately trained physician, physician assistant or registered nurse to obtain instructions and guidance on conducting the examination.
West Virginia’s legislation requiring hospitals to have a trained healthcare provider available, or transfer agreement as provided in a county plan, to complete a sexual assault forensic examination (SB 89) became effective May 21, 2023, 90 days after its passage. “Available” includes having access to a trained sexual assault forensic examination expert via telehealth.

Legislation and Rulemaking Activity in Proposal Phase
Highlights:

Illinois progressed legislation (SB 2123) in the second chamber that would adopt the Counseling Compact.
Texas continued to progress legislation (HB 1771) in the second chamber that would require that each agency with regulatory authority over a health professional providing a telemedicine medical service, teledentistry or telehealth to adopt rules necessary to standardize formats for and retention of records related to a patient’s consent to treatment, data collection and data sharing.
Texas also progressed legislation (HB 617) in the second chamber that would establish a pilot project to provide emergency medical services instruction and emergency prehospital care instruction through a telemedicine medical service or telehealth service provided by regional trauma resource centers to healthcare providers in rural trauma facilities and emergency medical services providers in rural areas.

Why it matters:

Telehealth capabilities can reduce disparities in forensic examinations. States continue to progress legislation aiming to decrease disparities in the quality of forensic examinations by providing expert, live, interactive quality control and evidence-based methodologies to less experienced providers. Proponents argue that partnering on-site staff with telehealth [...]

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Trending in Telehealth: May 2– 8, 2023

by Lisa Mazur, Amanda Enyeart and Taylor Hood | May 12, 2023 | Telehealth

Trending in Telehealth is a series from the McDermott digital health team in which we highlight state legislative and regulatory developments that impact healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate virtual care.

Trending in the past week:

Maternal Health
Licensure/Prescription Flexibilities
Interstate Compacts

A CLOSER LOOK

Finalized Legislation & Rulemaking
Highlights:

Georgia enacted SB 106 also known as the Healthy Babies Act. The legislation, sponsored by Senate Majority Caucus Senator Larry Walker III, creates a three-year pilot program for remote maternal health services via the Georgia Department of Community Health. Beginning in FY 2024, the program will provide remote monitoring for pregnant women under the state’s Medicaid program. State legislators prioritized this bill in an effort to increase benefits for at-risk mothers in underserved rural communities. The program’s expanded benefits aim to encourage expecting mothers to utilize prenatal care.
Montana enacted legislation, SB 112, creating a new section related to a pharmacist’s prescribing authority exception. The exception states that a pharmacist may prescribe a drug or device for a legitimate medical purpose, as allowed under this section, for a person with whom the pharmacist has a patient-prescriber relationship. Supporters of the bill cited access-to-care hurdles for rural communities that could otherwise be overcome by allowing pharmacists to serve as a point of first contact. The bill, modeled after similar legislation passed in Idaho, will allow patients to be treated for certain minor conditions without having to visit a doctor’s office. Montana also enacted legislation (SB 214) to enact the Audiology and Speech-Language Pathology Compact and Occupational Therapy Compact (SB 155).
Oklahoma enacted legislation, SB 754, authorizing licensed dentists to allow teledentistry treatment by certain dental hygienists for patients in certain long-term care settings.

Legislation Rulemaking Activity in Proposal Phase
Highlights:

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Trending in Telehealth: April 11 – 17, 2023

by Marshall E. Jackson, Jr. and Jayda Greco | Apr 21, 2023 | Telehealth

Trending in the past week:

Interstate Compacts
Telehealth Coverage and Reimbursement
Informed Consent Standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

In North Dakota, HB 1095 was enacted. The legislation requires health carriers to, in part, provide coverage for licensed pharmacists to provide comprehensive medication management, which may be provided via telehealth. North Dakota also enacted HB 1530, which requires that Medicaid cover asynchronous teledentistry.
Florida enacted SB 300. The legislation prohibits physicians from using telehealth to provide abortions or prescribe abortion-inducing medication. It also requires the physical in-person presence of a physician with a patient when an abortion is performed or when abortion-inducing medication is dispensed.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

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