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telehealth

Trending in Telehealth: November 26 – December 10, 2024

by Amanda Enyeart and Angela Irene Theodoropoulos | Dec 13, 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:

Behavioral and mental telehealth
Coverage and payment parity

A CLOSER LOOK

Proposed Legislation & Rulemaking:

In Illinois, HB 4475 gained another co-sponsor. If adopted, the bill would provide that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025, or any third-party administrator administering the behavioral health benefits for the insurer, must cover all out-of-network medically necessary mental health and substance use benefits and services (inpatient and outpatient) as if they were in-network for purposes of cost sharing for the insured. The bill specifically provides that the insured has the right to select the provider or facility of their choice and the modality, whether the care is provided via in-person visit or telehealth, for medically necessary care. To date, the proposed legislation has passed the house chamber and committee.
In Washington, the Department of Health announced a proposed rule concerning certification standards for the new, voluntary certified peer specialist and trainee credentials created by passed SB 5555 (chapter 469, Laws of 2023) for behavioral health. The proposed rule would require a certified peer specialist who provides telehealth services to take the telehealth training as specified in WAC 246-929-340.

Finalized Legislation & Rulemaking Activity:

Missouri enacted several emergency rule amendments related to coverage under the Missouri Consolidated Health Care Plan, which provides coverage to employees and retirees of most state agencies, as well as public entities that have joined the plan. The amendments include revisions to coverage of virtual visits, non-network payments, the timing of other deposits to health savings accounts, and the right of the state plan to recoup certain deposits. Under the amendments, virtual visits offered through the vendor’s telehealth tool are covered at 100% after deductible is met unless Internal Revenue Service guidance permits them to be paid at 100% prior to deductible being met.

Why it matters:

Use of telehealth services for behavioral healthcare continues to grow. There has been a notable trend of telehealth modalities being adopted for mental health and substance abuse care. Legislative and regulatory activity is responding to this trend with increased access, as in the Illinois proposed legislation regarding telehealth coverage parity, and increased safeguards, such as the telehealth training requirements in the Washington proposed rule. This expansion of tele-behavioral health may increase access to mental health services for those in remote or underserved communities, and may increase convenience and flexibility, in turn promoting more consistent attendance and better treatment outcomes.
States are assessing the extent of insurance coverage and payment rates for telehealth services. Telehealth services continue to inspire debate regarding coverage parity (i.e., covering telehealth services to the [...]

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Trending in Telehealth: November 19 – 25, 2024

by Lisa Mazur and Nathan Gray | Nov 26, 2024 | Telehealth

Trending in the past week:

Medical marijuana

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In New York, the governor signed an act (A 8168) requiring Medicaid to provide remote ultrasound and remote fetal nonstress tests in certain circumstances.

In Massachusetts, the Massachusetts Cannabis Control Commission finalized amendments that permit patients to request a telehealth appointment for a patient’s initial visit to a provider. An initial visit conducted via telehealth must be synchronous and face-to-face. The adopted changes also permit certified providers to be out-of-state so long as the conditions for certification are met.

Why it matters:

Regulators continue to recognize telehealth as an effective care delivery method in new settings. Massachusetts’ decision to permit the use of telehealth to conduct a patient’s initial visit to a provider for a certificate of registration for medical marijuana and New York Medicaid coverage of remote ultrasounds and fetal nonstress tests reflects growing recognition by regulators that telehealth can be an effective care delivery method for a wide range of procedures and patients.

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: November 12 – 19, 2024

by Patrick Zanayed and Nathan Gray | Nov 20, 2024 | Telehealth

Trending in the past week:

Veterinary services

A CLOSER LOOK

Proposed Legislation & Rulemaking:

In Florida, the Board of Veterinary Medicine proposed a rule that would require veterinarians to include a notation in the medical record if an examination was conducted by telehealth. The Board also proposed a set of guidelines that the Board must follow when imposing disciplinary penalties for violations of telehealth practice rules. The penalties include reprimand, suspension with administrative fines, and revocation of the individual’s license.

In New York, a bill requiring Medicaid to provide remote ultrasound procedures and remote fetal nonstress tests in certain circumstances passed the first house.

Why it matters:

Regulation of the use of telehealth in veterinary medicine continues to grow. Florida joins an increasing number of states beginning to develop regulations specifically related to the practice of veterinary medicine via telehealth. This emerging trend in the health industry regulation reflects the steady adoption of telehealth as a valuable care delivery modality across the full gambit of health services industries.

Trending in Telehealth: October 7 – 14, 2024

by Amanda Enyeart, Lauren Ellison and Jayda Greco | Oct 18, 2024 | Telehealth

Trending in the past week:

Speech language pathology
Mental health and substance use disorder treatment

A CLOSER LOOK

Proposed Legislation & Rulemaking:

Illinois introduced to amend its insurance code to require coverage for speech therapy services that a treating provider deems medically appropriate as treatment for stuttering, regardless of whether the services are provided in person or via telehealth, as of January 1, 2026. Coverage would include the use of any communication technology, applications, or platforms that comply with the applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996.

The District of Columbia Department of Health Care Finance proposed a rule regarding the provision of medication therapy management services by pharmacists under the district’s Medicaid program, in accordance with the requirements of 29 DCMR § 910, which establishes the department’s standards for the provision of telemedicine services. The services, which are aimed at optimizing therapeutic outcomes for Medicaid beneficiaries, are limited to one initial visit and three follow-up visits per calendar year and may be provided in person or via telehealth.

Finalized Legislation & Rulemaking:

Alaska enacted HB 126, which authorizes associate counselors to provide certain services via telehealth. The legislation also extends certain immunity protections to providers who volunteer to provide services without pay through a medical clinic, medical facility, nonprofit facility, temporary emergency site, or other governmental facility, if acting within the scope of their responsibilities in such organization.
Pennsylvania’s upper house passed HB 2268, which, if signed by the governor, will mandate insurance coverage of rehabilitative speech therapy treatments for individuals with childhood stuttering and neurological stuttering.

Why it matters:

States are increasingly relying on telehealth to expand access to speech-language pathology services. Pennsylvania and Illinois took steps this week to expand access to such services, particularly for treatments involving stuttering therapy.
States continue to use telehealth as a means to address mental health and substance use disorders. Last week, Mississippi enacted a final rule to allow community service providers to perform substance use assessments either in person or via telehealth. Continuing this trend, this week Illinois expanded insurance coverage for behavioral health benefits with the goal of enhancing equity in mental health and substance use treatment. We expect to see a continued uptick in this activity going forward.

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: March 6 – March 12, 2023

by Marshall E. Jackson, Jr. and Ashley Ogedegbe | Mar 16, 2023 | Telehealth

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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2021 Digital Health Year in Review

by McDermott Will & Emery | Feb 22, 2022 | Telehealth

The continuation of the COVID-19 public health emergency (PHE) and consumer demand for digitally delivered healthcare not only necessitated the shift from in-person to virtual care, but also continued to drive interest, adoption, investment and transactions in digital health in 2021. Digital health funding in 2021 far surpassed 2020’s totals, with no signs of slowing down in 2022, and the potential permanence of some regulatory flexibilities beyond the PHE are charting a course for continued digital health growth in 2022 and beyond.

Access the report.

After the Curve Podcast: Focus on Digital Health

by McDermott Will & Emery | Oct 1, 2020 | Telehealth

COVID-19 has demanded a rapid shift in the world of telehealth and digital health, resulting in a global embracing of a telehealth and digital health system that is not yet fully developed. On this episode of the McDermott Health podcast, our digital health partners have joined to discuss the future of telehealth and use of digital tools to speed up care delivery and to improve outcomes in the wake of COVID-19, as well as the vital role of data readiness in reshaping the healthcare system. McDermott’s Chief Marketing Officer Leslie Tullio is joined by partners Stephen Bernstein and Lisa Mazur to examine current trends and potential changes to both telehealth as well as the broader digital health landscape, including:

The most impactful regulatory telehealth changes that have resulted from COVID-19
A look beyond telehealth to a paradigm shift in the broader digital health landscape
The impact that a more refined data exchange pathway could have on treatment during the next wave of COVID-19 or future pandemics
Meaningful collaborations that are currently happening in the digital health space
A look at innovations that are emerging from the demands of post-COVID-19 healthcare
Legal and regulatory compliance steps that still need to be taken to allow these telehealth programs to continue in the future

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CMS Takes a Preliminary Step to Make Certain COVID-19 Waivers Permanent

by Lisa Mazur and Rachel Stauffer | Aug 14, 2020 | Telehealth, Uncategorized

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to update its payment policies under the Medicare Physician Fee Schedule (PFS) for calendar year 2021. The proposed rule was issued in tandem with a presidential executive order, which directed the Secretary of the US Department of Health and Human Services (HHS) to propose regulations expanding telehealth services covered by Medicare. CMS stated that the proposed rule “is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.”

In response to the coronavirus (COVID-19) public health emergency (PHE), CMS has issued several temporary waivers and flexibilities that expand telehealth reimbursement under Medicare, Medicaid and the Children’s Health Insurance Program for the duration of the COVID-19 PHE. CMS issued these waivers under authorities granted pursuant to HHS’s public health declaration, as well as legislation passed in response to the pandemic. Many of these waivers have substantially altered the Medicare telehealth reimbursement landscape and, as we detailed in our prior On the Subject, many can be made permanent via regulatory action. The proposed rule represents the first official word that CMS will take such action to make certain of its waivers permanent. These policy changes have the potential to greatly increase the availability of telehealth to Medicare beneficiaries around the country.

CMS will accept comments, either electronically or by mail, on the proposed rule until 5 pm EDT on October 5, 2020.

Changes to Medicare Telehealth Services

CMS proposed to add several services, listed below, to its list of services that may be delivered via telehealth. Many of these were previously added on an interim final rule basis for the duration of the PHE. The proposed rule would keep them on the Medicare telehealth services list even after the PHE ends.

CMS also proposed a new method for adding or deleting services from the Medicare telehealth services list. Currently, CMS evaluates new services for inclusion based on two categories: Category 1 is for services that are similar to professional consultations, office visits and office psychiatry visits that are already on the Medicare telehealth services list, while Category 2 is for services that are not similar to those already on the list, but that would still be appropriate to include because the service is accurately described by the corresponding code when delivered via telehealth and providing the service via a telecommunications system results in clinical benefit for the patient. Because of the COVID-19 PHE, CMS has proposed to add a Category 3, which would include services that would be temporarily on the Medicare telehealth services list. CMS proposed this third category because, while CMS currently has the authority to waive or modify Medicare telehealth payment requirements during the PHE, that authority will expire once the PHE [...]

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New Laws Expand Telehealth in California

by Lisa Mazur | Nov 1, 2019 | Telehealth

California Governor Gavin Newsom recently signed into law two bills that expand the delivery of telehealth services in the state. In particular, the legislation:

Permits providers to prescribe medications without a synchronous interaction
Requires payment parity of telehealth services under commercial plans
Loosens restrictions on Medicaid coverage of store-and-forward services.

California healthcare providers and commercial health payers should consider the following key takeaways from these laws.

Remote Prescribing

Assembly Bill No. 1264 (codified at Cal. Bus. & Prof. Code § 2242(a)) took immediate effect on October 11, 2019. This provision alters the standard for prescribing, dispensing and furnishing dangerous drugs (including any prescription medication):

Such drugs may be prescribed, dispensed and furnished as long as there is an “appropriate prior examination and a medical indication.”
The law specifies that the appropriate prior examination “does not require a synchronous interaction” (e., real-time communication) and can be administered via telehealth as long as the provider abides by the appropriate standard of care.
The provision expressly identifies certain asynchronous technologies, including questionnaires and self-screening tools, that are permissible methods for conducting the prior examination.

Previously, the law required an “appropriate prior examination” but gave no detail regarding what that examination entailed. The new provision provides clarity and enables providers to use innovative solutions such as dynamic questionnaires when prescribing medications to patients.

Payment Parity

Although California previously required certain insurers (including commercial payers and Medi-Cal managed care plans) to cover telehealth services, it did not specify that telehealth services have to be reimbursed at the same rate as in-person care. Assembly Bill No. 744 changed that with its addition of two new statutes: Cal. Health & Safety Code § 1374.14 and Cal. Ins. Code § 10123.855. These new provisions do not require reimbursement parity for Medi-Cal managed care plans, however.

These statutes incorporate the following provisions for contracts that are issued, amended or renewed on or after January 1, 2021:

Commercial payers must reimburse services appropriately delivered through telehealth “on the same basis and to the same extent” as the services are reimbursed when provided in person.
Insurers and providers retain the ability to negotiate reimbursement rates, but healthcare services that are the same, “as determined by the provider’s description of the service on the claim,” will be reimbursed at the same rate, whether provided in person or through telehealth.
Telehealth services offered by an out-of-network provider do not need to be covered by a health plan or insurer, unless required under other provisions of law.
Insurers can establish copayment or coinsurance requirements for telehealth services if they do not exceed the copayment or coinsurance for in-person services. However, cost sharing is not required for telehealth services.
Telehealth reimbursement does not need to be separated from other capitated or bundled risk-based payments.
Insurers cannot limit coverage only to corporate telehealth service providers.

Medicaid Coverage of Store and Forward

Previously, Medi-Cal only permitted certain services to be delivered via store [...]

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Telemedicine – The New Standard of Care

by Dale C. Van Demark, McDermott Will & Emery and Lisa Mazur | Jun 27, 2018 | Telehealth

Across the health care sector, telemedicine is naturally and strategically being integrated into health care delivery and treatment plans as targeted and efficient solutions to specific health issues by hospitals, medical groups and drug-to-consumer telemedicine companies.

Telemedicine is no longer viewed as a secondary option for care—it is a new standard of care that is both expected by patients and popular with providers. Consumers expect to see health care adapt—like many other industries already have—to fit within their daily lives and schedules. Whether it’s electronic check-in procedures or better automated systems, health care providers are beginning to treat their patients a little bit more like customers, and see telemedicine and patient engagement tools as a means of improving customer loyalty and engagement while reducing costs.

However, complex billing structure and payor and reimbursement issues can create significant hurdles for health care providers looking to advance telemedicine programs. Telemedicine billing requires special attention, and if not enough consideration is given on the front end of programs, organizations may be surprised to find that that something they thought was a billable service is, in fact, not.

The Bipartisan Budget Act, which provided for the reimbursement of the distance provider, significantly increased the telemedicine use cases that are approved under the Medicare reimbursement structure. However, because Congress will now pay for it, there is a new expectation that hospitals that do not have particular areas of expertise available on-site will investigate opportunities to incorporate a telehealth programs that ensure adequate patient care.

The standard of care continues to improve as patients have greater access to nationwide physicians and as new technology like telestroke and clinical decision support tools become more widely available. For example, a stroke neurologist in one New York can now diagnose a stroke patient in Florida, and then facilitate an emergency room physician to treat that stroke. Telestroke programs check off all of the right boxes: better quality care, better access to care, and overall lower cost of care.

As use cases like this continue to be integrated into health care delivery and familiarity builds around how telemedicine can be used effectively, expectations shift around the standard of care and new questions arise around the risks of integrating—or failing to integrate—telehealth programs. If the tools are available and easily accessible, and if there is a supportive reimbursement model, how much a part of the standard of care does telemedicine become and what is the risk of failing to embrace these tools? If hospitals choose not to implement telehealth programs, and then patients suffer harm as a result, for example a delayed diagnosis and treatment of a stroke, could that lead to increased medical malpractice suits or other types of liability?

In the newest episode of the Of Digital Interest podcast, McDermott Digital Health partners, Lisa Schmitz Mazur and Dale Van Demark, share their perspectives on these questions and the various barriers, risks and opportunities associated with the rise of telemedicine and other technological advancements in health care delivery. Access this [...]

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