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Trending in Telehealth: January 4 – 15, 2024

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

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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Trending in Telehealth: June 6 – 12, 2023

by Amanda Enyeart and Adetoro Olugbemi | Jun 15, 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:

Telehealth pilot programs

A CLOSER LOOK

Finalized Legislation & Rulemaking

Nebraska enacted LB 227, which amends the definition of the “practice of dietetics and nutrition” to include telehealth services.
Nebraska enacted LB 50, which requires the state court administrator to create a pilot program to use physical space and information technology resources within Nebraska courts to serve as points of access for virtual behavioral health services for individuals at court. The pilot program is intended to provide access to confidential, reliable and safe behavioral health treatment via telehealth for individuals involved with the criminal justice system as defendants, probationers or victims in criminal proceedings.
Nevada enacted AB 432, which amends state optometry laws to establish requirements for synchronous and asynchronous optometry telemedicine and remote patient monitoring in optometric practice. The law imposes an established patient requirement for certain optometric telemedicine services, meaning that an optometrist must have conducted an in-person “comprehensive evaluation” of the patient within two years before the date of the service. Exceptions to the comprehensive evaluation requirement include synchronous services where the performing optometrist has access to records of a comprehensive examination conducted by another optometrist and certain limited asynchronous evaluations solely to determine whether a comprehensive evaluation is necessary. The law permits optometrists with out-of-state licenses to conduct the limited asynchronous services without a Nevada license. Finally, the law specifically imposes the comprehensive exam requirement with respect to patients who are located outside of the state and are treated by optometrists licensed in Nevada.
Oregon enacted SB 232, which allows out-of-state physicians or physician assistants who are not licensed in Oregon to provide care to patients located in Oregon, specifically when the out-of-state physician or physician assistant has established a provider-patient relationship with the patient in Oregon temporarily for the purpose of business, education, vacation or work and such patient requires direct medical treatment by the out-of-state physician or physician assistant. Out-of-state physicians or physician assistants may also provide care for patients with whom they have an established provider-patient relationship to provide temporary or intermittent follow-up. The law further clarifies that the practice of medicine using telemedicine occurs where patient is physically located.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Connecticut progressed SB 1075 in the second chamber. The legislation would require the state’s Department of Public Health to establish, in collaboration with a hospital in the state, a Hospice Hospital at Home pilot program to provide hospice care to patients in the home through a combination of in-person visits and telehealth. If passed, the law would require the Department of Public Health to create [...]

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Trending in Telehealth: April 25 – May 1, 2023

by Patrick Zanayed and Jayda Greco | May 3, 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:

Interstate Compacts
Professional Practice Standards
COVID-19 Licensure Flexibilities

A CLOSER LOOK

Finalized Legislation & Rulemaking

Illinois enacted HB 559, which allows any person who was issued a temporary out-of-state permit by the Illinois Department of Financial and Professional Regulation during the COVID-19 pandemic to continue to practice under her temporary out-of-state permit if she submits an application for licensure by endorsement to the Department on or before May 11, 2023. The legislation allows any such person to continue to practice under his temporary out-of-state permit until the Department issues the license or denies the application, at which time the temporary out-of-state permit will expire. The legislation also updates the definition of “direct supervision” for a speech language pathologist assistant to include video conferencing.
Tennessee enacted HB 498 and companion bill SB 721. The legislation exempts a patient receiving an initial behavioral health evaluation via telehealth from the reimbursement requirement that the patient have an in-person encounter with a healthcare services provider, the provider’s practice group or the healthcare system within 16 months prior to an interactive visit in order to establish a provider-patient relationship for purposes of telehealth.
North Dakota, Montana and Oklahoma enacted legislation (SB 2187, HB 777 and SB 575, respectively) to join the Counseling Compact.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Montana progressed legislation to join the Occupational Therapy Compact (SB 155). Meanwhile, Iowa and Indiana progressed legislation to the second chamber (HF 671 and SB 160, respectively) to enact the Counseling Compact. South Carolina introduced legislation (S 610) that would enact the Counseling Compact, and Louisiana introduced legislation (SB 186) to join the Occupational Therapy Compact.
New Hampshire progressed legislation (HB 500) that would modify which controlled substances are permitted to be prescribed via telemedicine. The legislation would allow an advanced practice registered nurse (APRN) to prescribe non-opioid and opioid controlled drugs in schedule II through IV by means of telemedicine after establishing a relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV via telemedicine, a practitioner licensed to prescribe the drug must conduct subsequent in-person exams at intervals appropriate for the patient, medical condition and drug, but not less than annually. The legislation further provides that an APRN who prescribes these drugs by telemedicine must obtain oral or written consent for the provision of services through telemedicine from the patient or, if the patient is a minor, from the patient’s parent or guardian unless state or [...]

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Of Digital Interest Quarterly Roundup | Q1 2023

by McDermott Will & Emery | May 3, 2023 | Telehealth

McDermott’s digital health team continually monitors legal developments affecting all aspects of the remote delivery of care. This inaugural issue of our Of Digital Interest Quarterly Roundup highlights key issues and trends in the first quarter of 2023.

Remote care is an important development in care delivery, but the regulatory patchwork is complicated. Our 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?

Download the report here.

Trending in Telehealth: April 18 – 24, 2023

by Amanda Enyeart and Jayda Greco | Apr 28, 2023 | Telehealth

Trending in the past week:

Interstate Compacts
Professional Practice Standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

West Virginia enacted Final Rules that create telehealth standards of practice for nurse practitioners. The rules, among other standards, permit a nurse practitioner to use telemedicine technologies that incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services or real-time audio-only calls to establish a practitioner-patient relationship during the initial provider-patient encounter.
Louisiana adopted rulemaking that establishes telepsychology and telesupervision standards.
Indiana enacted SB 73, which established the Occupational Therapy Licensure Compact. The law becomes effective on July 1, 2023.
Montana enacted legislation, HB 777, to join the Counseling Compact.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Montana progressed legislation to the governor to enact the Audiology and Speech-Language Pathology Compact (SB 214) and Occupational Therapy Compact (SB 155). Meanwhile, North Dakota progressed legislation to the Second Chamber (SB 2187) to enact the Counseling Compact.
Oregon introduced legislation (SB 232) that allows out-of-state physicians or physician assistants to provide care to patients located in Oregon in limited circumstances without obtaining full Oregon licensure or the equivalent telehealth licensure. These scenarios include emergencies (as defined by the Oregon Medical Board); consulting with another physician or physician assistant who is licensed in the state, so long as the out-of-state physician does not take on primary responsibility for diagnosis and treatment; providing care when the physician has an established relationship with the patient who is traveling for work, education or vacation; and in cases where the physician has an established relationship and is providing intermittent or temporary follow-up care. The bill further clarifies that the practice of medicine using telemedicine occurs where the patient is physically located.
Montana’s Senate passed HB 676 with amendments and sent the bill back to the state’s House of Representatives for reconciliation. The House of Representatives passed an earlier version of the bill on March 3, 2023. The bill enumerates fundamental parental rights with respect to children, including with respect to a child’s medical care, and requires a health professional to verify the identity of a parent who has given consent through telemedicine at the site where the consent is given.

Why it matters:

Elevated activity involving the adoption of interstate compacts continues. Many states are progressing legislation that would enact various licensure compacts across healthcare professions, easing burdens to licensure and reciprocity for professionals seeking to practice across state lines.
States continue to refine and adopt professional standards for telehealth practice. This week we saw increased adoption of telehealth practice [...]

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Trending in Telehealth: January 9 – 16, 2023

by Amanda Enyeart and Abby Higgins | Jan 19, 2023 | Telehealth

Trending in Telehealth is a new weekly series from the McDermott Digital Health team where we track telehealth regulatory and legislative activity. Each week we will highlight 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 This Week:

Provider Licensing
Telehealth Definitions
Tele-behavioral health

A Closer Look:

Finalized: 2

Illinois enacted emergency changes to the Telehealth Act and other statutes that expand the ability of certain out-of-state providers to provide reproductive care via telehealth in the state.
Massachusetts’ Department of Medical Assistance finalized rules that amend definitions for diagnostic, case consult and treatment services (beginning on page 139), and establish requirements for licensed independent clinical social workers (LICSWs) to enroll as MassHealth providers and use of telehealth by LICSWs (beginning on page 309).
Oregon adopted a rule that clarifies that acupuncturists can provide telemedicine services.

Proposed: 6

Alaska proposed a rule that would amend the educational requirements for a professional counselor license, requiring that at least three of the hours are in telehealth. This is added alongside the existing professional ethics requirements and new additions of cultural competencies and suicidality.
Florida proposed updates to disciplinary rules for those licensed under the Florida Board of Osteopathic Medicine. The new rules include penalties for failing to identify to patients the type of license under which the practitioner is practicing, expanding the state’s existing rules imposing penalties related to care being provided through telehealth.
Texas proposed three rules relating to behavior analysts’ use of telehealth, as a result of a four-year rule review conducted by the Texas Department of Licensing & Regulation. These proposed rules establish requirements for behavior analysts’ use of telehealth in delivering care and align definitions with telehealth regulations for other providers. The public comment period for all three rules ends on February 5, 2023.
Wyoming proposed a rule that would modify standards of practice for occupational therapy. This includes clarification surrounding the requirement for occupational therapists and occupational therapist assistants to hold a Wyoming license to provide services to a patient in Wyoming, including treatment delivered through telehealth technologies, at the time of services. The public comment period ends March 5, 2023.

Highlights for the Industry:

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Telemedicine Providers Take Note – The No Surprises Act Is Effective January 1, 2022

by Emily Jane Cook, Jamie Gelfman, Lisa Mazur and Drew Elizabeth McCormick | Dec 30, 2021 | Enforcement, Telehealth

On December 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act, 2021. In July and October 2021, respectively, the Department of Health and Human Services, the Department of Labor, the Department of the Treasury and the Office of Personnel Management (the Departments) issued two Interim Final Rules implementing core aspects of the No Surprises Act, including (1) prohibiting non-participating providers from balance billing individuals who receive services in participating facilities unless prior notice and consent is provided and obtained (referred to as Part I);[1] and (2) requiring providers and facilities to provide good faith estimates (GFE) to uninsured (or self-pay) individuals of expected charges prior to their scheduled services (referred to as Part II, and together with Part I and the statute, the NSA).[2]

Effective as of January 1, 2022, to the extent that an out-of-network telemedicine provider furnishes services to a patient at an in-network facility, the disclosure notice requirements and balance billing prohibitions under Part I apply. Additionally, to the extent that a telemedicine provider furnishes services to an uninsured (or self-pay) patient, the transparency requirements under Part II, including the requirement to provide a GFE, may apply. Notably, the NSA provides for steep penalties, including imposition of civil monetary penalties of up to $10,000 per violation. Additional information regarding a telemedicine provider’s compliance obligations under the NSA are outlined below.

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Top Takeaways | Cybersecurity & Insurance Coverage in the Age of Telehealth: Understanding and Mitigating Your Risk

by McDermott Will & Emery | Apr 20, 2021 | Cybersecurity, Data breach, Data Privacy, Telehealth

With more frequent and more severe ransomware attacks against health care platforms and vendors and the increasing use of telemedicine, it is critical to understand how to proactively defend your organization using robust legal, regulatory and cyber-coverage strategies. In this webinar, McDermott partners Dale Van Demark and Edward Zacharias joined Brett Buchanan of Marsh & McLennan Agency and Larry Hansard of Gallagher USA to explore the intersection of telemedicine and cybersecurity. Our panelists offered attendees a road map for navigating this rapidly changing space, including practical strategies for shoring up their defenses and addressing potential risks to their businesses.

Providers engaging in telemedicine should consider three critical areas of insurance coverage: medical professional liability, technology errors and omissions, and cyber/privacy liability. “Several carriers have packaged these three important coverages into a one-policy format, referred to as a virtual health program,” Hansard said.
A medical professional liability program should include incident reporting, punitive damages, and sexual abuse and molestation. The latter may seem surprising in a telemedicine context, but is important given reports of inappropriate patient behavior during telemedicine encounters, Hansard said.
New telehealth technologies, such as AI chatbots for patient intake, create new and more complex bodily injury exposures, Buchanan said. “Working with an insurance underwriter that understands these nuances is absolutely key,” he said. In addition to bodily injury, coverage should include technology errors and omissions, cyber liability and general liability.

Click here for the full list of highlights.
Click here to view the full webinar.

Telehealth and Prescribing: What’s Permissible in Your State?

by McDermott Will & Emery | Mar 2, 2021 | Telehealth

Telehealth’s state-by-state regulatory patchwork means that healthcare providers must navigate a variety of regulations that govern which types of care can be provided by virtual means, and even what modalities can be used in different care settings.

Our new interactive map explores the standards and requirements that physicians and nurse practitioners must follow when prescribing non-controlled substances or ordering tests via a telemedicine encounter in all 50 states and the District of Columbia. Key issues addressed in the survey include:

In what states are asynchronous solutions permitted?
What are state rules governing prescriptions when a physician-patient relationship does not exist prior to the telehealth encounter?
What are state rules on prescribing via audio-visual encounters or audio-only encounters?
Under what state regulations can a questionnaire be sufficient to create a physician-patient or advance practice registered nurse-patient relationship?

Click here to access the map and download the full report.

Remote Care Providers Await Final New Jersey Registration and Reporting Regulations

by Amanda Enyeart and Marshall E. Jackson, Jr. | Aug 17, 2020 | Telehealth

In 2017, the New Jersey legislature passed the New Jersey Telehealth and Telemedicine Act (codified at N.J.S.A. 45:1-61 et seq.), which established registration and reporting requirements for “telemedicine and telehealth organizations.” After a multi-year wait for details regarding the registration process, the New Jersey Department of Health (NJ DOH) published a proposed rule in April 2020 that brought providers of telehealth services in New Jersey one step closer to the implementation and enforcement of the registration requirements. A final rule is expected by April 2021.

New Jersey providers are also expecting the publication of a proposed rule detailing the reporting requirements for registered organizations. While the coronavirus (COVID-19) public health emergency has led many states to implement waivers and other measures to allow for the expansion of remote healthcare services within their states, telehealth and telemedicine organizations operating in New Jersey should prepare to comply with additional requirements and the outlay of annual registration fees if the state finalizes the registration requirements as proposed.

Background: The 2017 Telemedicine and Telehealth Act

For purposes of the Act, a “telemedicine or telehealth organization” is defined as a corporate entity “that is organized for the primary purpose of administering services in furtherance of telemedicine or telehealth.” The Act differentiates telemedicine from telehealth: “telehealth” is the use of information and communications technologies (including telephones, remote patient monitoring devices or other electronic means) to support clinical healthcare, provider consultation, patient and professional health-related education, public health, health administration and other services, whereas “telemedicine” is the delivery of healthcare services using electronic or technological means (not including the use, in isolation, of audio-only telephone, electronic mail, instant messaging, phone text or facsimile transmission) to “bridge the gap” between a healthcare provider located at a distant site and a patient located at an originating site.

In addition to establishing requirements for providers’ use of telemedicine and telehealth, the Act requires telemedicine or telehealth organizations to register with the NJ DOH annually, and to submit annual reports to the NJ DOH that include data elements established by the NJ DOH commissioner and, at a minimum, the following de-identified encounter data:

The total number of telemedicine and telehealth encounters conducted
The type of technology utilized to provide services using telemedicine or telehealth
The category of medical condition for which services were sought
The geographic region of the patient and the provider
The patient’s age and sex
Any prescriptions issued.

The Act did not establish any enforcement mechanism for the registration and reporting requirements, and because the NJ DOH has not yet implemented criteria for registering or reporting, New Jersey providers of remote health services have generally operated without regard to these statutory requirements.

Implementation of the Registration Requirement

The April 2020 proposed rule would implement the registration requirement for telemedicine or telehealth organizations and establish enforcement mechanisms available to the NJ DOH against any telemedicine or telehealth organization that fails to comply.

The proposed rule would require telemedicine and telehealth organizations to register with the NJ DOH [...]

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