OF DIGITAL INTEREST

Trending in Telehealth: April 9 – April 15, 2024

by Dale C. Van Demark and Jayda Greco | Apr 22, 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
Professional standards and licensure
Reimbursement requirements and payment parity

A CLOSER LOOK

Finalized Legislation & Rulemaking

Michigan enacted a final rule that outlines telehealth practice standards including consent to telehealth, referrals to in-person providers (when needed), delegation of prescribing of controlled substances to advanced practice registered nurses, training standards related to human trafficking, licensure and continuing education.
Delaware enacted a final rule related to social work practice. The amendments change the requirements for direct supervision in post-degree supervised clinical social work experience for licensure applicants to specify that supervision may be through 100% live video conferencing at the discretion of the supervisor. Telehealth requirements are revised to exempt individuals practicing through a Delaware interstate telehealth registration from the prerequisite that the individual hold a Delaware license.
Tennessee enacted SB 1674, which directs the bureau of TennCare to – no later than December 31, 2024 – amend existing rules, or promulgate new rules, on fee-for-service and Medicaid managed care plans regarding reimbursement (specifically, to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests using established CPT codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient’s provider and meets the same standard of care).

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

In New Jersey, A 2803 passed the first chamber. If enacted, the bill would authorize certain out-of-state healthcare professionals and recent graduates of healthcare training programs to practice in the state upon application for licensure/certification in the state, but before such license is granted.
In Texas, HB 1771 passed one chamber. If enacted, the bill would require that each agency with regulatory authority over a health professional providing a telemedicine medical service, teledentistry or telehealth adopt rules necessary to standardize formats for and retention of records related to a patient’s consent to: (i) treatment, (ii) data collection and (iii) data sharing.
In Minnesota, SF 4399 passed both chambers. If enacted, the bill would provide that, subject to federal approval, substance use disorder services that are otherwise covered as direct face-to-face services may be provided via telehealth as defined in section 256B.0625, subdivision 3b. The use of telehealth to deliver services would need to be medically appropriate to the condition and needs of the person being served. Reimbursement would be at the same rates and under the same conditions that would otherwise apply to direct face-to-face services.
In Alabama, SB 207 passed one chamber. If enacted, the bill would adopt the dietitian licensure compact. In Tennessee, HB 1863 (paired with SB 1862) also passed one chamber, and if enacted, would [...]

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Trending in Telehealth: April 2 – April 8, 2024

by Amanda Enyeart and Jayda Greco | Apr 12, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Professional standards and supervision requirements
Reimbursement requirements

A CLOSER LOOK

Finalized Legislation & Rulemaking

Arizona enacted SB 1173, enacting the counseling compact.
Mississippi enacted SB 2157 (mentioned in last week’s post) adopting the Psychology Interjurisdictional Compact.
Kentucky enacted both bills mentioned in last week’s blog post:
SB 255 establishes requirements and standards for the provision of social work services via telehealth.
SB 111: Requires health benefit plans, limited health service benefit plans, Medicaid and state health plans to provide coverage for speech therapy provided in person or via telehealth.
West Virginia also enacted rulemaking pertaining to the practice of licensed dietitians. Specifically, the rulemaking established procedures for the practice of telehealth by licensed dietitians. The rule provides for relevant telehealth definitions, licensure standards, establishing a practitioner-provider relationship solely via telehealth and standards of telehealth practice (e.g., consent, identify verification, standards for confidentiality, etc.).
Arizona enacted rulemaking, applicable to the Medicaid program, which requires the Arizona Department of Health Services (Department) to allow a healthcare provider who is not licensed in Arizona to provide telehealth services to a client located in Arizona if the healthcare provider registers with the Department and pays a registration fee. Providers who register with the Department must maintain a statutory agent for service of process in the state and ensure the provider’s professional liability insurance policy includes coverage for telehealth services provided to clients in Arizona, among other requirements.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Wyoming enacted emergency rulemaking which provides that a physician or physician assistant who has established a provider-patient relationship in another state with a patient who is a resident of Wyoming may provide continued care to the patient via telehealth without a Wyoming physician or physician assistant license subject to the following:
(i) The provider-patient relationship must have been established in an in-person encounter in a state in which the physician or physician assistant is licensed;
(ii) Subsequent care may be provided to the patient via telehealth while the patient is in Wyoming if the care is a logical and expected continuation of the care provided in an in-person encounter in the state where the physician or physician assistant is licensed. If the patient is presenting with new medical conditions, or conditions that the standard of care dictates an in-person encounter is needed, patient must either return to the state in which the physician or physician assistant is licensed for care or must be referred to a Wyoming-licensed healthcare provider.
(iii) The telehealth care may continue for up to six months after the establishment of the provider-patient relationship in another state, after which an in-person encounter must take place in a jurisdiction where the physician or physician assistant is [...]

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Trending in Telehealth: March 26 – April 1, 2024

by Amanda Enyeart and Jayda Greco | Apr 2, 2024 | Telehealth

Trending in the past week:

Interstate compacts
Reimbursement requirements
Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

West Virginia enacted SB 522, which specifies that an emergency medical services agency may triage and transport a patient to a destination other than a hospital, dialysis center, skilled nursing facility or residence within the state or treat the patient in place if the ambulance service is coordinating the care of the patient through medical command or telehealth services. The bill also requires insurance plans to provide coverage for those services. SB 522 further requires the West Virginia Office of Emergency Medical Services to establish related protocols by October 1, 2024.
West Virginia also enacted rulemaking pertaining to the practice of medical imaging and radiation therapy technologists. The rulemaking includes a provision stating that telehealth practice is inapplicable to the practice of a medical imaging and radiation therapy technologist.
Maine enacted LD 1965, which provides telehealth standards for optometrists, including requirements for establishing an optometrist-patient relationship via telemedicine. While the bill establishes new flexibilities to allow for telehealth and provides relevant practice standards and definitions for telehealth practice, it also includes limiting language requiring either an in-person visit or an established relationship with the patient.
- For example, an optometrist-patient relationship is established when an individual agrees to receive ocular or healthcare services from the licensee and there has been an in-person encounter between the licensee and the individual, unless the standard of care requires that an individual be seen without an in-person visit, such as in an emergent situation as reasonably determined by the licensee.
- The bill also provides a pathway for an optometrist-patient relationship in which a licensee who uses telehealth in providing care and a patient who receives telehealth services through consultation with another licensee or other healthcare provider and who has an established relationship agrees to participate in, or supervise, the patient’s care through telehealth.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Three states – Kansas, Tennessee and Colorado – either introduced or progressed legislation relating to the Social Work Licensure Compact.
- In Kansas, SB 2484 passed both chambers.
- In Tennessee, HB 2405 also passed both chambers.
- In Colorado, SB 24-1002 passed the first chamber.
In Arizona, SB 1173 passed both chambers. If enacted, the bill would adopt the Counseling Compact.
In Mississippi, SB 2157 passed the second chamber. If enacted, the bill would adopt the Psychology Interjurisdictional Compact.
In Tennessee, JB 2587 passed the second chamber. If enacted, the bill would revise the state’s insurance code to remove from the definition of “provider-based telemedicine” the requirement that [...]

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Trending in Telehealth: March 19 – March 25, 2024

by Stacey Callaghan and Nathan Gray | Mar 26, 2024 | Telehealth

Trending in the past week:

Behavioral Health
Licensure Compacts
Telehealth Practice Requirements

A CLOSER LOOK

Finalized Legislation and Rulemaking:

Florida enacted SB 7016, which, among other things, enters Florida into the Interstate Medical Licensure Compact, the Physical Therapy Compact, and the Audiology and Speech-Language Pathology Compact.
In Utah, HB 365 was enacted. This act allows physicians, nurse practitioners and physician assistants to conduct initial consults for certain cosmetic procedures via telemedicine, including cryolipolysis (i.e. the removal of fat deposits using cold temperatures) and certain cosmetic laser treatments. Telemedicine consults would not be permitted for hair removal or tattoo removal treatments.
Washington enacted HB 1939 to enter the Social Work Licensure Compact.
In Washington, SB 5481 was also enacted. This act establishes professional practice standards for healthcare practitioners that provide telehealth services and establishes requirements for out-of-state health care practitioners.
Washington also passed SB 5821, which amends existing standards for establishing a provider-patient relationship related to audio-only coverage requirements. The act defines an established relationship to include a provider of audio-only telemedicine who has, among other things, seen the patient in-person or through real-time interactive audio and video technology at least once in the last three years or an audio-only provider to whom the patient was referred by a physician who had seen the patient, in-person or through real-time interactive audio and video technology, at least once in the past three years.
Wisconsin enacted SB 476, which prohibits the Wisconsin Medicaid program from requiring that telehealth providers have a physical address in the state.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

In Alaska, SB 91 passed the first chamber. The bill would permit an out-of-state member of a physician’s multidisciplinary care team to provide services in Alaska via telehealth if the service provided by the out-of-state member is not reasonably available in the state or it involves ongoing treatment or follow-up care regarding a suspected or diagnosed life-threatening condition. The bill would also establish grounds for disciplinary action against an out-of-state member of a physician’s multidisciplinary care team.
In Georgia, HB 441 passed both chambers. If enacted, the bill would, among other things, require a dentist intending to provide care via teledentristry to notify the Georgia Board of Dentistry and to provide documentation that the dentist has 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 [...]

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Trending in Telehealth: March 12 – March 18, 2024

by Patrick Zanayed and Nathan Gray | Mar 19, 2024 | Telehealth

Trending in the past week:

Expanding Telehealth
Telehealth Practice Requirements

A CLOSER LOOK

Finalized Legislation and Rulemaking:

Indiana enacted SB 132, which removes the requirement that out-of-state providers licensed in Indiana and their employer/contractor file a certification to be subject to Indiana jurisdiction and laws with the Indiana Professional Licensing Agency before providing telehealth services in Indiana. Providers would still be subject to Indiana jurisdiction and substantive and procedural law.
In Indiana, SB 104 was also enacted, which requires veterinarians and veterinary technicians to disclose certain information when renewing a license or registration certificate including whether services are provided via telehealth.
New Hampshire adopted a final rule, which includes amendments to describe the initial application process, qualifications, renewals and audits for psychologists. It also clarifies requirements for a tele-pass license for psychologists.
Utah enacted HB 44, which enters Utah into the Social Work Licensure Compact.
Utah enacted HB 145, which permits veterinarians to supervise veterinary technicians via telehealth. Previously, veterinarians were only permitted to supervise state-certified veterinarian technicians via telehealth.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

In Maryland, HB 1078 passed the first chamber. The bill would require the state Medicaid program to provide ultrasound procedures and remote fetal nonstress tests in certain circumstances.
In Wisconsin, SB 823 passed the first chamber. This bill would require out-of-state practitioners to register with the Department of Safety and Professional Services or an applicable Wisconsin credentialing board to provide telehealth services in Wisconsin.
In Kentucky, HB 829 passed the first chamber. This bill, among other things, would require a patient or designated caregiver to complete a consultation with an authorized pharmacist prior to purchasing medical cannabis and would require the patient to complete the consultation annually. The bill includes an exception to the consultation requirement for visiting qualified patients presenting a valid out-of-state registry identification card and proof of diagnosis of a qualifying condition. It provides that the consultation may be completed via telehealth and establishes a process for pharmacists to become authorized to provide medical cannabis consultations.
In Michigan, a proposed rule would require chiropractors to obtain consent from patients before providing telehealth services, maintain proof of consent in patient’s medical record and require chiropractors to exercise the same standard of care applicable to in-person service when providing service via telehealth.
In Nevada, a proposed rule would establish provisions related to teledentistry, including requiring dentists to collect a digital form of written consent for a patient, specify recording keeping requirements for teledentistry and establish standards for collaborations with other providers.
In Texas, a proposed rule would permit physical therapists providing services to students with disabilities in the educational setting to perform certain examinations via telehealth by removing the onsite examination requirement.
In [...]

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