OF DIGITAL INTEREST

Trending in Telehealth: September 17 – 30, 2024

by Patrick Zanayed, Lauren Ellison and Grayson Dimick | Oct 1, 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:

Insurance and Medicaid reimbursement
Professional standards

A CLOSER LOOK

Proposed Legislation & Rulemaking:

The California governor vetoed AB 2339, which would have expanded the definition of “asynchronous store and forward” for Medicaid purposes to include asynchronous electronic transmission initiated directly by patients, including through mobile apps. The bill would have allowed Medicaid providers to establish a provider-patient relationship using asynchronous store and forward when the visit related to sensitive services.

The District of Columbia gave notice of a proposed Medicaid state plan amendment. The amendment would allow DC Medicaid to cover and reimburse for new remote patient monitoring (RPM) preventive services for eligible pregnant and postpartum individuals who are at risk of experiencing pregnancy-related morbidity or mortality issues. This amendment would include coverage for medically necessary monitoring devices, initial set-up and patient education on such devices, and collection and interpretation of the results by a healthcare professional.

The Texas Medical Board proposed repealing and replacing its telemedicine regulations. The proposed regulations are pared down from the current regulations, addressing only licensure and requirements for prescribing, and affirming that telemedicine medical services, including supervision, delegation, and posting of notices regarding filing a complaint, must be in compliance with Tex. Occ. Code C 111 and the Medical Practice Act.
At the federal level, the US House of Representatives approved the bipartisan HR 6033, which would create a task force focused on access to healthcare information technologies for non-English speakers. The bill would create best practices for:
- Facilitating and using interpreters during telemedicine visits.
- Providing accessible instructions for how to use telecommunication systems.
- Improving digital patient portals for non-English speakers.
- Integrating the use of video platforms that enable multi-person video calls via telecommunications.
- Providing patient materials, communications, and instructions in multiple languages. This would include text message appointment reminders and prescription information.

The bill defines “health information technology service providers” to include electronic medical record companies, RPM companies, and telehealth and mobile health vendors.

Finalized Legislation & Rulemaking:

Delaware enacted SB 301, which requires public universities to provide access to medication for the termination of pregnancy and emergency contraception. Although the medication and contraception must be provided onsite, the consultation to provide them may be performed through telehealth services.
Illinois enacted HB 4475, which amends the Insurance Code to address mental health and substance use parity requirements. The act provides that insured individuals have the right to select the provider or facility of their choice and modality, whether the care is provided via in-person visit or telehealth, for medically necessary mental health and substance use care.
The US Senate issued a joint resolution,
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Trending in Telehealth: August 26 – September 17, 2024

by Amanda Enyeart, Jessica Vishny and Grayson Dimick | Sep 20, 2024 | Telehealth

Trending in the past week:

Out-of-state telehealth providers
Interstate compacts
Reimbursement requirements

A CLOSER LOOK

Proposed Legislation & Rulemaking:

California’s AB 2339 was approved by both chambers and sent to the governor for signature. The bill would expand the definition of “asynchronous store and forward” for the state’s Medicaid program, Medi-Cal, to include asynchronous electronic transmission initiated directly by patients, including through mobile apps. Existing law prohibits a healthcare provider from establishing a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, audio-only, remote patient monitoring, or other virtual communication modalities, except as specified. Among those exceptions, existing law authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services (e.g., mental or behavioral health, sexual and reproductive health, substance use disorder treatment, gender affirming care) and when established in accordance with Medicaid-specific requirements. AB 2339 would expand this exception to the use of asynchronous store and forward when the visit is related to sensitive services. Existing law also authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests that they do not have access to video. AB 2339 would remove from that exception the option of the patient attesting that they do not have access to video, and would add a parallel exception to permit the use of an asynchronous store and forward modality when the client requests.
The North Dakota Board of Medicine proposed regulations that would provide exceptions to physician licensure for telehealth providers licensed in another state, including for continuation of care received outside of the state, temporary care while the patient is located within the state temporarily, preparation for a scheduled in-person visit, practitioner-to-practitioner consultations, and emergency circumstances.

Finalized Legislation & Rulemaking:

Delaware enacted SB 331 into law. Under the act, out-of-state practitioners who wish to prescribe controlled substances in Delaware, including those who have privilege based on a telehealth registration or compact license, must obtain a Delaware controlled substance registration.
Alaska enacted SB 75 into law, entering the state into the Audiology and Speech-Language Pathology Interstate Compact.
Alaska enacted SB 91 into law. The act updates the telehealth licensure exceptions (which currently allow physicians licensed in another state to provide telehealth services in Alaska without Alaska licensure under certain circumstances) to include exceptions for members of a physician’s multidisciplinary care team. “Multi-disciplinary care team” is defined to include nurses, advanced practice registered nurses, physician assistants, social workers, psychologists, licensed professional counselors, marriage and family therapists, physical therapists, occupational therapists, and other provider types. The exception applies when such services provided are not reasonably available [...]

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Updated Mandatory Disclosure Requirements for Colorado Mental Health Providers Go into Effect

by Lisa Mazur, Stacey Callaghan, Sam Siegfried and Angela Irene Theodoropoulos | Sep 11, 2024 | General Interest

On August 1, 2024, Colorado legislation took effect amending the mandatory disclosures that mental health providers must make to their clients under state law. Providers of mental health services in Colorado should take note of the new legislation and review their existing patient disclosure notices to ensure compliance.

Colorado law requires mental health providers to disclose certain information in writing during initial client contact. The statute covers a broad range of mental health providers, including psychologists, social workers, marriage and family therapists, licensed professional counselors, addiction counselors, and licensee candidates. Key elements of the mandatory disclosures include the following:

The provider’s name, business address, and business phone number.
The provider’s degrees; credentials; certifications; registrations; licenses; and related education, experience, and training.
Contact information related to the applicable board that regulates the provider’s profession.
Certain statements regarding fees, patient freedom of choice and rights to information, inappropriateness of sexual relationships between providers and clients, confidentiality of information discussed during sessions, and record retention requirements.

Colo. Rev. Stat. Ann. § 12-245-216(1).

The newly enacted legislation reduced the extent of the required mandatory disclosures. Previously, the Colorado statute required that providers include information explaining the levels of regulation applicable to different mental health professionals, but Senate Bill 24-115 removed this requirement. 2024 Colo. Legis. Serv. Ch. 217 (S.B. 24-115). This is a positive change for providers because it reduces some of the mandatory disclosures.

If you need assistance creating a patient notice to comply with the Colorado statute overall or assistance updating your existing disclosures, please reach out to us. We will work to address any questions you may have regarding the impact of this legislation and the compliance of your current forms.

Trending in Telehealth: August 13 – 26, 2024

by Amanda Enyeart and Angela Irene Theodoropoulos | Sep 4, 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:

Licensing requirements
Substance use disorder
Teleoptometry

A CLOSER LOOK

Finalized Legislation & Rulemaking:

In Maine¸ the comment period deadline passed for a Department of Professional and Financial Regulation proposed rule, which, in part, implements the legislation to establish telehealth standards, uses, and limitations for the practice of optometry. The proposed rule would establish a comprehensive framework of virtual care delivery, imposing guidelines around scope of practice, underscoring the importance of identity verification, and providing a necessary reminder about the importance of informed consent for telehealth providers. If adopted, the rule would prohibit prescribing to a patient based solely on a static questionnaire and defines telehealth to exclude the provision of optometric services exclusively through an audio-only telephone, email, text messaging, instant messaging or US mail or other parcel service. While the proposed rule states that eye examinations should generally be performed in-person, it allows for a remote interview and examination “if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis” as though care had been delivered in person.
In Nevada, the Board of Psychological Examiners adopted a final rule relating to the supervision of psychological assistants, psychological interns, and psychological trainees. The regulation imposes additional duties on the supervisor to ensure that “a psychological trainee receives at least 1 hour of individual supervision for each 10 hours of service delivery per week.” Notably, the regulation specifies that “service delivery” means “activities that involve direct contact with a client in-person or through telehealth.” Nevada currently defines “telehealth” as “the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including standard telephone, facsimile or electronic mail.”
The Oregon Criminal Justice Commission adopted a final rule to administer the state’s Jail-based Medications for Opioid Use Disorder Grant Program. The program will provide $10 million in funding to develop substance-abuse recovery programs to adults in custody. Under the rule, applicants for the grant must describe how the funds will be used to meet one of four requisite aims, including the provision of “medication, telemedicine, or any other reasonable treatment to persons in custody with an opioid disorder.”

Why it matters:

Regulators are adapting to the evolving healthcare delivery landscape. States continue to authorize telehealth care delivery for a wider range of practitioners. As evident from the proposed rule in Maine, however, such new authorizations can come with a myriad of compliance considerations, including obtaining informed consent, restrictions around prescribing, as well as heightened privacy and security concerns.
Regulators disavow a one-size-fits-all approach for virtual care delivery. As legislators and regulators become increasingly sophisticated as to the various telehealth modalities, they [...]

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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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