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Telehealth

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: July 18 – 24, 2023

by Marshall E. Jackson, Jr. and Grayson Dimick | Jul 26, 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

A CLOSER LOOK

Finalized Legislation and Rulemaking

Connecticut enacted Substitute for SB 9, which enters the state into the Physical Therapy Licensure Compact.
Hawaii enacted SB 674, which enters the state into the Interstate Medical Licensure Compact.
Maine enacted LD 1749, which enters the state into the Physical Therapy Licensure Compact. Maine also enacted LD 717, which enters the state into the Audiology and Speech-Language Pathology Interstate Compact.
Rhode Island enacted HB 5737, which enters the state into the Nurse Licensure Compact.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Alaska proposed a rule that would establish teletherapy standards of practice for psychologists and psychological associates, with the aim of providing clear guidelines for engaging in technology-assisted distance professional services.

Why it matters:

There continues to be elevated activity surrounding licensure compacts. This year has seen an uptick in legislative activity by states seeking to ease out-of-state licensure barriers through the use of interstate compacts. Certain compacts have a majority of states as members. As examples, Hawaii and Missouri became the Interstate Medical Licensure Compact’s 40th and 41st members, respectively, while Rhode Island became the Nurse Licensure Compact’s 41st member. As established compacts continue to grow their membership, a new compact has emerged: Missouri joined the Social Worker Licensure Compact earlier in July, becoming the first state to adopt the compact.

Trending in Telehealth: July 11 – 17, 2023

by Dale C. Van Demark and Grayson Dimick | Jul 21, 2023 | Telehealth

Trending in the past two weeks:

Medicaid coverage
Maternal health

A CLOSER LOOK

Finalized Legislation and Rulemaking

Alaska finalized regulations that implement 2022 legislation (HB 265) requiring the state Medicaid program to provide coverage for telehealth services. The regulations set out requirements related to coverage and payment through Medicaid for services provided via telehealth, including requirements for modalities and providers.
Maryland finalized regulations for the state Medicaid program that update the final date for which telehealth includes audio-only telephone conversations. The final date has been moved from June 30, 2023, to June 30, 2025, in line with legislation enacted in May 2023. The regulations also broaden eligibility for remote patient monitoring services by removing the requirement that the participant be at high risk for avoidable hospital utilization.
Maryland also finalized regulations for the state Medicaid program that update the requirements for urgent care centers, including requirements for supervision and services provided via telehealth.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

California passed AB 1478 in the first chamber. The bill would require the Department of Public Health to maintain a public database of referral networks for community-based mental health providers and support services addressing postpartum depression and prenatal care, including information on mental health providers and support groups that allow for patient-driven care access through telehealth and virtual care.
Colorado proposed a rule that would authorize the use of electronic consultation (eConsults) in the state Medicaid program. eConsults would take place through the authorized eConsult platform, which is currently in the process of being implemented by the Colorado Department of Health Care Policy and Financing. eConsults would involve an asynchronous interaction between a primary care provider and a specialty provider in order to obtain the specialty provider’s expert opinion. Specialty providers would be reimbursed only for eConsults that occur on the approved eConsult platform. More information regarding the eConsult Platform, currently scheduled to go live in winter 2024, is available here.
Texas proposed a rule that would extend the eHealth Advisory Committee (eHAC) for an additional two years. eHAC advises the Health and Human Services Commission Executive Commissioner and Health and Human Services agencies on strategic planning, policy, rules and services related to the use of health information technology, health information exchange systems, telemedicine, telehealth and home telemonitoring services, and is scheduled to sunset December 31, 2023.

Why it matters:

States continue to adopt rules addressing the use of telehealth in state Medicaid programs. Much of this regulatory activity is focusing on clarifying and expanding coverage for telehealth services in state Medicaid programs, [...]

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Trending in Telehealth: June 27 – July 10, 2023

by Stacey Callaghan and Grayson Dimick | Jul 12, 2023 | Telehealth

Trending in the past two weeks:

Telehealth pilot programs, with a focus on home health
Licensure compacts

A CLOSER LOOK

Finalized Legislation and Rulemaking

Connecticut enacted SB 1705, which requires the Department of Public Health to establish a Hospice Hospital at Home pilot program to provide hospice care through a combination of in-person visits and telehealth.
Delaware adopted rules for home health agencies and personal assistance services agencies that define “telehealth mechanism” and address services provided via telehealth mechanisms.
Illinois enacted SB 1913, which requires the Department of Healthcare and Family Services and contracted managed care plans to provide for coverage of mental health and substance-use disorder treatment or services delivered as behavioral telehealth services, and reimburse such services on the same basis, in the same manner, and at the same reimbursement rate as in-person services are reimbursed.
Maine enacted LD 231, which establishes a statewide child psychiatry telehealth consultation service, to the extent funding allows. The service will support primary care physicians who are treating children and adolescent patients and need assistance with diagnosis, care coordination, medication management and any other behavioral health questions.
New Mexico finalized rules that define “telemedicine” for respiratory therapists.
Missouri enacted SB 70, which enters the state into the Counseling Interstate Compact, Interstate Medical Licensure Compact and Social Work Licensure Compact.
Oklahoma enacted HB 2686, which specifies telehealth encounters cannot be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisoprodol, unless the encounter is used to prescribe opioid antagonists or partial antagonists under certain circumstances, or Schedule III-V controlled substances for medication-assisted treatment or detoxification treatment for substance-use disorder.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Kentucky proposed a rule that would significantly update telehealth requirements for optometrists, including revising applicable definitions, informed consent requirements, practice standards and jurisdictional considerations (i.e., where a patient or physician may be located).
New Jersey passed S 3604 in the first chamber. The bill would incorporate the use of healthcare platforms (defined as “as an Internet-based service through which a consumer, who may or may not have separate health insurance coverage, may set-up an account or become a member to obtain discounts on prescription or non-prescription drugs or devices and through which other services, including telemedicine, may be provided”) into the laws governing pharmacy benefits managers, pharmacists and telehealth.
Ohio passed SB90 in the first chamber to enter the state into the Social Worker Licensure Compact.

Why it matters:

States continue [...]

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Trending in Telehealth: June 20 – 25, 2023

by Lisa Mazur and Adetoro Olugbemi | Jun 30, 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:

Medicaid reimbursement

Medical marijuana

Mental health

Reproductive health

A CLOSER LOOK

Finalized Legislation & Rulemaking

Florida enacted H 387, permitting qualified physicians to perform telehealth physical patient examinations before issuing subsequent physician certifications for the medical use of marijuana, as long as the patient examination for the initial certification was conducted in person.

Hawaii enacted HB 907, which conforms the state’s law regarding telehealth to the Medicare standards by clarifying that telehealth services provided by way of an interactive telecommunications system will be reimbursed by Medicaid.

Louisiana passed a final rule to adopt provisions in the Professional Services Program to continue to provide Medicaid reimbursement for physician-directed treatment-in-place ambulance services after the COVID-19 public health emergency ended on May 11, 2023. Reimbursement to the ambulance providers for initiation and facilitation of the physician-directed treatment-in-place telehealth service requires a corresponding treatment-in-place telehealth service. The corresponding treatment-in-place telehealth service is demonstrated via a Louisiana Medicaid paid treatment-in-place telehealth service claim.

New Hampshire enacted SB 264, which defines a mental health consultation during a surrogacy process to include a telehealth meeting.

New York enacted S 6749, creating a community-based paramedicine demonstration program that would permit emergency medical service personnel to provide community paramedicine and use alternative destinations, telemedicine to facilitate treatment.

New York enacted SB 1066, expanding protections for persons who perform legally protected reproductive health activity under state law to include protections for reproductive health services provided in person or by means of telehealth.

Ohio passed a final rule to amend the Ohio Vision Professionals Board rules to define telehealth-related terms and clarify the standard of care for telehealth services, patient consent requirements, doctor-patient relationship requirements and prescribing requirements.

Rhode Island enacted SB 565, which establishes telepractice standards for speech language pathologists and audiologists and adopts and incorporates the American Speech-Language-Hearing Association’s Code of Ethics.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Maine progressed LD 231 in the second chamber to establish a statewide child psychiatry telehealth consultation service to support primary care physicians who are treating children and adolescent patients and need assistance with diagnosis, care coordination, medication management and any other necessary behavioral health questions.

Maine progressed LD 717 in the second chamber, establishing the Audiology and Speech-Language Pathology Interstate Compact.

West Virginia issued a proposed rule to establish procedures for the practice of telehealth by a licensed dietitian, including requirements for the patient-provider relationship.

Why it matters:

States continue to progress and pass legislation establishing telehealth processes for medical [...]

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Trending in Telehealth: June 13 – 21, 2023

by Patrick Zanayed and Adetoro Olugbemi | Jun 27, 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

Mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking

Connecticut enacted HB 6768, which permits physicians, advanced practice registered nurses and physician assistants to certify a qualifying patient’s use of medical marijuana and provide follow-up care using telehealth if they comply with other statutory certification and recordkeeping requirements.

Florida enacted HB 5101, which requires each school district to implement a school-based mental health assistance program that provides behavioral health services in-person and supplemented by telehealth.

Florida enacted SB 2500, which provides additional funding for telehealth services under the Minority Maternity Care program.

Illinois enacted SB 1298, amending the Home and Community-Based Services Waiver Program for Adults with Developmental Disabilities to permit medical and emergency telehealth services for persons with intellectual and developmental disabilities.

Louisiana enacted SB 186, adopting the Occupational Therapy Licensure Compact.

Louisiana enacted SB 66, which amends the state insurance code by replacing the term “telemedicine” with “telehealth,” for consistency throughout the code. The amendment does not require a provider to have an in-person examination with the patient prior to using telehealth but does require that a referral be made to an in-state healthcare provider or in-state follow-up care be arranged if necessary. The amendment also permits the use of interactive audio without video if, after access and review of the patient’s medical records, the healthcare provider determines that the provider is able to meet the same standard of care as if the services were provided in-person.

Louisiana enacted HB 41, which requires health plans to provide equivalent coverage and payments for telehealth occupational therapy services as for in-person services, unless the plan and the provider agree otherwise.

Louisiana enacted HB 181, which allows coroners to use telehealth when conducting an examination for an emergency mental health commitment.

Texas enacted HB 2727, which amends the requirements for the home telemonitoring program under Medicaid, including reimbursement requirements.

Texas enacted HB 617, which establishes 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.

Texas enacted SB 1146, increasing access to telehealth services for inmates. The law requires the Department of Criminal Justice, in conjunction with The University of Texas Medical Branch at Galveston and the Texas Tech University Health Sciences Center, to establish procedures to expand access to telemedicine medical services, telehealth services and onsite medical care [...]

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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: May 31 – June 5, 2023

by Marshall E. Jackson, Jr. and Adetoro Olugbemi | Jun 9, 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

Medical Cannabis

Mental Health

A CLOSER LOOK

Finalized Legislation & Rulemaking

Iowa enacted HF 671, adopting the Professional Counselors Licensure Compact.

Minnesota enacted HF 100, permitting the medical sale and use of cannabis through the state’s registry program. HF 100 permits remote pharmacist consultations by secure videoconference, telephone or other remote means, as long as the pharmacist engaging in the consultation is able to confirm the identity of the patient and the consultation adheres to patient privacy requirements that apply to healthcare services delivered through telemedicine. A Minnesota licensed physician, physician assistant or advanced practice registered nurse (APRN) must determine on a yearly basis if the patient continues to have a qualifying medical condition for enrollment on the Division of Medical Cannabis registry.

Missouri passed a final rule establishing the Telehealth Dental Pilot Project for Medically Underserved Populations to examine new methods of extending dental care to residents in assisted living facilities, intermediate care facilities, residential care facilities and skilled nursing facilities, and homebound special needs patients. This rule permits the supervision of dental assistants and dental hygienists using telehealth technology.

Oklahoma enacted SB 12, creating a mental health transport revolving fund for the Department of Mental Health and Substance Abuse Services. This law permits telemedicine assessments of patients when assessments are requested by sheriffs or peace officers. The state’s criminal code defines the term peace officer as “any sheriff, police officer, federal law enforcement officer, tribal law enforcement officer, or any other law enforcement officer whose duty it is to enforce and preserve the public peace.” Okla. Stat. tit. 21 § 99.

Vermont enacted three telehealth-related laws:

H 62 adopts the Interstate Counseling Compact to facilitate interstate practice of licensed professional counselors with the goal of improving public access to professional counseling services.

H 86 adopts the Audiology and Speech-Language Pathology Interstate Compact, which streamlines the licensure process for audiologists and speech-language pathologists and allows the use of telehealth technology to facilitate increased access to audiology and speech-language pathology services.

H 282 adopts the Psychology Interjurisdictional Compact, which regulates the day-to-day practice of telepsychology and streamlines the licensure process for psychologists.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Connecticut progressed HB 6768, which would permit physicians, APRNs and physician assistants to certify a qualifying patient’s use of medical marijuana and provide follow-up care using telehealth if they comply with other statutory certification and recordkeeping requirements.

Louisiana progressed two bills:

HB181 would [...]

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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 16 – 22, 2023

by Stacey Callaghan and Taylor Hood | May 26, 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

Telehealth Flexibilities

A CLOSER LOOK

Finalized Legislation & Rulemaking

The North Carolina General Assembly voted to override Gov. Roy Cooper’s veto of SB 20. Dubbed the Care for Women, Children, and Families Act, SB 20 operates to reduce access to reproductive health services, including by eliminating the provider’s ability to give patients information contained in the relevant consent form over the telephone. The legislation takes effect July 1.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Alaska progressed legislation (SB 75) in the first chamber to join the Audiology and Speech-Language Pathology Interstate Compact.

Illinois progressed legislation (SB 2123) in the first chamber to adopt the Counseling Compact.

Oregon progressed legislation (SB 232) that would update the Oregon Medical Board’s telemedicine regulations at 52 O.R.S. §§ 677.080 and 677.137 to clarify that the practice of medicine occurs where a patient is physically located.

Texas continued to progress legislation (HB 1771) that would require each agency with regulatory authority over a health professional providing a telemedicine, teledentistry or telehealth to adopt rules 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 first chamber that would establish a pilot project to provide emergency medical and prehospital care instruction through telemedicine/telehealth services by regional trauma resource centers to healthcare providers in rural area trauma facilities.

Why it matters:

Interstate compact adoption remains elevated. States continue to progress legislation that would enact licensure compacts across healthcare professions. This week, Alaska and Illinois took steps to adopt compacts that would ease out-of-state licensure hurdles and improve shared systems across public agencies.

Texas addresses rural care via telehealth. Many states are progressing legislation that would permanently extend telehealth flexibilities to allow providers to practice across counties and use technologies to reach and educate patients in rural low-access areas.

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.

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