OF DIGITAL INTEREST

Trending in Telehealth: November 15 – 28, 2023

by Purnima Boominathan and Angela Irene Theodoropoulos | Dec 1, 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 two weeks:

Professional Licensure
Telehealth Practice Standards
Medicaid Reimbursement
Cross-State Licensing Compact

A CLOSER LOOK
Finalized Legislation and Rulemaking

In Alaska, the Board of Optometry’s final rule from October concerning licensing, continuing education and telehealth standards went into effect on November 15, 2023. The final rule created new standards for optometrists providing services via telehealth. Notably, an optometrist must create a pre-existing optometrist relationship verbally, in writing or through an in-person exam before conducting a patient visit through telehealth, as well as verify the patient’s identity. Additionally, the optometrist also may not determine an ophthalmic prescription used to correct a refractive error based solely on an examination conducted through telehealth.
The District of Columbia passed legislation requiring professional members of licensing boards to be District residents and to maintain an active, primarily non-telehealth healthcare practice. This legislation was signed by the Mayor of the District of Columbia on November 21, 2023, and will take effect following a 30-day period of congressional review and publication in the District of Columbia Register.
Florida’s Department of Health issued a final rule, effective December 7, 2023, to update its procedure for healthcare providers licensed in other states and territories to register with the department to provide telehealth services to patients in Florida.

Legislation and Rulemaking Activity in Proposal Phase
Highlights:

Texas, through the Texas Behavioral Health Executive Council, proposed amendments to §781.323, which would provide clarification regarding telehealth practice requirements for social workers.
In Utah, the Department of Health & Human Services issued a notice of a proposed rule to update its current telehealth policies, in part to implement the reimbursement provision for audio-only telehealth legislated in H.B. 437, passed in the 2023 general session.
Washington’s Department of Health published a proposed rule focused on implementing the multistate nurse licensure compact. The department also published a proposed rule that would allow a certified dietitian or nutritionist to provide services in person or through telehealth, as appropriate, based on the needs of the client.

Why it matters:

Increased Barriers to Telehealth Flexibilities. The end of the COVID-19 public health emergency brought with it the expiration of interstate licensure waivers and the rollback of telehealth regulatory flexibilities across the states. As states continue to assess how the shift in telehealth policies will impact residents, some of the recent legislative and rulemaking activity illustrate the impact of restrictive attitudes toward telehealth on patient care. Some common policy barriers to telehealth include a requirement to establish the provider-patient relationship via an in-person visit prior to a telehealth appointment or the outright prohibition of using telehealth as the sole method [...]

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Trending in Telehealth: November 8 – 14, 2023

by Patrick Zanayed and Angela Irene Theodoropoulos | Nov 17, 2023 | Telehealth

Trending in the past week:

Coverage and Payment Parity
Regulatory Licensing
Interstate Compacts
Medicaid Reimbursement

A CLOSER LOOK
Finalized Legislation and Rulemaking

In Florida, the Florida Board of Psychology issued Rule 64B19-17.002 to revise the disciplinary guidelines for licensed psychologists who commit professional conduct violations. The guidelines provide for first and subsequent offenses committed by licensees, including separate disciplinary consequences for out-of-state telehealth registrants.
In Texas, the state’s Health and Human Services Commission (HHSC) renewed its e-Health Advisory Committee (eHAC) by final rule. eHAC currently advises the HHSC executive commissioner and health and human services agencies in the state 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. eHAC was set to expire on December 31, 2023, but has now been extended for a two-year period until December 31, 2025.
Legislation and Rulemaking Activity in Proposal Phase

Highlights:

Michigan proposed several bills concerning coverage and payment parity for telehealth services.
- HB 4580 focuses on coverage parity for telemedicine services in the Medicaid context for the state’s medical assistance program or Healthy Michigan program through amending the state’s Social Welfare Act.
- HB 4131 aims to amend the state’s insurance code to prohibit health insurance policies from denying or restricting coverage for telemedicine services and to require that telemedicine services be treated the same as in-person medical care.
- HB 4579 focuses on amending the state’s insurance code to provide coverage parity for services provided via telemedicine.

Why it matters:

A push for parity. Michigan’s proposed bills are pushing for coverage parity across insurers and payment parity (i.e., telehealth and in-person services must be reimbursed at equal rates). While coverage parity for private payors is already widespread across most states, there is an ongoing debate as to the benefits and drawbacks of payment parity for telehealth. Some argue that equal reimbursement rates for telehealth results in overuse, or that telehealth services are lower value and/or cause less to administer, thereby warranting the lower reimbursement rate. However, without payment parity, a lower reimbursement rate makes telehealth financially impractical for many providers, particularly those with small practices or who are working in underserved communities. The reduction in telehealth services, in turn, has a negative outcome; without as many options, patients face diminished access to care overall and to provider choice, expertise and quality.
Advisory committees can provide state-level oversight to health initiatives. While some states quickly sunset their telehealth advisory councils, others continue to have telehealth and e-health advisory committees and initiatives to guide state programs. Texas’ choice to renew eHAC for another two years signals a [...]

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Trending in Telehealth: November 1 – 7, 2023

by Stacey Callaghan and Angela Irene Theodoropoulos | Nov 10, 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:

Telehealth Practice Standards
Medicaid Reimbursement
Interstate Licensure Compacts
Regulatory Licensing

A CLOSER LOOK

Finalized Legislation and Rulemaking

In Michigan, the Department of Licensing and Regulatory Affairs promogulated, through final rule, practice standards and requirements for dentistry (including tele-dentistry under Part 6B of the final rule) found at Mich. Admin. Code R. 338.11611 to 338.11615.
- Under the final rule, “telehealth” covers the use of electronic information and telecommunication technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health or health administration. Telehealth also may include, but is not limited to, “telemedicine,” which is the use of electronic media to link patients with healthcare professionals in different locations. The final rule also allows for e-prescribing, subject to enumerated requirements.
- The Department waived the existing requirement for in-person contact with the dentist or dental therapist once every 24 months for telehealth services, unless the dentist or dental therapist delegates or assigns duties other than radiographic imaging to allied dental personnel.
- The Department set forth specific requirements for the informed consent process to treat remotely via telehealth. Among other requirements, the licensee must explain the alternatives, capabilities and limitations of telemedicine, and the patient may decline to receive telehealth services.
- The Department articulated privacy standards for telehealth, including that the telehealth encounter must be secure and compliant with federal and state security and privacy regulations.
In Washington, the state’s Health Care Authority issued a permanent rule amending the standards for Medicaid reimbursement of childbirth education classes. The permanent rule added criteria to allow reimbursement for online classes through telemedicine, subject to a one-on-one check-in with the client and qualified childbirth education provider during or after the online classes.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

In West Virginia, the Governor’s Committee on Crime, Delinquency, and Correction modified its proposed rule on Sexual Assault Forensic Examinations to specifically include sexual assault telehealth services. The modification adds a definition for “TeleSANE” to allow certified sexual assault nurse examiners (SANE) with documented expertise to provide forensic exam guidance through telehealth technology.
In Wisconsin, SB 1, discussed in-depth last week, continued to advance after passing through the first chamber and being recommended for concurrence during an executive session. The proposed legislation would ratify and enter Wisconsin into several interstate compacts, including the Audiology and Speech-Language Pathology Interstate Compact, the PA Licensure Compact, the Social Work Licensure Compact and the Counseling Compact.

Why it matters:

Telehealth increasingly represents a mechanism to satisfy niche and specialty care needs. This week saw significant rulemaking activity aimed at leveraging telehealth in unique contexts, from dentistry services to childbirth education, and even sexual assault forensic [...]

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Trending in Telehealth: October 24 – 31, 2023

by Marshall E. Jackson, Jr. and Ashley Ogedegbe | Nov 3, 2023 | Telehealth

Trending in the past week:

Interstate Licensure Compacts
Telehealth Practice Standards
Fiscal Policies and Incentives
Behavioral Health
Regulatory Licensing

A CLOSER LOOK

Finalized Legislation and Rulemaking

In Wisconsin, the governor signed AB 364 into law. The bill amends the Wisconsin tax code by adopting certain Internal Revenue Code provisions relating to telehealth services and other remote care services and high-deductible health plans (HDHPs) under the Consolidated Appropriations Acts of 2022 and 2023. Specifically, AB 364 authorizes individuals covered by an HDHP to claim a state income tax deduction for contributions to a health savings account, even if the plan has a $0 deductible for telehealth or remote services. The tax deduction will be available for taxable years beginning after 2021.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

In Wisconsin, SB 1 passed through the first chamber. The proposed bill aims to ratify and enter Wisconsin into the following interstate compacts: the Audiology and Speech-Language Pathology Interstate Compact, the PA Licensure Compact, the Social Work Licensure Compact and the Counseling Compact.
In Illinois, SB 767 passed through the first chamber. The proposed bill would amend the HMO Act and permit audiologists and physicians to prescribe hearing aids via in-person or telehealth evaluations.
Nevada proposed a rule that defines the remote practice standards for social workers. Among other things, the rule would 1) permit the remote supervision of trainees, removing the in-person supervision requirements; 2) clarify that telehealth must be provided through Nevada-licensed providers; 3) authorize social workers to elect “inactive status” for periods during which the licensee is not actively providing services in the state; and 4) create a new licensure-by-endorsement process for social workers licensed in different countries.
Vermont proposed a rule to implement two new professional credentials created by statute: the telehealth license and telehealth registration. Under the proposed rule, out-of-state healthcare professionals may obtain 1) a telehealth license to provide telehealth services to a total of no more than 20 patients in Vermont during a two-year license term or 2) a telehealth registration to provide telehealth services for a period of no more than 120 consecutive days from the date the registration was issued and to a total of no more than 10 patients over the 120-day period. The license and registration offer a discount for out-of-state providers, as the fee for a telehealth license is 75% of a full license fee, and the telehealth registration is one-half of the full license fee.

Why it matters:

Professional mobility and flexibility. Vermont’s initiative to introduce telehealth licenses and registrations for out-of-state healthcare professionals represents a significant step in facilitating telehealth practice within the state. This proposal aims to streamline the licensure process by offering [...]

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Trending in Telehealth: October 17 – 23, 2023

by Dale C. Van Demark and Ashley Ogedegbe | Oct 27, 2023 | Data breach, Telehealth

Trending in the past week:

Interstate Licensure Compacts
Telehealth Practice Standards
Disciplinary Guidelines
Behavioral Health
Regulatory Licensing

A CLOSER LOOK

Finalized Legislation and Rulemaking

Alaska adopted a final rule creating new standards for optometrists providing telehealth services. To provide telehealth services, optometrists must: establish an optometrist-patient relationship verbally, in writing or in-person; verify the patient’s identity; maintain patient confidentiality; provide telehealth services at the same quality as in-person services; diagnose patients at the time of the patient visit; maintain complete and timely records; and perform additional examinations, in addition to telehealth, when dispensing prescription eyewear.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

In Wisconsin,
- Three Interstate Compact bills advanced through the first chamber:
  - SB 196 would enact the Counseling Compact;
  - SB 391 would enact the Social Work Licensure Compact; and
  - SB 197 would enact the Audiology and Speech Pathology Compact.
- The legislature is also considering AB 364, which advanced through the second chamber.
  - AB 364 would amend the Wisconsin tax code by adopting certain Internal Revenue Code provisions relating to high-deductible health plans (HDHPs) under the Consolidated Appropriations Acts of 2022 and 2023. Specifically, AB 364 authorizes individuals, covered by an HDHP, to claim a state income tax deduction for contributions to a health savings account, even if the plan has a $0 deductible for telehealth or remote services. The tax deduction would be available for taxable years beginning after 2021.
In Ohio, SB 90, a bill to enact the Social Work Licensure Compact (the Compact), passed through the first chamber. While Missouri is currently the only state to officially enact the Compact, Ohio is one of six states with pending legislation to join the Compact.
Oregon proposed a rule to implement and clarify SB 232. The Oregon Legislature passed SB 232 to enact certain exemptions for telemedicine licensure, clarify that the “temporarily” definition includes patients in Oregon for business, vacation or education, and authorize out-of-state physicians or physician assistants to provide telemedicine intermittently to Oregon patients when the healthcare professional has an established patient relationship. The proposed rule amendments align with these updates.

Why it matters:

Hybridization of Healthcare. Alaska’s final rule is an example of the further acceptance of hybrid healthcare models. While the new initiative authorizes optometrists to provide telehealth services to established patients, optometrists in the state must combine telehealth with other forms of examination, likely in-person, to dispense eyewear prescriptions to patients.
Modernizing Licensure Infrastructures. The legislative activity in Wisconsin, Ohio and Oregon facilitates the provision of services across state lines by standardizing licensing requirements for healthcare professionals. The streamlined licensure process also enables a [...]

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