COVID-19 Archives - OF DIGITAL INTEREST

COVID-19

Florida’s Extension of its COVID-19 Out-of-State Provider Waiver: A Sign of the Times

by Adam J. Rogers, Dale C. Van Demark and Danielle N. Scheer | Apr 17, 2020 | General Interest, Telehealth

Background: Issuing Florida’s Emergency Order

On March 16, 2020, Florida Surgeon General Dr. Scott Rivkees signed, stamped and finalized Emergency Order 20-002. In doing so, Florida joined what would become the vast majority of states in modifying licensure requirements for physicians in response to the Coronavirus (COVID-19) emergency.

The surgeon general’s order waived licensing requirements for out-of-state healthcare professionals, advanced life support professionals and basic life support professionals so that they could render services in Florida for the purposes of preparing for, responding to and mitigating any effect of COVID-19. In addition to waiving licensing requirements for in-person services, the order exempted out-of-state physicians, osteopathic physicians, physician assistants and advanced practice registered nurses from licensing requirements governing the provision of telehealth. The order also impacted emergency medical services training programs, physical examination requirements for physician certifications, prescription drug distribution and controlled substance prescription renewals (including medical marijuana). The order was to expire 30 days after signing—April 15, 2020.

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Avoiding Confusion Over State Licensing Laws as CMS Further Loosens Telemedicine Restrictions

by Dale C. Van Demark, Dawn R. Helak, Lisa Mazur and Rachel Stauffer | Apr 10, 2020 | Telehealth

The Centers for Medicare & Medicaid Services (CMS) continues to loosen the conditions for participation in Medicare, as well as specific reimbursement requirements, to ensure facilities and practitioners are able to practice at the top of their license and across state lines without jeopardizing Medicare reimbursement. Unfortunately, as demonstrated when CMS took similar actions over the past few weeks in response to the Coronavirus (COVID-19) pandemic, headlines tend to overlook one fundamental component of the applicable regulatory regime: state law requirements.

Unlike the Veterans Affairs Administration’s (VA’s) action a few years ago, which preempted state licensing law for purposes of implementing a VA telemedicine program, the Department of Health and Human Services has limited its actions during the COVID-19 pandemic to modifications of federal regulations and rules. Secretary Alex Azar, in a letter to the Governors, instead encouraged the states to take action themselves to similarly loosen state laws to ensure maximum utilization of resources. The states have been doing so, in some instances since early March, with different approaches. These differences stem from a large number of variables that are implicated by state licensure laws.

Key Takeaways: The practical implication for the provider community is that new standards for Medicare need to be adopted in harmony with existing state laws requirements, which, unfortunately, are not uniform across the country. Nevertheless, nearly every state has taken action to loosen cross-border licensing restrictions for healthcare professionals and have modified other rules and regulations to help protect healthcare workers, maximize their numbers and help them practice at the highest level of their experience and training. There is a national movement in this direction, but it remains a patchwork.

For a deeper dive into telemedicine regulations during the COVID-19 pandemic, visit our Coronavirus Resource Center, which features articles, webinar recordings and videos on the telemedicine issues you need to know.

Telemedicine COVID-19 Briefing: March 16

by McDermott Will & Emery | Mar 13, 2020 | Telehealth

Government, media and industry have all pointed to the potential for telemedicine to assist in combating the COVID-19 pandemic. In addition, steps have been taken by the government to ease the burdens associated with the use of telemedicine during this crisis. Unfortunately, the complexity of the regulatory infrastructure has left a fair amount of confusion with respect to the extent to which rules have been, and may be, liberalized. At a time when our healthcare infrastructure is engaging with a health crisis that will get worse before it gets better, confusion about the requirements for care delivery needs to be reduced to a minimum.

Please join us on Monday, March 16 from 1 – 2pm ET for an update on:

Loosened Medicare reimbursement requirements
State emergency efforts
Related issues associated with the delivery of telemedicine services during the COVID-19 pandemic

CLICK HERE TO REGISTER

Bipartisan Bill Relaxes Federal Telehealth Requirements in the Wake of COVID-19

by Dale C. Van Demark, Lisa Mazur and Marshall E. Jackson, Jr. | Mar 5, 2020 | Telehealth

On March 4, 2020, the House passed the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, a bipartisan bill to aid in COVID-19 preparedness and response. The bill includes, among other things, provisions that waive certain telehealth requirements during the COVID-19 public health emergency to ensure Medicare beneficiaries can receive telehealth services at home to avoid placing themselves at greater risk of the virus.

Generally, Medicare beneficiaries may only receive telehealth services as a Medicare covered service if:

The beneficiary (patient) is located in a qualifying rural area;
The beneficiary is located at one of eight types of qualifying originating sites;
The services are provided by one of 10 categories of distant site practitioners eligible to furnish and receive Medicare payment for telehealth services;
The beneficiary and distant site practitioner communicate via an interactive audio and video telecommunications system that permits real-time communication between them—telephones, fax machines and email do not meet this requirement; and
The CPT/HCPCs code for the service is on the list of covered Medicare telehealth services.

The bill gives the secretary of the US Department of Health and Human Services (HHS) the authority to waive the originating site requirement for telehealth services provided to Medicare beneficiaries located in any identified emergency area during emergency periods by a qualified provider. An “emergency area” is a geographical area in which, and an “emergency period” is the period during which, there exists: (a) an emergency or disaster declared by the president pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and (b) a public health emergency declared by the secretary. The bill also allows telehealth services to be provided to Medicare beneficiaries via phone, but only if the phone allows for audio-video interaction between the provider and the beneficiary.

The bill takes important steps to allow healthcare providers to deploy telehealth resources in response to COVID-19 and other public health emergencies, and allows Medicare beneficiaries to receive telehealth services from the comfort of their home (even via their smart phone) without risk of exposure. While the bill represents a further step in the expansion of the availability of telehealth services, we should be careful not to overstate its impact. The waiver of the originating site requirement and expansion of telemedicine modalities is limited to emergency areas identified by the president and secretary during emergency periods. Accordingly, as a practical matter, this expansion of availability of telehealth reimbursement is very limited. In addition, healthcare providers must still comply with state laws and regulations that govern telehealth, including, but not limited to, professional licensure, scope of practice, standard of care, patient consent and other reimbursement requirements for non-Medicare beneficiaries.

The bill offers a welcome relaxation of the rigid Medicare requirements for telehealth reimbursement during a time of stress within the healthcare industry. It also represents another, albeit small, step in the gradual acceptance of telehealth within the healthcare reimbursement sector.

Coronavirus Resource Center | Preparedness Planning for Businesses

by McDermott Will & Emery | Mar 5, 2020 | General Interest, Telehealth

In our global economy, Coronavirus (COVID-19) raises serious concerns for employers in all industries. Workers may be on the front lines caring for patients and developing vaccines, travelling for business, or in close contact with individuals who travel or may have been affected. At this time, there is no vaccine or medication approved to prevent or treat the COVID-19 disease. Therefore, preparedness and prevention are crucial. Frontline responders must be especially vigilant as they deliver care and anticipate the challenges this uncharted territory presents.

McDermott’s Coronavirus Resource Center, brought to you by a multi-disciplinary team, will keep you informed of the latest developments and provide comprehensive insight to help you navigate this crisis with your employees, including:

Frequently asked questions for US and multi-national employers
Recent news updates
Podcasts
Upcoming events

Click here to access the Resource Center.

The Role of Telehealth in COVID-19 Response Efforts

by Dale C. Van Demark, Lisa Mazur and Marshall E. Jackson, Jr. | Mar 3, 2020 | Telehealth

As the number of confirmed COVID-19 cases in the United States grows, healthcare providers are stepping up their response planning. To combat the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) urged healthcare systems and providers to deploy all of the resources necessary to ensure health system preparedness. The CDC recommended the use of telehealth tools to help address COVID-19 preparedness and to assist in directing patients to the right level of healthcare for their medical needs.

Healthcare providers have a unique and pressing opportunity to offer telehealth services to potential COVID-19 patients. At the same time, healthcare providers’ response to the COVID-19 outbreak highlights some of the barriers to the provision of telehealth services. Providers considering using telehealth as part of their COVID-19 response efforts should take the following factors into consideration:

While healthcare providers cannot diagnose COVID-19 through a telehealth visit, they can perform a number of services without requiring a patient to visit crowded medical facilities where the virus might be present. These services include performing initial patient screenings, assessing and assigning risk categories to patients, determining if a patient needs to seek diagnostic testing, and answering patient questions and offering treatment recommendations.
Deploying telehealth services is not without its challenges. The varying reimbursement policies of private, state and federal payers, as well as differing state-based medical licensing requirements, may burden providers and patients with confusion, economic inefficiencies and onerous processes in a difficult engagement context.
As part of the COVID-19 response discussions, telehealth advocates propose that the Centers for Medicare and Medicaid Services reduce or eliminate its long-standing telehealth reimbursement restrictions. This change would allow Medicare to pay for virtual visits during national emergencies, regardless of originating site or geographic location. There is also a push to waive the lengthy enrollment process telehealth providers must undergo to be paid by Medicare.
While telehealth has the potential to assist in a healthcare system’s response to COVID-19, providers still must comply with state laws and regulations that govern telehealth, including but not limited to professional licensure, scope of practice, standard of care and patient consent, in addition to the reimbursement requirements and limitations put into place by third-party payers.
- Typically, telehealth providers must be licensed in the state in which the patient is located, although certain states have exceptions that telehealth providers may leverage in response to COVID-19.
- Telehealth providers must practice within the scope of practice of the profession in which they are licensed and within the standard of care set forth by the governing professional board in a given state.
- State telehealth laws may require a specific modality for telehealth consultations (e.g., audio-visual consultations). Likewise, third-party payers may require a specific modality for telehealth consultations for purposes of reimbursement.