interstate compacts Archives - OF DIGITAL INTEREST

interstate compacts

Trending in Telehealth: January 16 – 22, 2024

by Stacey Callaghan and Ashley Ogedegbe | Jan 24, 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
Behavioral health
Expanding telehealth

A CLOSER LOOK

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

Florida progressed SB 7016, which expands the telehealth minority maternity care pilot program to a statewide program; enacts the interstate medical licensure compact; and enacts the audiology and speech-language pathology interstate compact.
Oklahoma proposed a rule to include the use of telemedicine within the optometrist’s scope of practice under certain circumstances and clarify medication dispensation and storage requirements.
South Dakota progressed HB 1015 to adopt the social work licensure compact.
Texas proposed rule to expand the existing Department of Health’s Emergency Medical Care rules by providing telemedicine options in non-rural counties and expanding the use of telemedicine in rural counties, by integrating the use of telemedicine by Advanced Practice Provider (APP) in Rural Level IV trauma facilities under certain circumstances.
Utah progressed HB 44 to adopt the social work licensure compact.
Wisconsin proposed a rule to amend current standards of practice for supervising physical therapist assistants to incorporate new telehealth practices. Specifically, the current supervision rules require supervision physical therapists to provide on-site assessment and reevaluation of each patient at least once each calendar month or every 10th treatment day, whichever is sooner, while new telehealth practices permit patients to receive treatments using telehealth. The new rule will resolve the conflict between the on-site assessment and reevaluation requirements for supervision and patients’ ability to schedule telehealth visits.
Wisconsin progressed AB 573 and AB 541to the second chamber. AB 573 directs the Department of Health Services to establish a pilot program to implement virtual behavioral health crisis care services for use by county or municipal law enforcement agencies in the field to connect law enforcement officers who encounter persons in crisis to behavioral healthcare services. AB 541 provides that no mental health care provider may be required to be licensed, registered, certified, or otherwise approved to practice in the state to provide mental health services by telehealth to patients located in the state unless mental health care provider satisfies certain conditions.

Why it matters:

There continues to be elevated activity surrounding licensure compacts. This week, Florida, South Dakota and Utah progressed laws to adopt interstate licensure compacts.
States continue to progress laws to incorporate the use of telehealth in practitioners’ scope of practice. This week, several states progressed legislation expanding practitioners’ scope of practice to include telehealth services under certain circumstances.

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 [...]

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Trending in Telehealth: December 21, 2023 – January 3, 2024

by Amanda Enyeart, Taylor Hood and Adetoro Olugbemi | Jan 5, 2024 | Telehealth

Trending in the past week:

Behavioral health
Interstate compacts

A CLOSER LOOK
Finalized Legislation & Rulemaking

Arkansas issued a final rule whereby certain assessments under the Arkansas Independent Assessment (ARIA) system may be performed via telemedicine. The ARIA system is used to perform a functional-needs assessment for eligible Medicaid beneficiaries served through one of the state’s waiver programs or state plan personal care services.
Mississippi issued a final rule, which adds Licensed Marriage and Family Therapists and Mississippi State Department of Health clinics to the list of Medicaid-covered providers for telehealth services. The final rule also clarifies that Medicaid would not cover physician or other practitioner visits through telehealth for Evaluation and Management Level IV or V visits.
New Jersey signed AB 5757 into law on December 31, 2023. This substitute bill amends Section 11 of P.L.2021, c.310 to extend the end date from December 31, 2023, to December 31, 2024, during which time a health benefits plan in New Jersey must extend coverage and payment parity for telehealth services. Healthcare services delivered to a covered person through telemedicine or telehealth must be covered at a rate equal to the in-person provider reimbursement rate, provided the services are otherwise covered by the health benefits plan when delivered in-person.
Washington, DC, issued a final rule updating Medicaid’s Assertive Community Treatment reimbursement methodology from a fee-for-service model to a monthly rate model. The new model requires eight (8) contacts with a consumer per calendar month. Three (3) of the required eight (8) contacts can be performed via . The Assertive Community Treatment program provides intensive, integrated, rehabilitative treatment and community-based to adults with serious and persistent mental illness.
Virginia joins the Counseling Licensure Compact, effective January 1, 2024. The authorizing bill was signed into law on March 27, 2023, with a delayed effective date.

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

In New Jersey, AB 5311 passed the General Assembly with a vote of 73-0-0. If enacted, the bill would enter New Jersey into the Counseling Compact.
New Jersey’s General Assembly also passed SB 3604 with a vote of 74-0-0. The bill authorizes the use of healthcare platforms that provide discounted prices for payment of prescription and nonprescription drugs or devices and for telehealth and telemedicine services.

Why it matters:

There continues to be an increase in activity surrounding licensure compacts. States closed the year by adopting interstate compacts for a variety of professionals. In general, these state efforts ease the burdens of the licensing process and demonstrate a desire to facilitate multijurisdictional practice without giving up authority over professional licensure.
States continue to pass rules to increase access to behavioral [...]

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Trending in Telehealth: December 6 – December 13, 2023

by Dale C. Van Demark and Taylor Hood | Dec 14, 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:

Standards of practice

Interstate compacts

A CLOSER LOOK
Finalized Legislation & Rulemaking

Alaska’s Department of Commerce, Community, and Economic Development issued a final rule to clarify that the Alaska Board of Nursing may discipline a licensee by assessing a civil fine, in accordance with central licensing statutes, for each finding the board makes of a cause for discipline. The final rule also updates the standard of practice for advanced practice registered nurses (APRNs) for services provided via telehealth and adopts by reference the American Association of Nurse Practitioners’ position statement on telehealth. While the position statement reflects broad support for telehealth and payment parity, the final rule is much more specific. Effective January 5, 2024, 12 AAC 44.925 will be readopted to clarify that an APRN must provide the same standard of care to a patient who is at a different location as would be provided to that patient in person. The final rule also clarifies that an APRN may practice telehealth if (1) the APRN is licensed and (2) the APRN or another licensed healthcare provider is available to provide follow-up care. Finally, the rule provides that for a telehealth encounter, an APRN must complete and document:

The patient’s informed consent to use telehealth technologies;

A clinical history and review of systems establishing diagnoses and identifying conditions and contraindications to recommended treatment;

A plan of care that lists all recommendations and prescriptions issued by electronic means;

The patient and provider locations at the time of the telehealth visit; and

The provider-patient relationship prior to prescribing.

As previewed last week, Wisconsin enacted SB 196 and SB 197. The bills enact the Counseling Compact and Audiology and Speech-Language Pathology Interstate Compact.

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

New Jersey AB 5311 passed the General Assembly with a vote of 73-0. If enacted, the bill would enter New Jersey into the Counseling Compact.

Why it matters:

There continues to be an increase in activity surrounding licensure compacts. Consistent with past months, states intend to close the year by adopting interstate compacts for a variety of professionals. In general, these state efforts ease the burdens of the licensing process and demonstrate a desire to facilitate multijurisdictional practice without giving up authority over professional licensure.

States continue to amend and clarify telehealth-related standards of care. Following the advent of novel telehealth-related modalities, states continue to adopt and revise the definition of various standards of care to address telehealth-related concerns and provide certainty for providers predominately practicing in the remote space.

Telehealth is an important development in care [...]

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Trending in Telehealth: November 29 – December 05, 2023

by Amanda Enyeart and Taylor Hood | Dec 8, 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:

Interstate Compacts

A CLOSER LOOK
Finalized Legislation & Rulemaking

Ohio issued a final rule clarifying when annual assessments performed by registered nurses (RNs) under the Ohio home care waiver program may be conducted via telehealth. Ohio issued another final rule in connection with the Ohio home and community-based services program clarifying the same. In short, at least twice per year, the RN will conduct RN assessment visits in person. All other RN assessment service visits may be conducted via telehealth, unless the individual’s needs necessitate an in-person visit.

In Oregon, the Oregon Health Authority issued a final rule updating and amending certain defined terms under the Medical Assistance Program, including “telehealth,” “telemedicine,” “telecommunication technologies,” “asynchronous” and “meaningful access.”

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

Wisconsin presented Senate Bill 196 and Senate Bill 197 to the governor. The bills propose to enact the Counseling Compact and Audiology and Speech-Language Pathology Interstate Compact.

Why it matters:

There continues to be an increase in 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. Healthcare licensure compacts offer benefits to providers, licensing boards and states by enabling professionals to meet increased patient needs while maintaining state sovereignty and patient safety. Wisconsin’s advancing proposal to enter multiple interstate licensure compacts represents a continued effort by state lawmakers to improve access to care for its state’s residents.

States continue to amend and clarify telehealth-related definitions. Following the advent of novel telehealth-related standards of care, states continue to amend and clarify definitions, including incorporating those definitions across state healthcare programs.

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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Trending in Telehealth: November 8 – 14, 2023

by Patrick Zanayed and Angela Irene Theodoropoulos | Nov 17, 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:

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: September 26, 2023 – October 10, 2023

by Purnima Boominathan and Ashley Ogedegbe | Oct 13, 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:

Reproductive Health

Telehealth Practice Standards

Interstate Compact

Disciplinary Guidelines

Regulatory Licensing

A CLOSER LOOK
Finalized Legislation and Rulemaking

California signed into law SB 345, which goes into effect on January 1, 2024. The legislation states that California law applies to any civil, administrative or criminal proceeding involving individuals (that is, patients) located inside and outside of California engaged in providing, receiving, supporting, or attempting to provide or receive reproductive health and gender-affirming healthcare services via telehealth or other means. This “shield law” also provides legal protections for healthcare practitioners located in California who provide or dispense medication or other services for abortion, contraception or gender-affirming care to out-of-state patients. These protections apply regardless of the provider’s location during the activity. This law also prohibits California law enforcement, government officials or government contractors from cooperating with out-of-state prosecutions related to abortion, contraception or gender-affirming care. The law prohibits California-based corporations, including social media and tech companies, from disclosing to law enforcement any private patient communication regarding healthcare that is legally protected in the state.

New Hampshire enacted legislation effective October 7, 2023, that amends the prior law to permit out-of-state healthcare professionals to treat patients in the custody of the Department of Corrections via telemedicine, without a New Hampshire license, as long as the professionals are licensed in the state where they provide services. The prior law required all out-of-state healthcare professionals providing telehealth services to be licensed in New Hampshire, regardless of the patient’s location.

Legislation and Rulemaking Activity in Proposal Phase
(more…)

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Trending in Telehealth: September 19 – 25, 2023

by Patrick Zanayed and Jayda Greco | Sep 28, 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:

Interstate Compacts

Medicaid Coverage

Telehealth Practice Standards

Telehealth Access

A CLOSER LOOK

Finalized Legislation and Rulemaking

New Hampshire enacted HB 409, which enacts the Social Worker Licensure Compact.

Louisiana adopted rulemaking regarding Medicaid coverage for physician-directed treatment-in-place ambulatory services. The rule allows such services to be provided via telehealth when the provider meets certain requirements, such as enrollment and notification to the Department of Health.

Alaska adopted rulemaking that provides eligibility requirements and defines the scope of services for delivering psychological care through electronic means while physically separate from the recipient. The regulations require applicants for a courtesy license to be licensed in another jurisdiction where the licensing requirements are at least equivalent to those in Alaska.

Legislation and Rulemaking Activity in Proposal Phase

Highlights:

As mentioned in last week’s update, California progressed two bills that are now awaiting the governor’s signature.

AB 1478 was presented to the governor on September 20, 2023. The bill would require the State Department of Public Health to maintain, on its website, a database of referral networks for community-based mental health providers and support services addressing postpartum depression and prenatal care, and information on mental health providers and support groups that allow patient-driven care access, including telehealth and virtual care.

AB 48 also was presented to the governor on September 20. The bill would require the State Department of Public Health, in consultation with interested stakeholders, to develop a standardized informed consent form which would then need to be available to skilled nursing facilities and intermediate facilities by December 31, 2025. Additionally, the bill would permit prescribers to use remote technology, including telehealth, to examine patients and obtain the above mentioned informed written consent.

Ohio proposed rulemaking specifying the requirements for delivery of services by speech-language pathologists and audiologists via telehealth, such as licensure and encryption requirements and guidelines for assessing whether telehealth is appropriate based on the patient’s condition.

Why it matters:

Increased activity in California continues. California continues to move forward with legislation to address access to healthcare services via telehealth. While they increase access, these bills are addressed to specific sites of care, such as nursing facilities, reflecting an openness to telehealth under specific circumstances.

States are focused on Medicaid reimbursement for telehealth services. This week, we saw Louisiana adopt rulemaking regarding Medicaid coverage for physician-directed treatment-in-place ambulatory services.

Telehealth practice standards remain a focus. Alaska and Ohio’s enacted and proposed rulemaking, respectively, continue the trend of states expanding on telehealth practice standards for non-physician licensees.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott digital health team [...]

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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.

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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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 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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