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Trending in Telehealth: December 14, 2023 – December 20, 2023

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 pilot programs
  • Standards of practice

A CLOSER LOOK
Finalized Legislation & Rulemaking

  • Effective February 1, 2024, the Wisconsin Hearing and Speech Examining Board clarified, by final rule, the standard of care for hearing instrument specialists and audiologists. The final rule defines telehealth; expands the scope of unprofessional conduct; and requires licensure for a person engaged in the practice of selling or fitting hearing aids to a patient located in the state, whether in-person or via telehealth.

Legislation & Rulemaking Activity in Proposal Phase
Highlights:

  • New Jersey continues to progress Assembly Bill 5311. If enacted, the bill will enter New Jersey into the Counseling Compact.
  • Wisconsin progressed AB 573 and AB 541. 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. The service will 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 Wisconsin to provide mental health services by telehealth to patients located in Wisconsin if the mental health care provider satisfies certain conditions, including:
    • the mental health care provider is licensed, registered, certified or otherwise approved to practice in the state in which the provider is physically present when providing telehealth services;
    • the mental health care provider may provide telehealth services in Wisconsin within the scope of his or her license, registration, certification or approval from the state from which the mental health care provider is providing telehealth services; and
    • the mental health care provider informs the patient whether the provider is licensed in Wisconsin, what state he or she is providing telehealth services from, what states in which he or she is licensed, registered, certified or otherwise approved to practice, and which regulatory boards the patient may contact to file a complaint.
  • The Texas State Board of Dental Examiners issued a proposed rule that would amend 22 Tex. Admin. Code § 111.5 related to electronic prescribing waivers. The proposed amendment removes the requirement that a dentist must submit a written statement and supporting documentation describing the circumstances necessitating a waiver, and instead requires a dentist to attest to the circumstances necessitating a waiver. The board indicates that the amendment will make it less burdensome on the dentist when submitting a waiver request to the board and it will make the Board’s waiver process more efficient. The comment deadline is January 14, 2024.

Why it matters:




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Trending in Telehealth: December 6 – December 13, 2023

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:
    1. The patient’s informed consent to use telehealth technologies;
    2. A clinical history and review of systems establishing diagnoses and identifying conditions and contraindications to recommended treatment;
    3. A plan of care that lists all recommendations and prescriptions issued by electronic means;
    4. The patient and provider locations at the time of the telehealth visit; and
    5. 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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Telemedicine – The New Standard of Care

Across the health care sector, telemedicine is naturally and strategically being integrated into health care delivery and treatment plans as targeted and efficient solutions to specific health issues by hospitals, medical groups and drug-to-consumer telemedicine companies.

Telemedicine is no longer viewed as a secondary option for care—it is a new standard of care that is both expected by patients and popular with providers. Consumers expect to see health care adapt—like many other industries already have—to fit within their daily lives and schedules. Whether it’s electronic check-in procedures or better automated systems, health care providers are beginning to treat their patients a little bit more like customers, and see telemedicine and patient engagement tools as a means of improving customer loyalty and engagement while reducing costs.

However, complex billing structure and payor and reimbursement issues can create significant hurdles for health care providers looking to advance telemedicine programs. Telemedicine billing requires special attention, and if not enough consideration is given on the front end of programs, organizations may be surprised to find that that something they thought was a billable service is, in fact, not.

The Bipartisan Budget Act, which provided for the reimbursement of the distance provider, significantly increased the telemedicine use cases that are approved under the Medicare reimbursement structure. However, because Congress will now pay for it, there is a new expectation that hospitals that do not have particular areas of expertise available on-site will investigate opportunities to incorporate a telehealth programs that ensure adequate patient care.

The standard of care continues to improve as patients have greater access to  nationwide physicians and  as new technology like telestroke and clinical decision support tools become more widely available. For example, a stroke neurologist in one New York can now diagnose a stroke patient in Florida, and then facilitate an emergency room physician to treat that stroke. Telestroke programs check off all of the right boxes: better quality care, better access to care, and overall lower cost of care.

As use cases like this continue to be integrated into health care delivery and familiarity builds around how telemedicine can be used effectively, expectations shift around the standard of care and new questions arise around the risks of integrating—or failing to integrate—telehealth programs. If the tools are available and easily accessible, and if there is a supportive reimbursement model, how much a part of the standard of care does telemedicine become and what is the risk of failing to embrace these tools? If hospitals choose not to implement telehealth programs, and then patients suffer harm as a result, for example a delayed diagnosis and treatment of a stroke, could that lead to increased medical malpractice suits or other types of liability?

In the newest episode of the Of Digital Interest podcast, McDermott Digital Health partners, Lisa Schmitz Mazur and Dale Van Demark, share their perspectives on these questions and the various barriers, risks and opportunities associated with the rise of telemedicine and other technological advancements in health care delivery. Access this [...]

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