June Regulatory Update — This Month in Telehealth

This month in telehealth, researchers and health care organizations have been exploring the extent to which Medicare impacts the use of telemedicine.

On the state level, four states enacted the Interstate Medical Licensure Compact last month, while other states explored changes to telemedicine restrictions and coverage.

Also included in this month’s update is information on informed consent for telemedicine.

Federal and Medicare

Researchers: State Telemedicine Parity Laws Don’t Impact Its Use for Medicare Populations (Contrasts Previous Findings) (FierceHealthIT)

Read more here.

Read conflicting studies here (JAMA) and here (Telemed and e-Health).

Healthcare Orgs ask CBO, MedPAC to Use Alternative Data to Evaluate Telemedicine use for Medicare (FierceHealthIT)

Healthcare organizations, in a letter Monday, called on the Congressional Budget Office and the Medicare Payment Advisory Commission to use alternative data sources to create cost estimates and analysis of telemedicine use in Medicare.

Read more here.

What’s Happening at the State Level?

Arkansas

Arkansas May Loosen Telemedicine Restrictions (mHealth Intelligence)

The state’s medical board will hold a public hearing on a proposal to eliminate the in-person mandate for telemedicine encounters.  One of the last states to restrict initial telemedicine encounters may be changing its tune.

Read more here.

Read proposed Regulation 38, a revision of Article 2.8 in Arkansas Code 17-80-117.

Connecticut

CMS to Reimburse for Specialty Care Consults in Connecticut

The announcement comes after a year-long pilot in which primary care providers used an online platform to consult with cardiologists, dermatologists and other specialists.  Connecticut health centers are now being reimbursed for telemedicine consults with specialists, helping residents who would sometimes have to wait a year for an appointment.

Read more here.

Rhode Island

House OKs Kennedy Bill on Telemedicine Coverage (thewesterlysun)

The House of Representatives has passed a bill introduced by Rep. Brian Patrick Kennedy, D-Hopkinton, which will require health insurance companies to cover telemedicine services the same way they cover in-person consultations.

Read more here.

Regulatory Update Matrix

State Status Concerning Issue
Arkansas Draft June 9 Medical Board Practice Standards
Delaware Proposed Medicaid Coverage for mental health services via telemedicine for children
District of Columbia Proposed Department of Health Telemedicine practice standards for physicians
District of Columbia Meeting – June 8 Medicaid Telemedicine coverage
Florida Revised Medicaid Telemedicine coverage
Maine Final Medicaid Telemedicine coverage
Minnesota Proposed Medicaid State plan amendment
Nebraska Proposed Medicaid State plan amendment removing mileage requirements and permitting RPM and asynchronous coverage
New York ProposedComments Due June 11 Office of Mental Health Telepsychiatry
North Dakota Amended Medical Board Practice Standards
Ohio Meeting June 8 (Agenda available June 1) Medical Board Agenda available June 1
Texas Proposed rule Medical Board On call services
Washington Proposed rule Medicaid Telemedicine coverage for school-based services
Wisconsin Meeting – July 20 Medical Board Telemedicine Committee

*Information Gathered from ATA Monthly Update Webinar

 

Interstate Licensure Compact Updates

Expedited
Federation of State Medical Boards (FSMB) 16 states Alabama, Arizona, Idaho, Illinois, Iowa, Kansas, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, West Virginia, Wisconsin and Wyoming
Mutual Recognition
National Council for State Boards of Nursing Enhanced NLC Arizona, Florida, Idaho, Missouri, New Hampshire, Oklahoma, South Dakota, Tennessee, Virginia and Wyoming
APRN No states yet
Association for State and Provincial Psychology Boards (PSYPACT) Needs 7 states: Arizona

*Information Gathered from ATA Monthly Update Webinar

Kansas and Mississippi Enact Interstate Medical Licensure Compact Legislation (Licensure Portability)

Read more here.

Telemedicine Nursing Licensure Compact Legislation Enacted in 6 States and 7 More Right Behind (JDSupra)

Read more here.

Providers Aim to Cut Nurse Licensing Requirements to Encourage Telemedicine Growth (McKnight)

Read more here.

In Other News

6 Key Takeaways on Health System Telemedicine Integration (Becker’s Hospital Review)

Read more here.

Health Care Providers Embrace Telemedicine (Twin City Business)

Read more here.

Top Takeaways from ATA 2016 (Med City News)

Read more here.

FYI

Telemedicine Insurance Valuable to Employer, Employee (North Bay Business Journal)

Read more here.

Evidence for Telemedicine in Psychiatry (Medscape)

Read more here.

7 Telemedicine Myths Debunked (Modern Medicine Network)

Read more here.

Stay Tuned…

Jan ’17 new target for DEA proposal on Ryan Haight special Reg (ATA)

View Updated DEA Notice here.

“GOTCHA” of the Month

Informed Consent for Telemedicine Encounters

As with any other practice of medicine, the use of telemedicine technology comes with a responsibility on the part of providers to educate and inform patients on the benefits and, more importantly, on the risks associated with receiving care via telemedicine.

Why is informed consent important?

Getting patient consent is a recommended best practice by the American Telemedicine Association (ATA), and it’s actually a requirement in many states.  Compliance with this responsibility serves the dual purpose of providing consumers with the information needed to make an informed decision about their care, but also mitigates the provider’s potential liability exposure from medical malpractice claims.  Since telemedicine is a new way of receiving care for many patients, it’s important to let them know how it works.

You need to stay informed on your state and payer requirements

Getting your patient’s consent could be a legal requirement in your state, or a condition of getting paid, depending on the payer you’re billing.  Some states don’t have any state requirements. Others require verbal consent. Still, others require physicians to get written consent and store it in the patient’s health record.

The following consents apply for participating in a telehealth consultation by state:

Arizona: Guardian consents to verify his/her identity prior to performing a mental health screening or mental health treatment on a minor. AZ ST § 36-2272.

Connecticut: I understand that my primary care provider may obtain a copy of my records of any telehealth interaction. CT Public Act No. 15-88 (2015).

Iowa: I understand that as necessitated by the availability of resources in the community where services are delivered, telehealth may be used in delivering and coordinating interventions with appropriate providers for autism support, subject to the licensure of the participating provider. Iowa Code Ann. § 225D.2.

Kentucky: I understand that I have the right to be informed of any party who will be present at the site during the telehealth consult and I have the right to exclude anyone from being present. I also understand that I have the right to object to the videotaping of the telehealth consultation. KY Admin. Regs. Tit. 907, 3:170.

Maryland: I understand that I cannot request telehealth services to be conducted via correspondence only. Code of MD Reg. 10.41.06.04.

Nebraska: I understand that I have the right to be informed of any party who will be present at the site during the telehealth consult and I have the right to exclude anyone from being present. I understand that any dissemination of identifiable images or information from a consult requires my express permission. I understand that I have the right to request an in-person consult immediately after the telehealth consult and I will be informed if such consult is not available. NE Revised Stat. 71-8505; NE Admin. Code Tit. 471, Ch. 1.

Nevada: I understand that the transmission of any confidential medical information while engaged in telemedicine is subject to all applicable federal and state laws with respect to the protection of and access to confidential medical information. NV Rev. Stat. Ann. § 633.0165.

Pennsylvania: I understand that I may be asked to confirm my consent to behavioral health or tele-psych services.

Tennessee: I understand that I may request an in-person assessment before receiving a telehealth assessment.

Vermont: I understand that I have the right to receive a consult with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of the initial consult. I understand that receiving tele-dermatology or tele-ophthalmology services via telemedicine does not preclude me from receiving real-time telemedicine or face-to-face services with the distant provider at a future date. VT Stat. Ann. § 9361.

Creating a patient consent form:  Kinds of information to consider including on your consent form

The ATA suggests you should:

  • Inform patients of their rights when receiving telemedicine, including the right to stop or refuse treatment.
  • Tell patients their own responsibilities when receiving telemedicine treatment.
  • Have a formal complaint or grievance process to resolve any potential ethical concerns or issues that might come up as a result of telecare.
  • Describe the potential benefits, constraints, and risks (like privacy and security) of telemedicine.
  • Inform patients of what will happen in the case of technology or equipment failures during telemedicine sessions, and state a contingency plan.

Other things to consider:

  • You may want to outline some of your basic telemedicine program policies around billing, scheduling, cancellation etc.
  • You should also make sure to use clear and easy to understand language.
  • Including directions for the patient to contact 911 emergency services and to proceed to his/her nearest emergency department for emergency conditions.

Example forms

Other Resources/ Sources:

  1. Federation for State Medical Board’s Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine
  2. Developing and Implementing Effective Telemedicine Informed Consent Form
  3. American Telemedicine Association- Website
  4. Telemedicine and Informed Patient Consent: Done the Right Way

Every month we will feature a new “Gotcha of the Month.” Do you have a regulatory “gotcha” or question that you want us to pay special attention to?  Email cpapp@in-sight.net and your  topic could be featured in next month’s issue!

 

Featured image by Architect of the Capitol on Flickr.

 

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