March Regulatory Update—This Month in Telehealth

This month in telehealth, bills that would affect telemedicine services and reimbursement are making their way through Congress, particularly in the Senate.

On the state level, numerous states are taking positive steps toward enhancing telehealth access, services and coverage.

Federal and Medicare

Teleprescribing Bill Heads to Senate (Wyfi)

Legislation that would allow people to get prescriptions without an in-person exam or visit from a healthcare provider is headed to the Senate. But some lawmakers aren’t comfortable taking steps forward in “telemedicine” services.

Read more here.

New Bill Could Expand Home Health Telemedicine (Home Health Care News)

A bipartisan bill that would expand telemedicine services and remote patient monitoring (RPM) through Medicare is making headway in Congress with a projected cost savings of $1.8 billion over the next decade. The legislation could also help cut down the 7.88 billion miles home care workers traveled in 2013 for patient visits.

Read more here.

CONNECT for Health Act here.

AMA endorses CONNECT Health Act- Read more here.

Making Telehealth a Priority: Congress Mulls Changes to Medicare (mHealth Intelligence)

A report prepared by a working group of the Senate Finance Committee lists five policy changes that could boost telehealth – and its reimbursement – in a number of Medicaid programs for people with chronic conditions.

Read more here.

What’s Happening at the State Level?

State Medicare Policies for Telemedicine Impact Use of Services (FierceHealthIT)

State policies on telemedicine use under Medicare can have a great impact on adoption of the technology, according to a report published in Telemedicine and e-Health.

Read more here.

Read the report here.
Iowa Bill Includes Parity for State Employees While Other States Introduce Options for Out-of-State Practice (ATA)

Iowa lawmakers are making progressive steps toward telehealth parity coverage in the state.  HSB 502 was introduced to allow telehealth parity for state employee health plans.  Although the state has private insurance parity law, last year the Governor signed legislation extending telehealth parity to Medicaid plans.

Read HSB 502 here.

Florida, New Mexico and New Jersey

State legislatures are also pursuing licensure portability models for healthcare providers.  In addition to multi-state compacts, states are considering alternative models to address interstate practice.  Florida (HB 7087) and New Mexico (SB 78/HB48) legislation would create a registration process for out-of-state providers using telemedicine.  Missouri lawmakers introduced HB 2350, which would provide in-state licensure exemptions to out-of-state telemedicine providers who have previously examined  patients in-person.

Read HB 7087.

Read SB 78/ HB 48.

Read HB 2350.

New York and Vermont

New York lawmakers have introduced three new bills to enhance telehealth coverage under numerous insurance plans:

  • SB 6367 would allow telehealth coverage under worker’s compensation and motor vehicle insurance;
  • AB 8200/SB 5852 would allow coverage parity for telehealth provided home care services; and

Vermont lawmakers have introduced legislation to remove the biggest barrier in the state’s telehealth parity law – patient site restrictions.  If enacted, H 543 would allow telehealth coverage parity outside of a health care facility as well as prevent service frequency limits imposed by health plans.

Read  HB 543.

Arkansas

Arkansas Prepares New Telemedicine Practice Rules (The National Law Review)

The Great State of Arkansas was ranked last among all states in a recent report by the American Telemedicine Association on telemedicine practice standards. The good news is the Arkansas Board of Medicine indicated plans to address this issue through new rules this year.

Read more here.

Florida

Florida Expands Telemedicine Controlled Substance Prescribing (National Law Review)

The Florida Board of Medicine recently met and voted to uphold a rule allowing controlled substances to be prescribed via telemedicine for the treatment of psychiatric disorders. This change has enormous potential to benefit patients in the Sunshine State, promoting access to mental health services and receiving the full scope of psychiatric treatment. Providers of telemedicine-based services, as well as providers of psychiatric services, should take this opportunity to explore the possibilities of offering care via telemedicine for psychiatric disorders.

Read more here.

Read Florida Administrative Code r. 64B8-9.0141 here.

Illinois

Illinois Telemedicine Rules: Licensing, Practice, Payment (Health Care Law Today)

Illinois is experiencing growth in telemedicine and telehealth offerings available to patients in the Prairie State. Historically, Illinois telehealth services have been more limited to hospital and institutional settings, but the last few years have since seen an expansion among providers offering such services directly to patients. And yet, Illinois remains a state that has not seen the same level of growth or overall “embracing” of telemedicine services compared to other large states.

Read more here.

Indiana

Indiana Considers Allowing Telemedicine Prescriptions (MedCity News)

The legislation would permit physicians, physician assistants and advanced-practice nurses to write prescriptions for remote patients, as long as they have established a provider-patient relationship. The two parties may establish a relationship via telemedicine by collecting the patient’s medical history, obtaining informed consent, discussing the diagnosis and treatment options, creating a medical record of the patient and developing a plan for follow-up care.

Read more here.

Read HB 1263 here.

Telemedicine-based Prescriptions Gain Favor in Indiana (mHealth Intelligence)

Read more here.

Mississippi

Mississippi Lawmakers Introduce a Flood of Telemedicine Bills (ATA)

Telemedicine is a priority in Mississippi, as indicated by eight bills introduced this session.  Lawmakers are addressing everything from physician clinical use of telemedicine, state employee access to urgent care services and fines for insurers and health plans that deny payment claims and do not comply with the telemedicine parity law.

Read the proposed legislation:

HB 1177 – Codify physician practice standards via telemedicine

HB 1178 – Codify physician practice standards via telemedicine

HB 1187 – Codify physician practice standards via telemedicine

SB 2742 and HB 1192– Prohibit insurers from denying telemedicine claims

SB 2071 – Physician practice standards

Texas

Texas Slammed for Proposed Telemental Health Restrictions (mHealth Intelligence)

Texas health officials are coming under fire for yet another telemedicine proposal. In a Feb. 10 letter to the Texas State Board of Examiners of Professional Counselors, the American Telemedicine Association criticizes proposed regulations that it says would limit residents’ access to mental health services and hamstring the state’s limited ranks of mental health providers.

Read more here.

Read the letter here.

Regulatory Update Matrix
State Status Concerning Issue
Arkansas Draft– Feb. 4
Hearing
Medical Board Practice Standards
Delaware Proposed:
Comments Due
Feb. 17th
Mental Health
and Chemical
Dependency Board
Scope of Practice Standards
for Mental Health Counseling;
Chemical Dependency
Counselors: and Marriage
and Family Therapists
Delaware Proposed Medicaid Coverage for mental health
services via telemedicine for children
Florida Final:
Effective March 7th
Medical Board Prescribing Controlled
Substances
Idaho Board Approved-
See Telehealth
Services
Section
Medical Board Practice Standards
Maryland Proposed Medicaid Add community based
substance abuse disorder
provider as originating site
Missouri Discussions-
Taskforce Meeting
Feb. 5th
Pharmacy and
Medical Boards
No drafts or
proposals yet
North Dakota Amended Medical Board Practice Standards
Wisconsin Draft Proposal-
Jan. 20th Hearing
Medical Board Practice Standards
***Information Gathered from ATA Monthly Update Webinar

Stay Tuned…

Feds Urged to Make Telehealth a Standard of Care (mHealthIntelligence)

Read more here.

State Report Card Results Are In…

Telemedicine Report Cards Offer Good, Bad News for States (mHealth Intelligence)

Read more here.

3 States Earn Failing Grade When it Comes to Telemedicine (DSN)

Read more here.

In Past Year, Telemedicine Reimbursement Has Gotten Better, Licensure Worse (MobiHealthNews)

Read more here.

Reports available for download on ATA Website here.

“GOTCHA” of the Month

CMS: For Approval of Medicaid Home Health Services, Telemedicine Counts for Face-to-face Visits (Fierce Health IT)

The Centers for Medicare & Medicaid Services this week published a final rule clarifying requirements for face-to-face encounters for Medicaid beneficiaries to be eligible to receive home health services; the rule outlines that telehealth can be used for such encounters.

Read more here.

Read final rule here.

Accompanying CMS Fact Sheet

Does this mean that CMS has just approved telehealth services in the home for reimbursement? 

Unfortunately, not quite.  In order for a Medicaid beneficiary to receive in home health benefits, CMS requires that a patient have a documented “face-to-face” encounter with a physician for authorization.  CMS has now approved that this encounter may be done via video.

Does this provision make telehealth reimbursable through Medicaid?

The provision won’t make telehealth itself reimbursable by Medicaid per se, but might have that practical effect in some states, as there are already provisions for reimbursement for transportation to facilitate the required face-to-face visit, and states could decide to extend those to telehealth based on the new rule.  Reimbursement for services provided through telehealth is voluntary on the part of state Medicaid agencies as they are viewed as alternative methods of providing services, not as a separate type of service. Therefore, reimbursement is only available if the state has chosen to cover services provided via telehealth or telemedicine and only in the circumstances selected by the state.

What does this mean for the future?

Although this new provision may not be a big considered a big change, CMS did add that thorough guidelines on telehealth are forthcoming.

Every month we will be featuring 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 photo by Architect of the Capitol on Flickr.

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