12 Key Updates Plus 7 Virtual Care Models You Need to Understand

Welcome to another edition of the newsletter! If you’re in the business of telehealth and virtual care management, then you need to know about virtual care business models. Nixon Gwilt Law Partner Rebecca Gwilt wrote the kind of introductory guide every healthcare innovator needs, and you can get yours here.

Now let’s get to the updates.

As we look toward the end of the COVID-19 pandemic there is a growing push to make expanded telehealth and virtual care services a permanent fixture in our health care landscape. Highlighted in this issue of the newsletter are an HHS OIG report on the critical role telehealth services played during the first year of the pandemic, revisions to telehealth-related Medicare laws in Indiana, and a Massachusetts bulletin revising telehealth policies for home health and continuous skilled nursing services.

FEDERAL (2)

HHS OIG Releases Report Finding Telehealth was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic

TLDR:? The U.S. Department of Health and Human Services Office of Inspector General released a report examining the use of telehealth during the COVID-19 pandemic. According to the report, “Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic. Beneficiaries' use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. Further, it shows that beneficiaries particularly benefited from the ability to use telehealth for certain services, such as behavioral health services. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.”?

Key Takeaways:

• HHS OIG finds that telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic.
• Telehealth utilization during the pandemic demonstrates the long-term potential of telehealth to increase access to health care for Medicare beneficiaries.
• Telehealth demonstrated particular benefit for use with certain services, such as behavioral health services.
• CMS, Congress, and other stakeholders should take these findings into account in considering changes to Medicare that would expand telehealth services on a permanent basis.
• Check out HHS’s statement about the report here, and the full report here.

DEA Commits to Expanding Access to Medication-Assisted Treatment??

TLDR: The Drug Enforcement Administration (DEA) is in the process of developing the Special Registration process for the use of telemedicine to prescribe controlled substances under the Ryan Haight Act. In early March, 72 organizations asked the agency (and the Department of Health and Human Services (HHS) to permanently waive the requirement that patients receive an in-person evaluation before being prescribed controlled substances via telemedicine. Against the backdrop of these efforts, the DEA, in collaboration with federal, state, and local partners is championing several initiatives to expand access to medication-assisted treatment and to make temporary rules allowing the prescribing of medication-assisted treatment via telemedicine during the pandemic into permanent rules. Among other things, these changes will greatly increase remote access to a critical treatment for those suffering from opioid-related substance use disorder.

Key Takeaways:

• In July 2021, the DEA implemented a new regulation increasing the number of mobile methadone treatment facilities in an effort to expand access to treatment in remote and underserved communities.
• In response to the COVID-19 public health emergency, the DEA implemented temporary regulations allowing medication-assisted treatment to be prescribed by telemedicine. The DEA is now working to make those regulations permanent.
• Read the DEA’s full statement here.

INDIANA

State Legislature Revises Telehealth Laws and Medicaid Language

TLDR: On March 14, 2022, Indiana State Senate Bill 284 was signed by Governor Holcomb to become Public Law 109. The new law consolidates telehealth language across the state’s Medicaid statutes and makes several changes to the Medicaid program’s inclusion or exclusion of certain services for the purpose of telehealth. Medicaid providers in Indiana who offer telehealth services should review their billing policies under the new statutory language to avoid possible reimbursement issues.

Key Takeaways:

The new law provides several Medicaid-related changes, including:

• Clarification of when case management, care management, service coordination, and care coordination services do not qualify as “health care services” for Medicaid billing purposes.
• Expansion of the definition of “practitioner” to include occupational therapist assistants, school psychologists, specified developmental therapists, peers, clinical fellows, students and graduates of certain professional programs, physical therapist assistants, and certain community mental health center providers.
• Health analysts are now allowed to temporarily perform telehealth during the time when the professional licensing agency is preparing to implement licensure for the profession.
• Check out the full revisions here.

IOWA

Board of Pharmacy Revises Telepharmacy Regulations

TLDR: The Iowa Board of Pharmacy updated the regulations governing the use of telepharmacies in the state. These changes are a result of an overall five-year review of the state’s telepharmacy laws and aim to reduce duplicated rules and increase the effectiveness of the existing telepharmacy regulations. Telepharmacies operating in Iowa should review the updated regulations to ensure compliance with the new rules.

Key Takeaways:

The updated regulations include changes to:

• Reduce the notification period to terminate a written agreement between a managing pharmacy and a telepharmacy site from 90 days to 45 days;
• Authorize the practice of pharmacy support persons (PSP) at a telepharmacy site and establish requirements for PSP registration and training; and
• Authorize the Board of Pharmacy to establish a committee to consider requests for exemption from the technician practice experience requirements in exceptional circumstances that may otherwise result in the closure of the telepharmacy site.
• Check out the full revisions here.

LOUISIANA

Extension of COVID-19 Emergency Rule Allows Hospice Providers to Continue Use of Telemedicine Visits

TLDR: The Louisiana Department of Health has extended an existing emergency rule pertaining to relaxed requirements for certain Medicaid programs and services during the COVID-19 pandemic. The emergency rule, which was originally set to expire on April 19, 2022, will now remain in effect until October 19, 2022. Included in the emergency rule are provisions relaxing certain requirements on hospice providers and allowing the use of telemedicine for hospice visits.

Key Takeaways:

The emergency rule’s provisions include:?

• Waiver of the requirement for daily visits by hospice providers to patients under the age of 21.
• Hospice visits should be completed based on clinical need.
• Telemedicine visits may be used in place of in-person visits.
• Check out the full rule here.

MASSACHUSETTS

Massachusetts Revises Telehealth Policy for Home Health Services, Continuous Skilled Nursing Services, and Telehealth Documentation Requirements

TLDR: The Massachusetts Office of Medicaid has issued Home Health Agency Bulletin 74, which revises the MassHealth telehealth policies regarding home health services, continuous skilled nursing services, and the requirements for telehealth documentation. Home Health Agency Bulletin 74 supersedes previous guidance on these topics and will remain in effect until the end of the federal COVID-19 public health emergency. As this bulletin modifies the flexibilities available to telehealth providers in the state and updates their recordkeeping and documentation obligations, telehealth providers in Massachusetts should review the updated requirements and revise their own policies and practices accordingly.

Key Takeaways:

Among the guidance provided, the bulletin:

• Describes the COVID-19-related telehealth flexibilities for MassHealth home health services and continuous skilled nursing services that will remain in effect until the end of the federal public health emergency;
• Clarifies that telehealth visits may be used for follow-up visits that do not require hands-on care;
• Allows 60-day recertifications for home health services to be conducted through a telehealth visit; and
• Describes the recordkeeping and documentation requirements regarding telehealth services.
• Check out the full bulletin here.

MICHIGAN

Michigan Board of Physical Therapy Adds Rule Regarding Telehealth Services

TLDR: The Michigan Board of Physical Therapy has added a new rule which clarifies the requirements for licensed physical therapists providing telehealth services within the state. While the new rule is largely an adoption of previously existing obligations, physical therapists offering telehealth services in Michigan should review the new rule to ensure that their own policies and practices align with the rule’s requirements.????

Key Takeaways:

Under the new rule, a licensed physical therapist offering services via telehealth must:

• Obtain consent for treatment before providing telehealth services;
• Keep proof of consent for telehealth treatment in the patient’s up-to-date medical record;
• Act within the scope of the licensee’s practice; and
• Exercise the same standard of care applicable to a traditional, in-person health care service.
• Check out the full rule here under “R 338.7127 Telehealth.”

OREGON

Oregon Updates Rules Relating to Credentialing of Telemedicine Practitioners and Expands Rule Language to Reflect All Modes of Telemedicine

TLDR: Oregon has adopted a new set of rules governing the credentialing program for telemedicine practitioners in the state. The new program, termed the Oregon Practitioner Credentialing Application, is an updated version of an older program, but includes new language that expands the use of telemedicine from hospital-only settings to use in a wide range of health care facilities. This change reflects an expansion of telemedicine in the state across all of the current modes of providing telemedicine services that will greatly increase patient access to telemedicine services, as well as increase the ability of virtual care providers and practitioners to assist patients in need, regardless of the patient’s physical location.?

Key Takeaways:

Under the new rules for the credentialing of telemedicine practitioners:

• The Oregon Practitioner Credentialing Applications program has replaced the Oregon Common Credentialing Program.
• The rule language has been updated to indicate an expansion of telemedicine from hospital-only settings to use in a wide range of health care facilities.
• Check out the full revision here.

TENNESSEE

Board of Optometry Adopts New Rule Governing Telehealth in the Practice of Optometry

TLDR: The Tennessee Board of Optometry has adopted a new rule governing the use of telehealth in the practice of optometry. The rule became effective on March 20, 2022, and provides clarification regarding an optometrist’s obligations in providing telehealth services to patients within the state of Tennessee. By providing clear guidance on the use of telehealth and virtual care services in the context of optometry, the new rule gives confidence to optometrists who may wish to expand their practices into offering services via telehealth.

Key Takeaways:

The new rule clarifies the requirements for:

• The establishment of an optometrist-patient relationship within the context of telemedicine or telehealth services;
• The appropriate use of telehealth technologies in optometric practice;
• Informed consent requirements for telehealth services;
• Continuity of care using telehealth technologies; and
• Prescribing requirements for telehealth technologies.
• Check out the full rule here under “1045-02-.19 Telehealth in the Practice of Optometry.”

VERMONT

Vermont Extends COVID-19 Telehealth Flexibilities, But Increases Restrictions

TLDR: The current COVID-19 health care regulatory flexibilities in place in Vermont were set to expire on March 31, 2022. The Vermont legislature has extended these flexibilities until March 31, 2023, but has modified several of the flexibility provisions, including several regarding the use of telehealth services. Health care providers offering patient services under the COVID-19 health care regulatory flexibilities in Vermont should review the changes made to the flexibilities and update their own policies and procedures as needed in order to avoid any violations under the terms of the revised flexibilities.

Key Takeaways:

The changes to the Vermont COVID-19 health care regulatory flexibilities include:

• New registration requirements and procedures for licensed out-of-state health care professionals who wish to offer telehealth services to patients in Vermont.
• Removal of the waiver for the requirement to obtain informed consent for the use of telemedicine prior to the delivery of services if obtaining or documenting such consent was not practicable.
• Check out the full revisions here.

WASHINGTON

Payment Rules Updated for the Alien Emergency Medical (AEM) Program to Cover COVID-19 Telemedicine Visits

TLDR: The Washington State Health Care Authority has revised the payment rules for the Alien Emergency Medical (AEM) program to expand coverage for assessment and treatment of the COVID-19 virus. For the assessment or treatment of COVID-19, the program will now cover one physician visit provided in any outpatient setting, including visits made via telemedicine. For practitioners who offer telemedicine services in Washington, this change to the AEM payment rules will expand their payment options for telemedicine services that were previously unbillable under the program and will allow the practitioners to offer more telemedicine options to patients.?

Key Takeaways:

• For the assessment or treatment of COVID-19, the AEM program will cover one physician visit made in-person or via telemedicine.
• Check out the full rule revision here.

WYOMING

Wyoming Legislature Greenlights Up to $2 Million in Grants for Rural Telehealth Pilot Projects

TLDR: As part of its recent budget session, the Wyoming legislature considered how to disperse COVID-19 relief funds received from the federal government under the American Rescue Plan. Among the approved budget items is an appropriation to the Office of State Lands and Investments of $15 million for providing grants to rural health clinics, up to $2 million of which may be used to provide grants for rural telehealth pilot projects to expand telehealth services in the state. Providers seeking to participate in telehealth pilot programs may be able to expand their telehealth offerings and make these telehealth programs a permanent fixture in the state.

Key Takeaways:

• The Wyoming legislature has approved up to $2 million in state funds to provide grants for rural telehealth pilot projects to expand telehealth services in the state.
• Check out the full bill here.

And that brings another issue to a close.

As always, know that if you’re a client of Nixon Gwilt Law, then we’re keeping tabs on all of these law and policy changes for you. You don’t have to worry about tracking all these updates on your own or making key business decisions without fully understanding the evolving landscape. (And with 50 states and multiple federal agencies, something is always changing).

If you’re not yet a Nixon Gwilt Law client, you can always explore how we help businesses like yours by clicking here.

Next time we’ll share some special insights for TelePet innovators (who smartly predicted the demand for veterinary telehealth services once pet owners appreciated the ease of telehealth for humans).?

See you in two weeks with more updates!