12 Updates (and Why You’re Seeing More of Them Lately)

Welcome back to the Virtual Care and Telehealth Updates newsletter for busy healthcare innovators.

States and the federal government are working to address the gaps and opportunities left by the end of the PHE on May 11, 2023, and it shows in the growing number of updates in each edition of our newsletter.

If you think your network would benefit from this biweekly summary of legal and policy updates—especially in this transition from temporary pandemic policies to (hopefully) permanent telehealth legislation—please share this newsletter so they can subscribe, too.

We’ve got a lot to cover today, so let’s get to it.

ALABAMA

Board of Medical Examiners Allow Locally Remote Supervision of Non-ablative Procedures

TLDR: Effective July 15, 2023, the Alabama Board of Medical Examiners adopted a rule allowing delegating physicians to conduct locally remote supervision of Level 1 Delegates (defined below) who are performing a non-ablative procedure such as non-ablative laser skin rejuvenation. Non-ablative procedures include any laser or intense pulsed light treatment that heats up the underlying skin tissue without harming the top layer of skin. The delegating physician who is not providing on-site supervision must be within physical proximity of the patient not to exceed the usual and customary response time of emergency management services for the locality. As defined in the rule, a Level 1 Delegate is a physicians assistant, certified registered nurse practitioner, or registered nurse, authorized in a written protocol to use a specific laser/pulsed light device or other energy source and who has met the educational requirements necessary.?

Key Takeaways:?

• Locally remote supervision will allow delegating physicians to be readily available to Level 1 Delegates conducting non-ablative procedures via telemedicine for consultation, evaluation, referral, or direct medical intervention.
• Check out the full revisions here.

COLORADO

Includes Telehealth Reimbursement in Veterans Mental Health Program?

TLDR: Effective May 16, 2023, the Colorado Division of Veteran Affairs will reimburse providers who participate in the Veterans Mental Health Services Program for tele-mental health sessions.?

Key Takeaways:?

• The rate of reimbursement for tele-mental health sessions will be the same as in-person mental health sessions.
• Check out the full revisions here.

FLORIDA

Revises “Telehealth Provider” to Include Genetic Counselors?

TLDR: Effective July 1, 2023, Florida revised the definition “telehealth provider” to include persons licensed as genetic counselors. The change involved adding part III of chapter 483 into the definition as it appears in section 456.47 of the Florida statute. Genetic counselors were previously the only health care practitioner type that could not provide services through telehealth. The change will expand how genetic counselors can provide services to Florida residents.?

Key Takeaways:?

• Genetic counselors are now included in the term “telehealth provider,” expanding the health testing services included in the definition.
• Check out the full revisions here.

IOWA

Establishes Professional Counselors Licensure Compact

TLDR: Effective June 1, 2023, Iowa entered the Professional Counselors Licensure Compact. This will enable Licensed Professional Counselors (LPCs) in Iowa to practice in other Compact states, and will enable LPCs licensed in other Compact states to practice in Iowa, without the need to obtain additional licenses.?

Key Takeaways:?

• Iowa joined an interstate counseling compact, allowing licensed professional counselors to practice in any member state including via telehealth.
• Check out the full revisions here.

MARYLAND

Extends Telehealth Insurance Provisions

TLDR: Effective June 1, 2023 and through June 30, 2025, the definition of “telehealth” in Maryland includes an audio-only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service. In addition, reimbursement for a telehealth service will be made on the same basis and at the same rate as if the service were delivered in person. These provisions apply to both Medicaid and commercial health insurance.

Key Takeaways:?

• Medicaid and commercial health insurance must cover audio-only telehealth services through June 30, 2025.
• During this period, reimbursement for a telehealth service will be made on the same basis and rate as if the service were provided in person.?
• Check out the full revisions here.

MINNESOTA (2)

Revises Session Laws on Healthcare Impacting Telehealth?

TLDR: Minnesota’s legislature recently made numerous changes to provisions governing health care and health insurance. Effective January 1, 2024, medical assistance coverage of tobacco cessation services now includes services provided by telemedicine as well as telephone counseling cessation services provided through a quitline. In addition, the legislation extended coverage for audio-only telehealth through July 1, 2025 instead of July 1, 2023. Further, effective January 1, 2025, the commissioner of health may establish sufficiency of number and type of providers within a provider network by considering telemedicine or telehealth providers. Previously, a health carrier could only address network inadequacy with telehealth providers as part of a waiver process after failing to meet network adequacy requirements.

Key Takeaways:?

• Medicaid now covers telemedicine tobacco cessation services.
• The definition of “telehealth” includes audio-only communication through July, 1, 2025.?
• Telemedicine or telehealth providers can now be considered in establishing health carrier network adequacy.
• Check out the full revisions here.

Allows Yearly Medical Cannabis Assessment to be Conducted Via Telehealth

TLDR: Effective March 1, 2025, Minnesota will allow health care practitioners to conduct annual patient assessments to determine whether a patient continues to have a qualifying medical condition in accordance with the state’s medical cannabis program via telehealth. Check out the full revisions here.?

MISSOURI

Allows Behavioral Health Crisis Centers to Staff Telehealth Providers?

TLDR: Effective June 30, 2023, Behavioral Health Crisis Centers (“BHCC”) must have a medical director who is a licensed psychiatrist available remotely via audio or telemedicine.? Additionally, BHCC licensed physicians, licensed psychiatric mental health nurse practitioners, advanced practice registered nurses, and physician assistants can provide telemedicine services.? A minimum of four staff members must be on duty during receiving hours including two behavioral health staff on-site and one QMHP and one RN or LPN available in person or via telemedicine.

Key Takeaways:?

• Certain Behavioral Health Crisis Center Staff can now provide services via telemedicine, increasing flexibility for BHCC care teams.?
• Check out the full revisions here.

NEVADA

Continues Requirements Governing Telehealth Insurance Coverage

TLDR: Effective July 1, 2023, Nevada will continue to require third-party payors, who are not industrial insurers, to cover telehealth services at the same reimbursement amount as in person services if the services are received at an originating site or furnished by a federally-qualified health center or a rural health clinic and the services are not provided through audio-only interaction. Additionally, an insurer must provide reimbursement for counseling or treatment relating to a mental health condition or substance use disorder regardless of whether such counseling or treatment is provided through an audio-only telehealth interaction. Check out the full revisions here.

OKLAHOMA

Allows Out-of-Network Coverage of Behavioral Telehealth Services

TLDR: Effective November 1, 2023, if a beneficiary of a health benefit plan is unable to obtain covered behavioral health services, including medically appropriate telehealth services, from an in-network provider in a timely manner, the health benefit plan shall ensure coverage of the behavioral health services from an out-of-network (OON) provider by arranging a network exception with a negotiated rate from an OON provider. The beneficiary will not be responsible for any amount greater than the in-network cost-sharing amount. This change will ensure beneficiaries can access the behavioral health services they need on time and without overpaying, and may encourage OON providers to make themselves available to payers’ network exception rosters.?

Key Takeaways:?

• Starting this November, payers must cover medically appropriate OON behavioral telehealth services for beneficiaries ?unable to obtain timely in-network services.
• Eligible beneficiaries shall receive OON behavioral telehealth services at the same rate as in-network services.
• Check out the full revisions here.

PENNSYLVANIA

Changes Procedure Codes for Telemedicine??

TLDR: Effective June 1, 2023, the Department of Human Services is end-dating the GT telemedicine modifier for certain procedure codes from the Medical Assistance Program Fee Schedule and in its place adding the codes POS 02 or POS 10 to indicate the use of telemedicine. POS 10 will identify when telehealth is provided in the patient’s home and POS 02 will identify when telehealth is provided other than in the patient’s home.?

Key Takeaways:?

• For certain procedure codes, the GT telemedicine modifier from the Medical Assistance Program Fee Schedule will be replaced with either POS 02 or POS 10.
• Check out the full revisions here.

TENNESSEE

Eliminates Physical Address Requirement for Medicaid Telehealth Providers?

TLDR: Effective March 21, 2023, TN Medicaid no longer requires a vendor or healthcare provider who exclusively offers telehealth services to maintain a physical address or site in Tennessee as a condition for enrollment. Likewise, the Medicaid program will no longer require telehealth provider groups to maintain a physical address in the state as long as the providers that comprise the group are licensed with the appropriate healthcare licensing authority or are otherwise authorized by law to provide healthcare services in TN.??

Key Takeaways:?

• Out-of-state telehealth providers can now enroll in TN Medicaid even if they have no physical location in the state.?
• Check out the full revisions here.

VERMONT

Emphasizes Controlled Substances May be Prescribed Through Telehealth?

TLDR: Effective May 25, 2023, providers can prescribe controlled substances to treat opioid use disorder via telehealth in accordance with federal requirements. This amendment is part of the Department of Health and Vermont Health Access’ efforts to establish a regional system of opioid use disorder treatment.??

Key Takeaways:?

• Controlled substances for the treatment of opioid use disorder may be prescribed via telehealth.?
• Check out the full revisions 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).

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See you next time!