6 Updates Plus Analysis of the OIG’s Telehealth Program Integrity Review

The good news is that the OIG did not find significant fraud in their telehealth Program Integrity Review (only 0.0023% of all telehealth providers).

The other news? They’ve identified seven inappropriate billing practices to look out for and recommended CMS perform a targeted oversight of telehealth to minimize program integrity risk.

Get all the details from Faisal Khan on the Nixon Law Group blog—including four actions to take now. ?

Now let’s get to the updates!

COLORADO

Revises Medicaid Act for Telemedicine Entities

TLDR: The Colorado Department of Health Care Policy and Financing revised the Colorado Medical Assistance (Medicaid) Act by creating a new section of rules for telemedicine services. The new section of telemedicine rules includes coverage and eligibility provisions, and the term “eHealth Entities” is defined. In general, an Electronic Health Entity, “eHealth Entity”, is a group practice (other than a primary care practice) that delivers services exclusively through telemedicine. ?EHealth entities can be either in-state or out-of-state. Services that are approved by Medicaid for delivery via telemedicine can be provided by any licensed provider enrolled with Colorado Medicaid as long as those services are within the provider's scope of practice. The new telemedicine section has several covered services requirements including, but not limited to, meeting the same standard of care requirements as in-person care; documenting all verbal or written patient consents; and compliance with state and federal regulations regarding care coordination. Utilizing telemedicine for Medicaid patients does not change prior authorization requirements. Reimbursement rates for telemedicine must (at a minimum) be at the same rate for comparable in-person services. Services not otherwise covered by Colorado Medicaid are not covered when delivered via telemedicine.?

Key Takeaways:

• An “eHealth Entity”, is a group practice that delivers services exclusively through telemedicine and is enrolled in a provider type with an eHealth specialty.
• Providers that meet the definition of an eHealth Entity must enroll with Medicaid.
• The new telemedicine rules include several requirements such as standard of care; consent documentation; state and federal regulation compliance, and more.?
• Utilizing telemedicine for Medicaid patients does not change prior authorization requirements.?
• Telemedicine reimbursement rates must be at the same rate for comparable in-person services.?
• Health services not otherwise covered by Colorado Medicaid are not covered when delivered through telemedicine.
• Check out full revisions here.?

KENTUCKY?

Updates Telehealth Terminology Glossary

TLDR: A Kentucky emergency administrative regulation recently updated the glossary for telehealth terminology to include a definition for the term “temporarily located". According to the newly defined term, a patient is considered “temporarily located” if the patient is present in a location that is not their permanent residence (also called domicile) for i) a period of no more than 182 days per year or ii) a period of more than 183 days per year due to an extended temporary stay, such as college attendance or a job assignment with intent to return to their permanent residence. In Kentucky, state law allows (i) the delivery of telehealth services to a person who is a permanent resident of Kentucky who is temporarily located outside of Kentucky by a provider who is credentialed by a Kentucky professional licensure board; and (ii) the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person's state of permanent residence. Implementing these residential status qualifications is intended to offer providers and licensing boards clarity regarding the delivery of telehealth services to patients located in areas outside their home state for an extended period of time.?

Key Takeaways:

• A Kentucky emergency administrative regulation has added the term “temporarily located” to the telehealth terminology glossary.
• A patient is “temporarily located” if the patient is present in a non-domiciled location for less than 182 days per year.?
• A patient is “temporarily located” if the patient is present in a non-domiciled location for more than 183 days per year due to a temporary extended stay with the intent to return to their home state.?
• Check out the full revisions here.?

LOUISIANA?

Re-adopts Emergency Rule for Hospice Care?

TLDR: The Louisiana Department of Health (hereafter “Department”) amended the Louisiana Administrative Code by re-adopting a COVID-19 emergency rule, effective on October 17, 2022. Under the emergency rule re-adoption, the Department will not require hospice providers to conduct daily in-person visits with patients under the age of 21, but instead, will continue permitting visits to be performed based on the clinical need of the patient, the patient’s family, and staff availability. Furthermore, the rule permits telemedicine visits as an alternative to in-person visits. This rule remains effective for either the maximum time period allowed under Louisana’s Administrative Procedure Act or for the duration of the federal COVID-19 public health emergency declaration, whichever comes first.??

Key Takeaways:

• Hospice providers are not required to conduct daily in-person visits with patients under age 21.?
• Providers may complete daily visits based on the patient’s clinical needs.?
• Telemedicine visits qualify as an alternative to in-person visits.?
• Effective October 17, 2022.
• Check out the full revisions here.?

MAINE

Implements New Practice Requirements for Teledentistry

TLDR: Maine recently adopted a new rule identifying teledentistry practice requirements for dental professionals licensed by the Maine Board of Dental Practice. These new requirements include, but are not limited to, general licensure requirements; patient location verification; standard of care provisions; patient emergency contact record-keeping; HIPAA privacy and security compliance; delegation and supervision restrictions; patient disclosures; and technology and equipment utilization provisions. Furthermore, informed consent must be in writing and include i) the licensee's name, license number, credentials, qualifications, contact information, and practice location involved in the patient's care; ii) the name, license number, credentials, and qualifications of all dental personnel involved in the patient's care; and iii) the dentist who delegates a teledentistry service must ensure that the informed consent of the patient includes disclosure to the patient that the dentist has delegated the service. Violating these practice requirements constitutes unprofessional conduct and may result in disciplinary action.?

Key Takeaways:?

• Maine’s new teledentistry practice guidelines include various requirements for dental practice professionals and licensees.?
• Informed consent must be in writing with specific provider identification requirements and delegation disclosures.?
• Violation of these practice requirements may result in disciplinary action.??
• Check out the full revisions here.?

TEXAS

Updates Continuing Education Requirements for Licensed Marriage and Family Therapists

TLDR: The Texas Behavioral Health Executive Council adopted a new rule regarding continuing education requirements for licensed marriage and family therapists (LMFTs). Licensees who provide telehealth services must complete two hours of continuing education in technology-assisted services. Those two hours will count towards the overall minimum continuing education hours requirement.?

Key Takeaways:

• Telehealth LMFTs must complete two hours of continued education in technology-assisted services, which counts toward the minimum continuing education requirement.?
• Check out the full revisions here. ?

WEST VIRGINIA

Clarifies Abortion Laws Related to Telehealth

TLDR: A West Virginia House Bill amended the West Virginia Code by clarifying several abortion laws, including laws relating to abortions via telehealth. The amendment prohibits telehealth practitioners from prescribing and dispensing abortifacients to patients within the State. Abortifacient means mifepristone, misoprostol, or any other chemical or drug prescribed or dispensed with the intent of causing an abortion. Providers violating the West Virginia abortion laws will be subject to penalties such as criminal charges.?

Key Takeaways:

• The bill prohibits telehealth practitioners from prescribing and dispensing abortifacients to patients within the State.?
• Providers violating the West Virginia abortion laws will be subject to penalties.?
• Effective September 13, 2022.
• Check out 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).

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

See you next time!