6 Updates Plus How to Monetize Your Big Healthcare Idea

You’ve no doubt heard that the end of the PHE is on May 11. That means changes for telehealth and virtual care management, and we’re working on some resources for you right now. Stay tuned!

Be sure to read to the end for some helpful resources on finding revenue options for your big healthcare ideas. (We get this question *all* the time, so you’re not alone if you haven’t figured it out yet.)

Now let’s get on to the updates.

New York

Adopts Emergency Rule Covering Emergency Medical Aid and Telemedicine

TLDR: Effective January 10, 2023, the New York Workers’ Compensation Board adopted an Emergency Rule which amended rules regarding emergency medical aid and telemedicine. Specifically, the amendment outlines modified telemedicine billing guidelines under the Medical Fee Schedule, the Acupuncture and Physical Therapy and Occupational Therapy Fee Schedule, the Behavioral Health Fee Schedule, and the Chiropractic Fee Schedule. Practitioners in these practice areas should be aware of the modified billing procedures under New York Workers' Compensation requirements.

Key Takeaways:

• Authorized providers shall indicate on their report that an emergency assessment was done by telemedicine using specific modifiers.
• Providers who utilize the Official New York State Workers’ Compensation Fee Schedule may, when telemedicine is used, bill using the applicable Evaluation and Management codes using modifiers listed in the statute when services are rendered by telemedicine.?
• Authorized physical therapists and occupational therapists shall use CPT code modifiers listed in the statute when treatment is rendered by telemedicine, and when treatment is rendered by telephone.?
• Authorized chiropractors shall use CPT codes listed in the statute when treatment is rendered by telemedicine using two-way audio and visual communication.?
• Psychologists and licensed clinical social workers, shall use CPT therapy codes for services using specific modifiers listed in the statute when services are rendered via telemedicine.?
• Check out the full revisions here.?

Oregon

Expands Telemedicine to Acupuncture Services

TLDR: ?Effective January 11, 2023, the Oregon Medical Board adopted a rule clarifying that an Oregon-licensed acupuncturist may provide care to patients located in Oregon. Specifically, the rule amends Chapter 847 of the Oregon Administrative Code to allow acupuncturists to deliver services via telemedicine. This change opens the door for tele-acupuncture services in Oregon.

Key Takeaways:

• Licensed acupuncturists in Oregon can deliver care to patients remotely via telehealth.
• Check out the full revisions here.

Mississippi

Adopts Rule Outlining Requirements for Occupational Therapy Telehealth Services

TLDR: ?Effective February 13, 2023, the Mississippi State Department of Health adopted a rule which outlines the requirements for occupational therapists to provide telehealth.? Specifically, the rule establishes guidelines for practice requirements, patient identity and communication, informed consent, confidentiality, competence and scope of practice, maintenance and retention of records, and documentation requirements for telehealth.

Key Takeaways:

• Occupational therapists must establish a provider-patient relationship prior to diagnosis and treatment through a previous in-person examination, an ongoing personal or professional relationship, or through consultation with or referral by another occupational therapist.
• Occupational therapy assistants working under general supervision can provide services through telehealth.
• Occupational therapy practitioners must verify the identity of the patient prior to each visit and obtain alternative means of communication.
• Informed consent forms must include acknowledgments of the risk, limitations, and potential benefits of the use of telehealth.
• Occupational therapy practitioners using telehealth services are responsible for determining and documenting the reasoning for the use of telehealth, limiting the practice of telehealth services to their area of competence, and ensuring that confidential electronic communications are stored properly.
• Check out the full revisions here.

Illinois (2)

(1) Expands Availability of Temporary Permits for Out-Of-State Health Care Professionals

TLDR: ?On January 13, 2023, the Medical Practice Act, Physician Assistant Practice Act, and Nurse Practice Act were amended by the Illinois General Assembly to create temporary permits for out-of-state medical professionals to provide services in Illinois on a temporary basis.? Specifically, out-of-state physicians, physician assistants, advanced practice registered nurses, and full practice advanced practice registered nurses may be issued temporary permits pursuant to an agreement with a sponsored licensed medical facility.??

Key Takeaways:

• The Department of Financial and Professional Regulation (Department) can now issue a temporary permit to physicians, physician assistants, advanced practice registered nurses, and full practice advanced practice registered nurses who are licensed to practice in another state.
• The temporary permit shall expire 2 years after its date of issuance and may be renewed for an additional 2 years.
• Check out the full revisions here.

(2) Expands Availability of Telehealth Services for Health Care Professionals with Temporary Permits

TLDR: ?On January 13, 2023, the Illinois General Assembly amended the Telehealth Act to permit out-of-state physicians, physician assistants, advanced practice registered nurses, and full practice advanced practice registered nurses with temporary permits for health care to treat patients located in Illinois through telehealth services.?

Key Takeaways:

• Healthcare professionals with these temporary permits may treat patients via telehealth in a manner consistent with their scope of practice.
• Check out the full revisions here.

Texas

Outlines Medicaid Requirements for Audio-Only Telehealth Services

TLDR: Effective January 23, 2023, the Texas Health and Human Services Commission (‘HHSC’) adopted a rule that expands Medicaid coverage for healthcare services delivered via telehealth, including certain behavioral health services using an audio-only platform. The adopted rule also (1) standardizes the definition of telehealth services and telemedicine services, eliminating the exclusion of audio-only services; (2) adds a definition for ‘audio-only’ services; (3) distinguishes ‘in-person’ services from those provided via telehealth; (4) establishes criteria for whether a covered service may be delivered via an audio-only platform; and (5) expands home telemonitoring coverage to those that are 20 years of age or younger. Audio-only behavioral services will now be reimbursable by Medicaid.?

Key Takeaways:

• Audio-only is defined as an interactive two-way communication that uses sound only and is compliant with HIPAA.?
• Considerations for whether a covered service may be delivered via an audio-only platform include clinical effectiveness, cost-effectiveness, health and safety, patient choice, and access to care, and other criteria specific to the service.?
• The rule establishes that telehealth services must be designated for reimbursement by the Texas HHSC to be reimbursed by Medicaid.?
• In-person services are defined as those services that are within the physical presence of another person. Telemedicine services are expressly excluded from this definition.
• The definition of ‘telehealth’ is harmonized with the Texas Occupations Code.
• Check out the full revisions here. (p. 209).

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.

Before you go, be sure to check out our resource list for how to actually get paid for your big healthcare idea.

Every day innovators tell us about their world-changing solutions. And often they aren’t quite sure how to actually earn revenue from them (or don’t know *all* the available revenue options).

Whether you are a digital health founder, a healthcare provider entity, or an international business looking to enter the US healthcare market, we’ve got tips for figuring out your revenue options in this list.

See you next time!?