As the Public Health Emergency Extends Again, States Continue to Adopt Changes to Expand Telehealth Access on Both Temporary and Permanent Basis

We’ll start with the most important news: The Department of Health and Human Services will extend the Public Health Emergency (PHE) beyond the current end date of July 15. Whether this means another 90-day extension, which would end the PHE on October 13, or a shorter extension date is unknown, as HHS has made no official announcement.

We’re working on a special resource to help you with planning for the end of the PHE (and YES you need to plan for this). Until then, we’ll keep updating you with law and policy updates you need to know to make smart decisions for your business.

Now let’s get to them!

IOWA (2)

The Iowa Board of Nursing Creates Minimum Telehealth Standards to Govern Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)?

TLDR: The Board of Nursing’s new rule defines the standards of practice for telehealth for LPNs and RNs, including the scope and standard of practice, how a license is acquired, and technology requirements. Iowa defines “telehealth” to include asynchronous store-and-forward technologies, remote monitoring and real time interactive services, including teleradiology and telepathology, conforming with the state’s definition of “telemedicine” for physicians.?

Key Takeaways:

The regulations provide the following standards for RNs and LPNs providing telehealth:

• Provides that all telehealth services and technologies must be HIPAA compliant;
• Nursing services cannot be provided through audio-only telephone, email or other written communications;
• Requires holding an active license or have an active privilege to practice in Iowa to provide services;
• Check out the statute here.

The Iowa Board of Nursing Creates Minimum Telehealth Standards to Govern Advanced Registered Nurse Practitioners (ARNPs)?

TLDR: The new regulations define telehealth standards of practice for ARNPs and include new definitions for telehealth that include audio-only and asynchronous store and forward transmission.

Key Takeaways:

The law provides the following standards and definitions:

• Telehealth services include electronic audiovisual communications and information technologies, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider for ARNPs.
• A telehealth encounter may be used to establish a patient-practitioner relationship;
• Nursing services cannot be provided through audio-only telephone, email or other written communications;
• Licensed ARNPs must first obtain consent from patient before providing telehealth services;
• Check out the statue here.?

MAINE

Maine Allows Verbal, Email Consent for Mental Health Telemedicine

TLDR: The newly adopted law provides that informed consent in verbal or electronic form for mental health or substance abuse services can be provided via telehealth during the PHE.?

Key Takeaways:

The law establishes that during the PHE:?

• Maine HHS can no longer require written consent for mental health or substance abuse services provided via telehealth;
• Check out the full statute here.

NEW YORK

New York Updates, Expands Mental Health Standards for Telehealth

TLDR: In order to continue to expand telemental health services, The New York Office of Mental Health readopted an emergency rule to replace references to “telemental health” with “telehealth,” reimburse for audio-only telehealth for Medicaid and CHIP, and expand eligible practitioners.?

Key Takeaways:

The emergency rule does the following in regard to telemental services:?

• Includes reimbursement for audio-only telehealth services under Medicaid and CHIP;
• Clarifies that telehealth practitioners must be licensed, permitted, designated or approved by the Office to provide services;
• Removes the requirement of an in-person initial assessment;
• Allows practitioners to deliver services from outside NYS;
• Check out the full statute here.

TEXAS?

Texas Board of Occupational Therapy Examiners Adopts Rule to Enable the Provision of Telehealth Services More Readily

TLDR: The Texas Board of Occupational Therapy Examiners adopts amendments clarifying supervision requirements for telehealth and expanding access to remote occupational therapy services.?

Key Takeaways:?

The rule makes the following changes:

• Removed requirement for on-site presence of OTPs for the initial application of adaptive/assistive splints;
• Telehealth evaluations must be done by either (1) synchronistic audio and synchronistic visual; or (2) synchronous audio contact, provided the OTP makes use of store-and-forward technology in preparation for or during the session;
• Newly defines “store and forward” as technology that stores and transmits or grants access to a client's clinical information for review by an OTP at a different physical location than the client;
• The full rule is available here.

VERMONT

Vermont carves a new telehealth-only licensure pathway for out-of-state healthcare professionals.

TLDR: Vermont added a new telehealth licensure and registration pathway for out of state health care professionals. The new law distinguishes a telehealth license from an in-person health care service license. The law applies to dentists, naturopaths, occupational therapists, pharmacy, occupational therapy, respiratory care, veterinary medicine, physicians, PAs and more.?

Key Takeaways:?

Under the law, all out of state telehealth providers must:

• Obtain a telehealth registration or license in the state of Vermont to practice Telehealth;
• Renew licenses every two years and renew registrations every three years;
• Note that practitioners using a telehealth license, without a regular Vermont license, are limited to serving 20 telehealth clients during a two-year term;
• Check out the full statue here.?

VIRGINIA (2)

Virginia Allows Telehealth with Out-of-State Practitioners, Virginia State Licensee Fee Waiver

TLDR: The newly adopted law allows a health care practitioner licensed in another state and in good standing to practice within the scope of their license to provide care using telehealth to a patient in Virginia even without a Virginia medical license, if there is a prior practitioner-patient relationship and has performed an in-person examination on the patient within the past 12-months.?

Key Takeaways:

The law also allows for:

• The practitioner-patient relationship to extend to each practitioner in the multispecialty group of the patient’s primary physician;?
• The waiver of renewal fees to practice medicine or osteopathic medicine or as a physician assistant or nurse practitioner during a Board issued emergency health order;
• Check out the full statutes here and here.

Virginia Requires Medicaid to Reimburse EMS Agencies for Telehealth Services

TLDR: The newly adopted law provides for Medicaid reimbursement to emergency medical service agencies that facilitate telehealth visits between distant site providers and patients.

Key Takeaways:

The law allows for:

• Creates a provision for payment of the originating site fee to emergency medical service agencies for facilitating synchronous telehealth;
• The“originating site” to include the location of wherever telemedicine services are received;
• Allows for the waiver of renewal fees to practice medicine or osteopathic medicine or as a physician assistant or nurse practitioner during a Board issued emergency health order;
• Check out the full statute here.

WEST VIRGINIA (4)

West Virginia Establishes Teledentistry Standards

TLDR: The newly adopted regulation establishes requirements for the practice of teledentistry by dentists and dental hygienists.

Key Takeaways:

The regulations allow for dentists and dental hygienists providing teledentristy to:?

• Provide services via telehealth within their scope of practice;
• Provide services through synchronous or asynchronous telecommunications technology;
• Establish a bonafide practitioner-patient relationship without an initial in-person visit;
• Check out the full statute here.

West Virginia Updates Dentist, Dental Hygienist Continuing Education Standards

TLDR: The West Virginia Board of Dentistry adopted regulations to establish continuing education (CE) requirements for teledentistry registrants and allow licensees who do not complete CE on time to make up the requirements and pay a late fee.

Key Takeaways:

The regulations require the following:

• Dentists and dental hygienists to fulfill CE requirements by the state they are licensed in;
• Dentists to complete a three-hour drug diversion training every two years;
• Check out the full statute here.

West Virginia Revises Allopathic, Podiatric, Physician Assistant Telehealth Standards

TLDR: The West Virginia Board of Medicine amended regulations to establish the telehealth scope of practice for allopathic physicians, podiatric physicians, and physician assistants to reflect interstate telehealth registration provisions.

Key Takeaways:

The amendments enable the following changes:?

• Out-of-state telehealth practitioners must be registered to provide telehealth services to patients located in West Virginia. The application for an interstate telehealth registration includes a form filing, a fee and board approval;
• Healthcare practitioners not licensed in WV may provide telehealth services to a patient located at an originating site in WV during a state of emergency or if the practitioner holds a Board approved interstate telehealth registration;???
• Real-time audio-only communications may be utilized to establish the provider-patient relationship
• Check out the full statute here.

West Virginia Revises Practitioner Requirements for Accessing the West Virginia Controlled Substances Monitoring Program Database

TLDR: The new law binds out of state practitioners with a telehealth only registration in WV to the West Virginia Board of Medicine requirements regarding accessing the West Virginia Controlled Substance Monitoring Program database.

Key Takeaways:

Highlights from the revision include:?

• Practitioners holding interstate telehealth registrations in WV must follow all requirements that are applicable to those licensed in-state regarding the state’s substance abuse monitoring program, repository and database, known as West Virginia Controlled Substances Monitoring Program or CSMP;?
• Check out the statute and practitioner requirements here.?

WISCONSIN

Wisconsin Revises Physical Therapy Assistant Supervision Requirements

TLDR: The new regulation temporarily suspends requirements that supervising physical therapists must have direct face-to-face contact with physical therapist assistants, and instead allows supervision using electronic communications.

Key Takeaways:

• Removes the need for approval by the Physical Therapy Examining Board in order to satisfy direct face-to-face contact requirement for patients every 14 days;
• Audio-only and text are not considered an electronic face-to-face requirement and will not satisfy the requirement;
• Check out the full statute here.

And that brings this 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.?

Before we go: Telehealth isn’t our only expertise at NGL! Every month we publish an info-packed email newsletter around a specific topic for healthcare innovators. In May, we shared current and predicted trends in Privacy and Security for healthcare innovators, and we’re *still* getting thank you emails from subscribers for the info. To check out this issue without subscribing, click here. (You can subscribe at the end if you find it useful.)

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