We’re back with a new edition of Fabric Regulatory Roundup! Let’s take a closer look at the latest telehealth regulations and what all changed during the last month.
Federal
Notice on the Continuation of the National Emergency – COVID-19 Pandemic
On February 18, 2022, President Biden issued a notice that the national emergency declared on March 13, 2020, would continue beyond March 1, 2022. The notice does not indicate an end date for the emergency declaration but ensures that 1135 waivers and Medicaid coverage flexibilities for the COVID-19 emergency continue for now.
Sense of Senate Regarding Mental Health – Senate Resolution 518
Introduced on February 17, 2022, this resolution recognizes the high prevalence of individuals with mental health conditions and substance use disorders (SUD) and need for historic financial investments in care. It also acknowledges that mental health and SUD care is a priority and equal to physical health.
Within the resolution, it is noted that there is a need to increase access to and utilization of telemedicine services for mental health and SUD within the US and across state lines. This would be accomplished by providing a process in which states can work together on licensure and certification and for reimbursement to telehealth providers across state lines.
US Senate Bill 3688 – Improving Access to Tele-Behavioral Health Services Act – Introduced February 17, 2022
This bill would provide awards for community-based mental health and substance use disorder (SUD) services and peer support programs. Funds awarded may be used to:
- Coordinate between programs that provide mental health and SUD for juveniles and adults
- Obtain technology to provide these services through audio or video telehealth services
- Compensate health care providers, including services provided virtually
- Provide education assistance to individuals seeking peer specialist certification
- Provide workforce development, recruitment, and retention activities to train, recruit, and retain peer specialists
- Support the provision of peer specialist-facilitated support services on a virtual platform and expand or improve virtual support services
By State
Idaho Senate bill 1328 – Moved to Health and Welfare Committee
This bill would strike the term “store-and-forward,” replacing it with “asynchronous interaction.” The new definition would read “asynchronous interaction means exchange of a patient’s health care information that does not occur in real time from an originating site to a provider at a distant site over a secure connection that complies with applicable state and federal security and privacy laws.”
The bill would also allow the provider-patient relationship to be established asynchronously, provided that the standard of care can be met.
Mississippi House Bill 452 – Passed the Committee on Insurance
The bill passed the first committee and is in the first chamber of the house. This bill would update the definition of telemedicine used in law and would require insurance coverage for out-of-network providers. The definition of telemedicine in the bill is defined as:
(d) “Telemedicine” means the delivery of health care services such as diagnosis, consultation, or treatment through the use of HIPAA-compliant telecommunication systems, including information, electronic and communication technologies, remote patient monitoring services and store-and-forward telemedicine services. Telemedicine, other than remote patient monitoring services and store-and-forward telemedicine services, must be “real-time” audio visual. The Commissioner of Insurance may adopt rules and regulations addressing when “real-time” audio interactions without visual are allowable, which must be medically appropriate for the corresponding health care services being delivered.
Missouri – House bill 2165 Public Hearing Held 02.14.22
This bill would modify the definition of telehealth or telemedicine to include the use of adaptive questionnaire digital technology. It would allow a physician-patient relationship to be established using an adaptive questionnaire.
At the public hearing, there was testimony in support of the bill that was met with opposition from a house committee member as well as a medical association and insurance representative. Testimony specifically noted opposition to allowing the use of asynchronous care for all conditions vs. limiting it to certain diagnoses. Another concern was insurance reimbursement going to less reputable, substandard care providers. The hearing on this bill adjourned with a request from the committee chair to have a demonstration of how adaptive interviews work before “squashing” the bill.
Missouri – House Bill 2434 Moved to House Professional Registration and Licensing Committee
This bill seeks to modify the definitions section of Chapter 197 Medical Treatment Facility Licenses. The terms advanced practice registered nurse (APRN) and physician assistant would be added, and both given authority to create and sign a home health plan of care. Geographic proximity restrictions to a collaborating physician would be eliminated along with the 10% chart audit requirement for APRNs. The 20% chart audit requirement when an APRN prescribes controlled substances would remain. The “Utilization of Telehealth by Nurses” document from the state board of nursing would remove the stipulation on geographic proximity.
Washington – House Bill 1821 Passed House & Referred to Senate
This act seeks to define the establishment of the provider-patient relationship for audio-only telemedicine. “Established relationship” would be defined as when the “provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate services.” For behavioral health or substance use disorders, within the last three years the patient must have had an in-person visit or “real-time interactive appointment using both audio and video technology” with the provider or a provider employed at the same medical group, at the same clinic, same integrated delivery system, or been referred by a provider that meets the three-year requirement.
For other health care services, the look-back for in-person, interactive telemedicine, or referral would be two years.
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