Melissa Ward
Sr. Business Analyst - Regulatory Affairs

Welcome back to the Zipnosis Regulatory Roundup! While this might be our Halloween edition, there’s nothing scary about this month’s updates. Let’s dive in to see what’s been happening!

virtual care regulation

Federal

The Department of Health and Human Services (HHS) has released its final rule to revise the regulations that govern Title X family planning. HHS has finalized telehealth as an acceptable modality of care and has replaced its use of “telemedicine” with the term “telehealth” to recognize that the scope of services extends across multiple disciplines. For full details on the rule: 2021 Title X Final Rule | HHS Office of Population Affairs

The Office of Inspector General (OIG) has released its annual report on Top Unimplemented Recommendations: Solutions to Reduce Fraud, Waste, and Abuse. The report includes the 25 unimplemented recommendations that the agency feels would be most impactful if implemented. In 2018, the OIG found that the Centers for Medicare and Medicaid (CMS) paid for telehealth services that did not meet Medicare requirements and recommended that CMS conduct periodic post-payment reviews. Had Medicare implemented the reviews, the OIG reported the estimated saving to be $3.7 million during 2014 and 2015. Expect to see CMS working with Medicare Administrative Contractors (MACs) to implement telehealth claim edits. For more details: 2021 Top Unimplemented Recommendations

The OIG released a data snapshot of Medicare beneficiaries’ use of telehealth during the COVID-19 pandemic. The report provides policymakers and stakeholders with information on provider-patient relationships to help guide telehealth structure on a more permanent basis. The report found that fee-for-service beneficiaries were more likely than Medicare Advantage beneficiaries to receive care where they had an established relationship. 84% of fee-for-service beneficiaries received care from providers with which they had an existing relationship. For more details: Office of Inspector General

Medicare beneficiaries’ use of telehealth during the COVID-19 pandemic

Protecting Telehealth Access Act – US House Bill 5424

This bipartisan legislation, introduced on September 29, 2021, would ensure rural health providers can continue treating patients according to the public health emergency telehealth flexibilities. This includes permanently allowing Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) to serve as distant sites and allow Medicare beneficiaries to receive telehealth services at any location, including their home. It is estimated that one in five Americans live in rural areas, are on average older, and have higher rates of chronic medical conditions.

A bipartisan bill has been reintroduced to reduce burnout healthcare professionals feel as hospitals continue to remain overwhelmed by the COVID-19 pandemic. The Temporary Responders for Immediate Aid in Grave Emergencies (TRIAGE) Act would allow healthcare workers that have let their license expire to return to the medical field to reduce the burden on the current workforce. In addition, the Act would create a Provider Bridge Program to streamline the mobilization of healthcare professionals during the COVID-19 pandemic and future health emergencies.

The Provider Bridge program would:

  • Support license portability by creating a dedicated customer service hub to assist clinicians in navigating state licensure requirements
  • Create a registry of professionals willing to treat patients via telehealth in highly impacted areas
  • Ease the burden on state agencies and healthcare entities in connecting with clinicians willing to provide telehealth services during emergencies
virtual care regulation

By State

Florida

Senate Bill 312 – Introduced
The bill has been referred to the Senate committee and is on the agenda for November 3, 2021. This bill seeks to revise the definition of telehealth to include audio-only services permanently. If enacted the definition of telehealth would be defined as follows:

“Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not e-mail messages or facsimile transmissions.

Mississippi

Medical Board Committee – Telemedicine Rules
During an October meeting, the Committee opposed the language authorizing asynchronous technology for establishing a provider-patient relationship and diagnosing and treating a patient. Those in opposition indicated that their intent for asynchronous store-and-forward was to transfer records and data and stated patients should be required, at minimum, to have a synchronous visit with the treating provider. This issue was tabled and will be revisited at a subsequent meeting.

New Jersey

Telehealth Organization Registration Deadline Extended
To gain additional regulatory oversight of telehealth-only providers, New Jersey has created a registration requirement. Telehealth organizations that do not have a brick and mortar presence in the state were required to register by Oct 15, 2021. However, the deadline has been extended to accommodate all applicants. Registration has been extended to January 3, 2022. Telehealth organizations doing business under multiple names must register under each name. For more information: Telemedicine and Telehealth Organization Registry · Department Of Health

Pennsylvania

Senate Bill 705 – Telemedicine Act
This bill passed in the Senate on October 26, 2021, and was referred to the House Committee on Insurance. If enacted, this bill would authorize professional licensing boards to create telemedicine regulations within the scope of practice and standards of care related to synchronous, asynchronous, and remote patient monitoring services. In addition, the act supports the establishment of a clinician-patient relationship and clinical evaluation via synchronous or asynchronous telemedicine. The act also includes telemedicine coverage and reimbursement parity consistent with in-person care for commercial payers and Medicaid. All provisions in the act would be effective on the date of enactment except for Medicaid. Medicaid provisions would be effective 90 days from the date of enactment.

Texas

Texas Medical Board – Amendments to Statute 174.5, Issuance of Prescriptions
The Medical Board has adopted additional rules that allow physicians to utilize telemedicine to continue issuing previous prescription(s) for scheduled medications to established chronic pain patients if the physician has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video communication. The amendments will consistently and conveniently provide patients access to scheduled drugs needed to ensure ongoing treatment of chronic pain and avoid potential adverse consequences associated with the abrupt cessation of pain medication.

 

Thanks for checking in for this month’s updates. I hope you learned something. Check back next month for more!

Disclaimer:
This information, and any other information, content or other materials (collectively “Information”) we provide, does not, and is not intended to, constitute legal advice; instead, all Information is provided for general informational purposes only. The Information may not constitute the most up-to-date legal or other information.  Readers should contact their attorney to obtain advice with respect to any particular legal matter. No reader or user of any Information should act or refrain from acting on the basis of Information without first seeking legal advice from counsel in the relevant jurisdiction. Only your individual attorney can provide assurances that the Information – and your interpretation of it – is applicable or appropriate to your particular situation. Use of, or access to, the Information does not create an attorney-client relationship between the reader or user, and the author or provider of the Information.

Tags: Industry

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