CMS, Congress, state legislatures, and other regulatory boards play a vital role in establishing telehealth policy. Policy influencers range from national organizations, such as the American Medical Association or AARP to federal and state courts to the Federal Trade Commission.
Here are six highlights.
1. Reimbursement. One of the top telehealth obstacles is reimbursement. Medicare restricts what telehealth services can be billed and limits telehealth access geographically. State Medicaid programs, however, have been a bit more lax since states are free to establish their own policies. States also create their own reimbursement rules for private payers, which often involve parity in coverage of services though not necessarily in cost.
2. Malpractice. Though there have been only a few cases of telehealth malpractice — and those are usually centered around teleradiology — providers should still ensure their malpractice insurance covers telehealth services and that the coverage extends to any other states they intend to practice in.
3. Licensing. Since states control and regulate licensing, some challenges and complications ensue. For example, a telehealth service is considered to occur in the physical location of the patient, regardless of where the provider is, meaning the provider must abide by the patient’s state licensing laws. There are a couple of workarounds for this, one being the enhanced Nurses Licensing Compact that allows nurses in the 29 currently enrolled states to practice telehealth in another eNLC state without obtaining another state license.
4. Privacy and security. Even if a technology markets itself as HIPAA compliant, there still needs to be extra safeguards in place. HIPAA does not have specific telehealth requirements, meaning a telehealth provider must meet the same HIPAA requirements as in-person care. Providers must also abide by any other state privacy laws. Therefore, providers may need to take additional steps, like establish rules and safeguards for its tech support team, which may be inadvertently exposed to patients’ protected health information when addressing tech issues.
5. Prescribing. While policies vary across states, most require providers establish an in-person relationship with patients prior to delivering care via telehealth. Using telehealth to prescribe controlled substances can only be done under certain circumstances, as laid out in the Ryan Haight Act.
6. Credentialing and privileging. Smaller hospitals don’t always have access to the specialists they need or the resources to credential physicians, so CMS allows hospitals and critical access hospitals to credential by proxy. That means a clinic can contract with another hospital of telemedicine organization to offer telehealth services and credential those providers, creating a quicker, more cost effective way of accessing specialty care.
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