Telehealth legal and policy challenges. University of Cincinnati National telehealth conference

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1 Telehealth legal and policy challenges University of Cincinnati National telehealth conference March 19-20, 2015

2 HPIO Mission To provide the independent, unbiased and nonpartisan information and analysis needed to create sound health policy

3 HPIO thanks our core funders, who are helping advance the Health of Ohioans through informed policy decisions. Interact for Health Mt. Sinai Health Care Foundation The Cleveland Foundation The George Gund Foundation Saint Luke s Foundation of Cleveland HealthPath Foundation of Ohio Sisters of Charity Foundation of Canton Sisters of Charity Foundation of Cleveland United Way of Greater Cincinnati Mercy Health CareSource Foundation SC Ministry Foundation United Way of Central Ohio Cardinal Health Foundation

4 Strategic priorities Prevention: Promoting healthy community environments and behaviors Payment: Encouraging payment models that drive cost-effective and evidence-based prevention and care Access: Ensuring timely access to comprehensive, integrated and appropriate health services

5 telemedicine and telehealth

6 HPIO s telehealth initiative Neutral forum to convene and discuss telehealth policy development and implementation

7 Telehealth definition No standard definition for telehealth or telemedicine adopted in literature or practice. We use the term telehealth as it is generally viewed as being broader in scope than telemedicine.

8 Telehealth opportunities

9 Triple Aim Institute for Healthcare Improvement 9

10 Telehealth challenges

11 Legal and policy landscape

12 Licensure

13 Nurse licensure compact states

14 Credentialing and privileging

15 Scope of practice

16 Malpractice and liability

17 Prescribing

18 Physician prescribing - OAC OAC proposed rule on physician prescribing Prescribing of non-controlled substances to a person the physician has never previously conducted a medical evaluation on, and who is at a location remote from the physician, under specific conditions outlined in the rule

19 Physician prescribing - OAC Requirements: Conformation to minimal standards of care consistent with an evaluation completed in a faceto-face interaction Use of diagnostic medical equipment that in realtime can: Ø Transmit patient s physical data Ø Transmit images of the patient s physical condition and can be adjusted for better image and quality

20 Physician prescribing - OAC Requirements: Informed consent Maintenance of a medical record that includes electronic prescription information Follow up with the patient as necessary to assess therapeutic outcome

21 Physician prescribing - OAC Prescribing of controlled substances to a person the physician has never previously conducted a medical evaluation on Various requirements under different scenarios including cross coverage

22 Payment

23 Payment and Medicare

24 Payment and Medicare Condition of payment: an interactive audio and video telecommunications system with real-time communication Originating sites (location of patient): Ø A rural HPSA located either outside of a MSA or in a rural census tract Ø County outside of MSA Eligibility: General-Information/Telehealth/

25 Payment and Medicare Distant site practitioners: Eight categories of practitioners Billing: Ø Most basic services are now allowed, including screenings and preventions Billing factsheet: Education/Medicare-Learning-Network-MLN/MLNProducts/ downloads/telehealthsrvcsfctsht.pdf

26 Payment and Medicaid Ohio Medicaid enrollment Source: Ohio Department of Medicaid monthly caseload report

27 Payment and Medicaid New Medicaid rule on payment for telemedicine services OAC Effective as of January 2015 direct delivery of services to a patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements

28 Payment and Medicaid Originating site Office of a MD, DO, optometrist, podiatrist FQHC Outpatient or inpatient hospital Nursing facility Document medical necessity of service Secure informed consent Develop and maintain progress notes Originating fee OR evaluation and management payment

29 Payment and Medicaid Distant site MD, DO, licensed psychologist Document the health care service delivered Send progress notes to originating site for incorporation in patient s records Five mile radius Professional payment

30 Payment and parity SB 32: Sponsor Tavares, Cosponsors: Seitz, Skindell Remove any exclusion of coverage for a telemedicine service solely because the service is not provided through a face-to-face consultation

31 31

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33 Keep up-to-date on the latest health policy news Subscribe for a free weekly update at

34 Contact Reem Aly JD/MHA Director Healthcare Payment & Innovation Policy

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