Telehealth legal and policy challenges University of Cincinnati National telehealth conference March 19-20, 2015
HPIO Mission To provide the independent, unbiased and nonpartisan information and analysis needed to create sound health policy
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
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
telemedicine and telehealth
HPIO s telehealth initiative Neutral forum to convene and discuss telehealth policy development and implementation
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.
Telehealth opportunities
Triple Aim Institute for Healthcare Improvement 9
Telehealth challenges
Legal and policy landscape
Licensure
Nurse licensure compact states
Credentialing and privileging
Scope of practice
Malpractice and liability
Prescribing
Physician prescribing - OAC 4731-11-09 OAC 4731-11-09 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
Physician prescribing - OAC 4731-11-09 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
Physician prescribing - OAC 4731-11-09 Requirements: Informed consent Maintenance of a medical record that includes electronic prescription information Follow up with the patient as necessary to assess therapeutic outcome
Physician prescribing - OAC 4731-11-09 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
Payment
Payment and Medicare
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: http://www.cms.gov/medicare/medicare- General-Information/Telehealth/
Payment and Medicare Distant site practitioners: Eight categories of practitioners Billing: Ø Most basic services are now allowed, including screenings and preventions Billing factsheet: http://www.cms.gov/outreach-and- Education/Medicare-Learning-Network-MLN/MLNProducts/ downloads/telehealthsrvcsfctsht.pdf
Payment and Medicaid Ohio Medicaid enrollment Source: Ohio Department of Medicaid monthly caseload report
Payment and Medicaid New Medicaid rule on payment for telemedicine services OAC 5160-1-18 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
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
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
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
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Contact Reem Aly JD/MHA Director Healthcare Payment & Innovation Policy raly@healthpolicyohio.org