Mid-Atlantic Legislative/Regulatory June 2018 Update Please Note: CCHP has a pending legislation/regulation webpage located at the following link: http://cchpca.org/state-laws-and-reimbursement-policies LEGISLATION Pending Legislation State Bill # Status Summary New Jersey AB 1/9/18: To Assembly Enters New Jersey into the Multistate Nurse 1583 Committee on Health and Licensure Compact. Senior Services New Jersey SB 954 1/16/18: To Senate Committee on Health, Human Services and Senior Citizens New Jersey SB 2560 5/14/18: To Senate Committee on Judiciary. Enters New Jersey into the Multistate Nurse Licensure Compact. Allows the Department of Health to implement pilot programs to improve response times when law enforcement officers request assistance in intervening with a person experiencing a mental health crisis, including the use of mobile response units and telemedicine. New Jersey SB 1699 2/5/18: Introduced An act to enter the Nurse Multistate Licensure Compact (NMLC). North Carolina 967 6/12/18: Referred to Senate Committee on Establishes the North Carolina Telemedicine Practice Act. Health Care. North Carolina SB 779 5/31/18: Sent to Senate Committee on Rules and Operations of the Senate Pennsylvania SB 780 6/19/18: To House Committee on Professional Licensure. Approved Legislation State Bill # Status Summary Establishes a telemedicine policy for the state; directs the Department of Health and Human Services to study and report recommendations by the Joint Legislative Oversight Committee on Health and Human Services. Reestablishes the Telemedicine Act; authorizing the practice of telemedicine by health care providers; and providing for insurance coverage of telemedicine.
Page 2 DC B. 177 6/5/18: Assigned law number 109 DC B. 232 3/55/18: Enacted with Act Number A22-0282. Authorizes the Mayor to join the Interstate Medical Licensure Compact. Establishes the School Health Innovations Grant Program, which requires The Department of Behavioral Health to select clinic operators to participate in the school health innovations program in District of Columbia Public schools and District of Columbia Public Charter schools for the purposes of expanding access to comprehensive behavioral health care services by incorporating telehealth. DC B. 233 5/8/18: Approved Requires the coverage of certain telehealth services by the Department of Health Care Finance; to provide for the scope of reimbursable telehealth services covered by Medicaid in the District of Columbia; to establish technology requirements for synchronous telehealth services; to specify which sites may serve as originating sites and distant sites for purposes of telehealth; to clarify that all categories of Medicaid recipients are eligible for telehealth services; among other components. Delaware 311 6/11/18: Approved The Board of Clinical Social Work Examiners has worked several years to amend Chapter 39, Title 24 of the Delaware Code to update the statute governing social work licensure and practice in this State. Specifies that clinical social work may be provided by telemedicine as permitted by regulation and may include participation in telehealth. Kentucky SB 112 4/26/18: Approved Requires the cabinet to regulate telehealth; sets requirements for the delivery of telehealth services to Medicaid recipients; requires equivalent reimbursement for telehealth services; requires provision of coverage and reimbursement for telehealth; prohibits the cabinet from requiring providers to be physically present with a recipient; prohibits prior authorization, medical review, or administrative clearance if not required for the in- person service; prohibits demonstration of necessity. Maryland 1132 5/8/18: Approved Requires a carrier that is an insurer, a nonprofit health service plan, or a health maintenance organization to ensure enrollees have access to local health departments and
Page 3 certain services provided through them, with an exception; requires that an access plan filed by a carrier include a description of the carrier s efforts to include local health departments in the carrier s network, with an exception; access includes services via telehealth. Maryland SB 234 5/8/18: Approved Enters into the Interstate Medical Licensure Compact to strengthen access to health care by developing a comprehensive process to complement existing licensing and regulatory authority and provide a streamlined method to allow physicians to become licensed in multiple States; requires a physician to meet certain eligibility requirements to receive certain licensure. Maryland SB 704 5/15/18: Approved. Requires the Maryland Department of Health, under certain circumstances, to include psychiatrists who are providing Assertive Community Treatment or mobile treatment services to certain Maryland Medical Assistance Program recipients in the types of providers eligible to receive reimbursement for health care services that are delivered through telemedicine and provided to Program recipients. Maryland SB 858 5/8/18: Approved Requires a carrier that is an insurer, a nonprofit health service plan, or a health maintenance organization, except for a group model health maintenance organization, to ensure in certain standards that certain enrollees have access to local health departments and certain services provided through local health departments to the extent that local health departments are willing to participate on a carrier s provider panel; access includes services via telehealth. Virginia Virginia 1054 1303 4/6/18: Approved. Acts of Assembly Chapter No. 790. Requires a practitioner to establish a practitioner-patient relationship, in-person or via telehealth, prior to prescribing Schedule II through V controlled substances. 3/19/18: Approved. Defines bona fide veteran-client-patient relationship; allows practitioners with veteran-client-patient relationship to prescribe controlled substances via telemedicine when a practitioner-provider relationship exists.
Page 4 West Virginia West Virginia 4447 4524 3/27/18: Signed by Governor; Approved. West Virginia SB 273 3/27/18: Signed by governor; Approved. Provides for a uniform and efficient system of broadband conduit installation; establishes regulation for broadband conduit installation in rights of way; provides for the valuation of certain compensation; provides for highway safety and existing highway policies; relates to provider initiated construction; provides for multiple providers in a single trench; provides for the use of spare conduits; provides for relocation; provides for infrastructure development. 3/27/18: Approved. Establishes guidelines for the substitution of certain biological pharmaceuticals; defines interchangeable biological product; relates to electronic reporting. Session Ended Amends the Opioid Reduction Act; clarifies physician responsibility for medication assisted treatment programs; requires consultation with patients prior to prescribing an opioid; limits the amount of opioid prescriptions; provides for referrals to a pain clinic or pain specialist; requires insurance coverage to treat chronic pain; expands acts subject to discipline or prosecution; amends the Uniform Controlled Substances Act; provides for unlawful retaliation and prescription drug monitoring; provides definition of telehealth. State Bill # Status Summary Kentucky 12 2/6/18: Posted in committee. Requires the cabinet to regulate telehealth; sets requirements for the delivery of telehealth services to Medicaid recipients; requires equivalent reimbursement for telehealth services; requires provision of coverage and reimbursement for telehealth; prohibits the ca780 binet from requiring providers to be physically present with a recipient; prohibits prior authorization, medical review, or administrative clearance if not required for the in- person service; prohibits Kentucky SB 143 2/14/18: Referred to Senate Committee on Banking and Insurance. demonstration of necessity. Creates a new section to require an insurer develop processes for electronic prior authorizations; establishes an extended length
Page 5 Kentucky SB 153 2/16/18: To Senate Committee on Licensing, Occupations, and Administrative Regulations. Maryland 596 4/9/18: To Senate Committee on Rules Maryland 1652 4/4/18: To Senate Committee on Rules. Maryland SB 211 4/9/18: From House Committee on Health and Government Operations: Reported favorably. of authorization under certain circumstances; requires that the Department of Medicaid Services comply with the provisions of this Act; amends to require a Medicaid managed care organization to comply with Sections 1 and Sections 8,9,10,11, and 12 of this Act; requires governmental units of the Commonwealth to promulgate. Enacts and enters into the Interstate Medical Licensure Compact with all other jurisdictions that legally join in the compact; declares the purpose of the compact; defines terms; recognizes a multistate licensure privilege to practice for physicians. Enters into the Interstate Medical Licensure Compact to strengthen access to health care by developing a comprehensive process to complement existing licensing and regulatory authority and provide a streamlined method to allow physicians to become licensed in multiple States; requires a physician to meet certain eligibility requirements to receive certain licensure; requires physicians to designate a certain state as the state of principal license for purposes of registration. Requires the Maryland Department of Health, under certain circumstances, to include psychiatrists who are providing Assertive Community Treatment or mobile treatment services to certain Maryland Medical Assistance Program recipients in the types of providers eligible to receive reimbursement for health care services that are delivered through telemedicine and provided to Program recipients. Requires that regulations adopted under certain provisions of law regulating behavioral health programs include provisions authorizing a medical director of a behavioral health program located in a federally designated health professional shortage area to provide services through telehealth, and prohibiting a behavioral health program located in a federally designated health professional shortage area from requiring a medical director to provide services onsite.
Page 6 Virginia Virginia 1507 2812 2/13/18: Left in House Committee on Appropriations. 1/10/18: Referred to House Committee on Government Organization Virginia SB 225 3/6/18: Left in House Committee on Appropriations. West Virginia West Virginia 2327 2778 1/10/18: Referred to House Committee on Banking 3/2/18: Referred to House Committee on Health and Human Resources Creates the Patient-Centered Medical Home Advisory Council. Among other duties, the council will recommend an implementation plan for a patient-centered medical home system which may include the use of telemedicine. It also creates the opioid addiction treatment and recovery system, which would include a partnership which would include telemedicine networks, and the Center for Telehealth at the University of Virginia. Creates the Office of Rural Health Policy, which is responsible for (among other items) administering grant programs designed to build health care capacity and promote telehealth technologies. Requires the Department to create a pilot on opioid addiction treatment and recovery services. The pilot would be in partnership with telemedicine networks and hospitals. Requires insurers to submit an access plan that includes the insurer s network, including how the use of telemedicine or telehealth or other technology may be used to meet network access standards (among other components). This bill establishes standards for twenty four hour programs requiring medical monitoring. It requires, among other components that the provider have a policy regarding the face to face or telemedicine availability of medical staff to directly observe the patient after hours within thirty minutes as necessary and appropriate unless an arrangement is made for alternative medical care. REGULATION Pending Regulation State Reg. Citation Status Summary Delaware 24 DAC 1700 6/1/17: Changes Proposed 7/3/17 Title: Board of Medical Licensure and Discipline Agency: Board of Medical Licensure and Discipline This rule revises current regulation, adding a new regulation clarifying the language in the Medical Practice Act pertaining to telemedicine and telehealth.
Page 7 Delaware 21 DC Reg 19 7/1/17: Proposed Rule 7/31/17 Delaware 24 DAC 2100 3/1/18: Proposed Rule Kentucky Kentucky New Jersey 201 KAR 28:235 201 KAR 33:070 NJAC 10:60-1.1, 1.2, 1.3, 1.6, 1.7, 1.8, 1.9, 2.2, 2.3, 2.5, 3.1 through 3.9, 5.1 through 5.11, 11.2, 10:60 Appendix A, 10:60-6, 10:60-3.10, 10:60-4, 7, 8, 9, 10 4/17/18 11/13/17: As amended at the Administrative Regulation Review Subcommittee 2/9/18: Proposed Rule 3/31/18 8/21/17: Proposed Rule 10/20/17 Title: Compensation for Chiropractic Services Agency: Office of the Commissioner Adopts rules to prohibit insurance carriers from including in any insurance policy terms and conditions that unreasonably discriminate against the payment for Chiropractic Care or Services, or Chiropractic Supportive Care, and puts in place a mechanism by which the Department of Insurance may enforce this prohibition. Provides a definition for telehealth and telemedicine. Title: Board of Examiners in Optometry Agency: Department of State/ Division of Professional Regulation/ Board of Examiners in Optometry Revises rules to clarify and provide more detailed information regarding the use of telehealth services for the provision of optometry services. Title: Telehealth Occupational Therapy Services Agency: Board of Licensure for Occupational Therapy This administrative regulation establishes the requirements for telehealth for occupational therapy services. Title: Telehealth and Telepractice Agency: General Government Cabinet/ Board of Licensure and Certification for Dietitians and Nutritionists This administrative regulation establishes procedures necessary to prevent abuse and fraud through the use of telehealth, prevent fee-splitting through the use of telehealth, and utilize telehealth in the provision of dietitian and nutrition services, and in the provision of continuing education. Title: Home Care Services Agency: Division of Medical Assistance and Health Services Concerns rules and regulations regarding several waiver programs providing home and communitybased services into the New Jersey 1115 Comprehensive Medicaid Waiver (the Comprehensive Waiver) and the implementation of sections of the Affordable Care Act. Contains section on telehealth.
Page 8 Pennsylva nia 55 PA Code 1153 and 5200 Virginia 12 VAC 30-50, - 60, -70, -80, - 130 10/20/2017 Independent Regulatory Review Commission - Notice of s Issued 1/17/17: Fast Track Proposed Rule 3/8/17 Virginia 18 VAC 85-20 12/19/17: Proposed rule West Virginia Title 64, Series 11 3/9/18 6/21/18: Proposed rule 7/21/18 Title: Outpatient Psychiatric Services and Clinics Agency: Department of Human Services Amends rules to update Chapters 1153 and 5200 to be consistent with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), to reflect changes in benefit packages resulting from the implementation of Medicaid expansion under the Patient Protection and Affordable Care Act and the consolidation of adult benefit packages, as well as codify the requirements for the delivery of Mobile Mental Health Treatment (MMHT) outlined in Medical Assistance Bulletin 08-06- 18, Mobile Mental Health Treatment. The definition of "telepsychiatry" is proposed to be added to allow for the utilization of technology to provide clinical services. Title: Scope of Medical and Remedial Care Services Agency: Department of Medical Assistance Services. Establishes a comprehensive program for addiction and recovery treatment services to provide a community-based continuum of addiction and recovery treatment services. Certain services are allowed to be delivered via telemedicine. Also provides a definition of telemedicine. Title: Practice of Medicine, Osteopathic Medicine, Podiatry Agency: Board of Medicine Proposes regulations for licensure by endorsement for physicians who hold licenses in other states and who meet certain requirements established in regulation. The goal of the planned action is establishment of an expedited process for licensure of qualified physicians who want to practice in Virginia, either in person or by telemedicine. Title: Behavioral Health Centers Licensure Agency: Department of Health and Human Resources Requires providers of programs requiring 24-hour medical monitoring to supply adequate staff monitoring via eyes on or technological methods and for those providers to have a policy regarding face-to-face or telemedicine availability of medical staff to directly observe patients after hours within 30 minutes as necessary. Adopted Regulation State Reg. Citation Status Summary
Page 9 DC DCMR Title 17, Ch. 46, Sec. 4618, 4699.1 10/23/18: Adopted Effective: 12/22/18 Title: Telemedicine; Definitions Agency: Department of Health This rulemaking seeks to establish rules specific to the practice of telemedicine. The amendments to Section 4699 (Definitions) are necessary to explain the terms used in Section 4618. Delaware 24 DAC 3700 2/20/18: Final Regulation Effective: 4/11/18 Delaware 24 DAC 38005 2/9/18: Final Regulation Effective: 3/11/18 Delaware 24 DAC 1799 1/2/18: Final regulation. Effective Date: 2/11/18 Delaware 24 DAC 2500 4/18/18: Final Regulation Effective Date: 6/11/18 Delaware 24 DAC 1700 4/3/18: Final Regulation Effective Date: 6/11/18 Maryland COMAR 10.09.49.07 2/20/18: Notice of Final Action Effective Date: 3/26/18 Title: Telepractice Standards Agency: Board of Examiners of Speech/Language Pathologist This rule would amend rules to set forth standards and requirements in order to allow licensees to engage in telepractice while protecting the public. Title: Telehealth Agency: Board of Dietetics/Nutrition The regulation defines telehealth, requires a licensee to obtain written informed consent and obligates its licensees to perform an initial evaluation face to face and not through telehealth, among other components. Title: Genetic Counselor Advisory Council Agency: Genetic Counselor Advisory Council Amends rules pertaining to the Genetic Counselor Advisory Council to set forth standards for the use of telehealth in the practice of genetic counseling. Title/Agency: Board of Pharmacy Provides a definition for telehealth and allows telehealth to be used for the provision of patient counseling. Title: Board of Medical Licensure and Discipline Agency: Department of State/ Division of Professional Regulation/ Board of Medical Licensure and Discipline Amends rules relating to telemedicine and telehealth. Title: Provider Conditions for Participation Agency: Medical Care Programs Amends rule to add federally qualified health centers (FQHCs) to the list of provider sites that may register as distance site providers eligible to deliver services via telehealth within the rendering provider's scope of practice; and physician assistants as permitted distant site
Page 10 Approved Emergency Regulation State Reg. Citation Status Summary Virginia 18 VAC 110-20-690, -700, -710, -735 5/8/17: Emergency Rule Adopted Effective: 5/8/17 Expires 11/7/18 rendering providers and permitted originating site providers. Title: Regulations Governing the Practice of Pharmacy Agency: Board of Pharmacy Authorizes issuance of a controlled substances registration to persons who have been trained in the administration of naloxone in order to process and dispense the drug to persons receiving training and an entity for the purpose of establishing a bona fide practitioner-patient relationship for prescribing when treatment is provided by telemedicine in accordance with federal rules. As applicable, regulations for controlled substances registrants will be considered for amendment, including recordkeeping, security, and storage requirements.