Regulatory Telemedicine Updates 2020: COVID-19

To minimize virus exposure risk and protect patient safety, providers are urged to conduct visits via telemedicine programs whenever possible throughout the duration of the COVID-19 health crisis. Several regulatory changes introduced in recent weeks aim to ease the process of implementing and utilizing telehealth services, lessening restrictions to allow physicians to continue providing much-needed care.

Alongside the limiting of HIPAA compliance regulations, the federal government has introduced several other policy and regulation amendments to help medical professionals provide much-needed care at this time.

HIPAA Compliance Regulations 

In light of the growing need for telehealth encounters and increasingly complex clinical setting, the Office for Civil Rights has announced it will be lessening the enforcement of HIPAA regulations at this time. As such, HIPAA-covered entities may disclose protected health information about a patient as needed to treat the patient and other patients without prior authorization. This includes the coordination and management of care, consultation between medical providers, and patient referrals for treatment.

Under the new guidance, penalties will not be collected for “good faith use of telehealth”, including the use of popular video chat applications (FaceTime, Google Hangouts, Skype) which will not result in noncompliance. However, physicians may not use public-facing telecommunication services (Facebook Live, TikTok), are encouraged to inform patients of the potential cybersecurity risks associated with telemedical services, and most obtain consent from patients before providing medical services online.

Changes in CMS Regulations

When the COVID-19 outbreak began, the Centers for Medicare and Medicaid Service took immediate action by loosening conditions for participation in the program and certification requirements. CMS officially waived the requirement for site visits, background checks, application fees, and fingerprinting for non-certified Part B suppliers, physicians, and non-physician practitioners. They also now allow licensed providers to be paid for services rendered outside of their state of Medicare, Medicaid, or CHIP enrollment.

In addition, the CMS announced it will allow states to apply for waivers that lift prior authorization requirements in their fee-for-service programs, allow providers located out of state to provide care to another state’s Medicaid beneficiaries, suspend certain provider enrollment requirements, and temporarily waive requirements that health care professionals must practice in the state in which they are licensed to increase overall access to care.

Telemedicine Updates

To facilitate the widespread use of telemedicine programs, the federal government has also relaxed regulations, including lifting the requirement for an established patient-provider relationship under the CARES Act. Physicians can now conduct online or voice-only appointments with new patients and qualify for the telehealth waiver. Further, many insurers have also adopted similar temporary policies, although benefits of each private payer need to be verified.

Under the 1135 waiver, the CMS has allowed Medicare to pay for office, hospital, and other visits conducted via telehealth; dermatologists can now bill for telehealth visits for any patient in any location. They can also provide virtual check-in services – including those conducted over voice-only communication platforms – and virtual visits which will be reimbursed at the same rate as regular, in-person visits.

In addition, practitioners can continue to bill from their currently identified practice location while working from home and can provide supervision to non-physician clinicians via virtual audio/video technology.

State Specific Telemedicine Policies

Specific states have issued their own regulations regarding the use of telemedicine. Several states have waived licensure requirements, including Mississippi which is allowing out-of-state physicians to treat patients via telemedicine without securing a Mississippi medical license – provided the practitioner holds an unrestricted medical license in their state of practice and is not the subject of an investigation or disciplinary proceeding.

The Maryland Secretary of Health authorized the delivery of health care services via telehealth platforms, including audio-only calls, to patients regardless of the patient’s physical location. In Arizona, the Department of Health Services and the Department of Insurance now requires all state-regulated insurers to cover telemedicine visits at a lower cost-sharing point than in-office visits.

Individual state laws and regulatory changes can be found on the Federation of State Medical Boards COVID-19 resource page.

Before beginning a telemedicine practice, providers are urged to consult with their malpractice carriers to determine whether they are insured for such services. As additional legislative and regulatory changes emerge, the AAD will make details available on their page dedicated to the most recent federal and state government actions addressing the COVID-19 outbreak.

For physicians looking for guidance on opening a telemedicine practice during the COVID-19 outbreak, additional resources can be found here.