Is telehealth getting a new lease on life?

6 PHE-Related Waivers

Through 2019, telehealth was mainly for rural patients living far from healthcare providers. Then came COVID and the Public Health Emergency (PHE) declaration from the Department of Health and Human Services (HHS). Since 2020, a series of rolling 90-day waivers opened telehealth to everyone, temporarily. 

Thanks to a recent surge in COVID cases, the current PHE extends to October 2022. When it ends, so does CMS’s authority to continue telehealth’s expended capabilities (unless there’s a further extension). That’s why Congress stepped in. The Consolidated Appropriations Act, which became law March 15, extends telehealth’s lifespan by five months (151 days, to be specific) after the PHE expires. (Related: Six key steps to reduce the impact of telehealth audits) 

That means telehealth is alive and well at least through year’s end. So are many of the PHE-related coverage flexibilities. Here are some of the highlights: 

  • Telehealth from anywhere Before the PHE, Medicare covered only services delivered to patients at hospitals and other provider facilities. The Act redefines “originating site” to mean “any site in the United States at which the eligible telehealth individual is located at the time the service is furnished.” This could be patients’ homes, their cars – anywhere with phone or Wi-Fi connectivity. 
  • More practitioners In addition to physicians, nurse practitioners, physician assistants and other specialized providers, occupational and physical therapists’, speech language pathologists’ and audiologists’ services will be covered. 
  • Payment for audio-only services will continue for 151 days after the PHE ends. 
  • Relaxed in-person mental health services requirement The waivers ensure that the requirement that mental health patients have in-person visits of the first telehealth visit and every 12 months afterwards won’t take effect until the 152nd day after the PHE ends. 
  • Reinstated first-dollar coverage Until the end of 2021, telehealth services to High Deductible Health Plan and Health Savings Account patients were not subject to plan deductibles. The new law reinstated this relief through December 31 of this year. 
  • More data transparency The Medicare Payment Advisory Commission is required to analyze telehealth utilization, expenditures, payment policies, and implications on access to and quality of patient care. Starting July 1, the HHS Secretary must publicly post quarterly telehealth utilization data. 

For more lasting, but not permanent, relief, the bipartisan Telehealth Extension and Evaluation Act, which would extend the telehealth waivers for two years, is inching its way through Congress. 

If all the flux and uncertainty at the federal level weren’t enough, there’s also the state level. As I posted almost a year ago, the states have their own telehealth coverage, reimbursement, and privacy regulations. For now, patients and providers can continue on through at least the end of 2022 with access to telehealth. Beyond that, healthcare organizations are working hard to future proof their approach to telehealth. Stay tuned! 

Read how one health system created a scalable repeatable process to address regulatory changes during the PHE. The hospital system is now fully prepared to revert those changes or update them to the new requirements. 

Get a 15-minute strategic overview of YouCompli

  

Telehealth expansion: Interstate licensure compacts benefit patients 

YouCompli Woman reviewing interstate licensure compacts for telehealth

Telehealth services and models have expanded rapidly during the pandemic. Healthcare employee burnout, the Great Resignation, and other factors are expected to further accelerate telehealth growth.  

Telehealth expansion has led to significant growth in the use of interstate licensure compacts. As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. 

Increasing use of interstate licensure compacts 

The National Council of State Boards of Nursing (NCSBN) recently published its annual report on interstate licensure. It noted 43 states and territories have enacted licensure compacts for nurses, physicians, physical therapists, emergency medical technicians, psychologists, speech therapists/audiologists, occupational therapists, and counselors. 

The Nurse Licensure Compact (NLC) is an interstate agreement allowing nurses to practice in multiple states with one multistate license issued from their home state. The compact enables nurses to provide nursing services to patients located in other NLC states via telehealth without obtaining additional licenses. The NCSBN says this approach allows for greater nurse mobility, public protection, and access to care.  

In addition, use of the Interstate Medical Licensure Compact (IMLC) grew by 47% in the past two years. The IMLC Commission noted “more than 8,000 licenses were issued through the compact from March 2020 to March 2021.” This is compared with nearly 4,000 licenses issued during the previous 12-month period.  

With more healthcare professionals practicing across state lines, patients have more choices. And healthcare compliance officers have processes and procedures to update.  

Interstate licensure compacts benefit patients 

For patients, one benefit of licensure compacts includes licensing boards being able to ensure that physicians maintain professional integrity and medical standards – regardless of where they practice. As more healthcare professionals obtain licensure under compacts, patients gain greater flexibility in making care decisions.  

For example, rural patients can participate in a telehealth visit with a specialist or provider at home. This saves patients the time and expense of driving long distances to see the same provider in a facility setting.   

Another positive is the increased use of remote monitoring devices, such as glucose monitors, blood pressure monitors, and heart monitors. Patients can receive state-of-the-art monitoring remotely, instead of as a hospital inpatient. In turn, healthcare costs decrease and patient compliance increases.  

A significant patient benefit with expanded telehealth is the inclusion of mental health services. Under the provisions of the Consolidated Appropriations Act of 2021, services for the diagnosis, evaluation, or treatment of mental health disorders may continue as telehealth services. Per the Centers for Medicaid & Medicare Services (CMS), the previous restrictions limiting telehealth mental health services to patients residing in rural areas no longer apply.  

Compliance considerations 

Compliance officers need to help their organizations keep up as healthcare delivery models change. Organizations will need to update everything from billing codes to human resources policies and procedures to information technology (IT) practices.  

For example, compliance officers should partner with Human Resources to make sure out-of-state licensed professionals have been educated in facility policies and procedures. They also need to ensure that professionals working under licensure compacts understand the nuances of the rules and laws in the state they are working. 

Compliance officers also need to work with the IT department to ensure that remote devices have been securely connected to the network. They also need to collaborate with the risk department on making sure proper medical professional liability insurance coverage has been obtained for these licensed professionals.  

Compliance officers should work with Revenue Cycle on two crucial issues:  

  • Ensuring that the organization stays abreast of the changes to the CMS list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth. 
  • Staying current on telehealth visit coverages and coding modifiers to decrease denials of patient charges.  

As your team manages your response to continuing regulatory changes, having a system to keep up with the moving parts can help. YouCompli can support your regulatory change management process. It provides regulatory analysis to help you know what changes are coming and decide whether they affect your institution. It also provides requirements, tasks, and deadlines, in clear business English, making it easier for you to manage changes and verify that you’ve taken the proper steps. 

Denise Atwood, RN, JD, CPHRM 
District Medical Group (DMG), Inc., Chief Risk Officer and Denise Atwood, PLLC 

Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.  

Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.  

Get more healthcare regulatory change management right to your email!

How is your healthcare organization keeping up with changes in regulations? Read more about our regulatory monitoring process or schedule a demo. 

Get a 15-minute strategic overview of YouCompli

Nursing-shortage solutions come with licensure challenges  

Nursing-shortage solutions

The nursing shortage in the US was bad before the pandemic started. Now after the double whammy of a two-year pandemic and an aging population, it’s even worse. 

The American Nursing Association estimates that this year will see more than 100,000 unfilled nursing jobs, “more than any other profession.” 

Hospitals have traditionally brought in “nurse travelers” from outside their service areas and their states to comply with state staffing requirements. In 2000, the Nursing Licensure Compact permitted nurses licensed in one participating state to practice in other participating states. In 2018 the Enhanced Nursing Licensure Compact (eNLC) added some requirements, such as state and federal fingerprint-based criminal background checks.  

With Vermont having started implementation February 1, 36½ states and territories are eNLC participants. Ohio has joined but won’t implement participation until January 2023.  Pennsylvania and the US Virgin Islands have joined but have not yet set implementation dates. The half is Guam, which recognizes eNLC licenses but whose nurses won’t be able to apply for one until later this year. 

Interstate licensing considerations for traveling nurses 

Nurse burnouts, quits, and anticipated retirements (500,000 RNs this year) have only added to the need for hiring travelers to fill the gaps. But before you do, there are potential pitfalls to watch out for:   

  • Does your state belong to the eNLC? Does the nurse’s home state? If not, what are the licensure requirements for nurses with out-of-state licenses? 
  • If your state has passed eNLC legislation, have they implemented it yet? If not, have they set a date for doing so? 
  • If eNLC legislation is pending in your state, what’s its status? 
  • Do you have a process in place for checking and verifying out-of-state licenses? 
  • If your state is not an eNLC participant, what are its regulations regarding out-of-state licensure? 
  • What if nurses you hired as travelers join your contracted staff and move to your state? Have you a process for making sure they updated their licenses from multi-state to your state? Are the in-state licenses current? If not, you’ll have been providing patient care services without a license.  

The expanding availability of out-of-state nurses can be hugely helpful for solving short-term nursing shortages. An audit of your practices against current regulations and compacts is a great first step in determining where and how to use traveling nurses in a compliant way. 

Do you have a system in place to manage regulatory changes? Having a solution that researches and analyzes regulatory changes, translates them into model procedures, and has a top healthcare law firm validate them can really pay. Read more about YouCompli’s regulatory monitoring process or schedule a demo.  

Get the latest article in your email

Get a 15-minute strategic overview of YouCompli