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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.
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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.
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