[PDF] Telehealth, Licensure, COVID-19: - vpqhc

41065_7071520_Telehealth_Licensure_Presentation.pdf

Telehealth, Licensure, COVID-19:

Practicing medicine when the provider and the patient are on opposite sides of a national line. And getting paid for it. •You need a license in the country where you are practicing. •Medicaid and Medicare will not reimburse a VT-practicing physician who lives in Canada "seeing" remotely their patients in Vermont. •BCBSVT and MVP will reimburse seeing Vermont patients from a

Canadian home.

•Don't forget to double check your professional liability coverage.

Telehealth, Licensure, COVID-19:

Practicing medicine when the provider and the patient are on opposite sides of a state line. And getting paid for it. •CMS 1135 Waiver for reimbursement for telehealth across state lines. •States need to set their own rules about what they will allow 1) for telehealth in a crisis and 2) for telehealth outside of a crisis. •Note: Rules will be different by state and timeline for when they expire will be different by state. You have to check.

Where to Find Information on States' Rules:

VT Office of Professional Regulation -information for what you need to work in Vermont https://sos.vermont.gov/opr/about-opr/covid-19- response/

VT Board of Medical Practice

-summarizes and links COVID-19 rules for telehealth in our neighboring states https://www.healthvermont.gov/health-professionals-systems/board- medical -practice/COVID19 Federation of State Medical Boards -national overview https://www.fsmb.org/advocacy/covid-19/

Vermont's Rule for Telehealth During COVID-19:

From the OPR Site:

The legislature passed emergency legislation* that was signed by Gov. Scott on March 30, 2020 that allows individuals who hold an out-of-state license to practice in Vermont without a VT license**. If you are providing only telehealth to people in Vermont you do not need a license and you do not have to provide your contact information to the Office of Professional Regulation.

If you are providing services to Vermonters in a licensed facility you do need to provide your contact

information to the Office of Professional Regulation. *H. 960 -extended rule to be through March 31, 2021, even if we exit a declared emergency.

**VT Board still has jurisdiction over individuals practicing in this "deemed" status. See also next slide.

Other Rules to Watch For:

VT Board of Medical Practice would like to remind non-Vermont based providers who are delivering telemedicine into Vermont that they have to follow Vermont requirements, in particular note: Rules for use of the Vermont Prescription Monitoring System https://www.healthvermont.gov/sites/default/files/documents/pdf/REG_vpms -20170701.pdf

Prescribing Opioids for Pain

https://www.healthvermont.gov/sites/default/files/documents/pdf/Opioid%20Prescribing%20Rule %202.1.19.pdf VT Board's Policies on Telemedicine, Opioids, and Medication Assisted Treatment (buprenorphine) https://www.healthvermont.gov/health-professionals-systems/board-medical- practice/statutes-laws-rules-and-policies

Other Rules to Watch For:

There are also guidelines for virtual supervision, for those license types that require a supervising provider: CMS describes how supervision can be provided remotely in its broader workforce flexibility rules https://www.cms.gov/files/document/covid-19-physicians-and- practitioners.pdf Vermont Office of Professional Regulation offers this more detailed document on virtual supervision for mental health professionals https://sos.vermont.gov/media/af0gx3np/emergency -mental-health-provider- internship-and-supervision-guidance.pdf

What Happens After COVID-19:

There are different avenues for practicing telemedicine across state lines. Including: •Obtain a license in the state in which you anticipate practicing. •State compacts for different license types can make this easier. •Federal License Portability Support Program supports building compact-style agreements for working across state lines. •11* states issue a special certificate / license to allow for telemedicine practices across state lines. Florida built options directly into its telehealth laws. •Federal law could change for a national solution, some lawmakers have proposed making the 's location the location where the care takes place. *AL, LA, NV, NJ, NM, OH, OK, OR, PA, TN, TX

What Happens After COVID-19:

The license question has other questions tied into it: •CMS would need to allow reimbursement across state lines. •Malpractice coverage would need to allow for practicing across state lines. •Credentialing is still an issue in some cases. •Would this apply to any patient or only to established patients with which the provider has a face-to-face relationships? •How does this affect the primary care provider relationship -for example how long can you go between in -person visits and still be someone's PCP / medical home. •We want ease of crossing state lines when it lets us reach our patients (stay-at- home, winter homes, summer school breaks) or when we can fill workforce gaps (e- ICU, mentoring programs) -not so much when it brings in competition that shifts us away from a community-centered care model.

What Happens After COVID-19:

Some recent articles on the trade-offs involved in mapping out a solution for interstate telemedicine practice: https://www.ama -assn.org/system/files/2019-12/i19-cms-report1-patient-relations-telemedicine.pdf https://www.aafp.org/dam/AAFP/documents/advocacy/health_it/telehealth/BKG-Telemedicine.pdf

https://mhealthintelligence.com/news/as-states-modify-telehealth-guidelines-licensing-arguments-resurface

More Telehealth Resources:

Vermont Telehealth Resource Guide:

https://televermont.atavist.com/telehealth-in-vermont

VPQHC Office Hours Recordings:

https://www.vpqhc.org/statewide-telehealth-events