boling telemedicine and law
TRANSCRIPT
TELEMEDICINE AND LAW
GEORGIA PARTNERSHIP FOR TELEHEALTH
2015 CONFERENCE
INTERSTATE LICENSURE
Out-of-state telemedicine licenses Interstate Medical Licensure Compact Other licensure exceptions
OUT-OF-STATE TELEMEDICINE LICENSES
Example 1: “The board shall issue a telemedicine license to allow thepractice of medicine across state lines to an applicant who holds a fulland unrestricted license to practice medicine in another state orterritory of the United States.” LA. REV. STAT. ANN. § 1276.1(A)
Example 2 (requiring reciprocity): “[T]he commission shall only issuea special purpose license to practice medicine or osteopathy acrossstate lines to an applicant whose principal practice location and licenseto practice is located in a state or territory of the United States whoselaws permit or allow for the issuance of a special purpose license topractice medicine or osteopathy across state lines or similar license to aphysician whose principal practice location and license is located in thisstate.” ALA CODE § 34-24-507
INTERSTATE MEDICAL LICENSURE COMPACT
• Proposed in late 2014 by the Federation of State Medical
Boards
• Creates new, expedited pathway to licensure outside of a
physician’s primary state
• To be administered by interstate commission
• Introduced as legislation in 15 states, already signed by
Wyoming and South Dakota
• Would greatly facilitate licensure process for telemedicine
providers seeking to extend into multiple states
Medicare:
• Part B reimburses at rates generally equal to in-person care
• “Interactive telecommunications system” with “real-time audio and video”
• Patient must be in Health Professional Shortage Area
REIMBURSEMENT
MEDICARE REIMBURSABLE SERVICES
Services:
Emergency department; inpatient/
outpatient; subsequent hospital services
(max 1 tele-consultation every 3 days);
psychotherapy; pharmacologic mgmt;
transitional care mgmt; more
Patient location (in HPSA):
Hospitals, physicians’ offices, FQHCs,
Rural Health Clinics, hospital-based
dialysis centers, skilled nursing facilities,
community mental health centers
MEDICAID/PRIVATE INSURANCE PARITY
Medicaid AND Private Insurance
Medicaid OR Private Insurance
Proposed legislation
MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov
MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov
MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov
• States’ laws will vary as to authority of physician extenders (NPs, PAs,
etc.) – be mindful!
SCOPE OF PRACTICE
• Georgia’s medical board rule offers good example of inclusive approach
to telemedicine scope of practice:
Electronic consultations authorized so long as a physician,
physician assistant or nurse practitioner has:
1. Has personally examined the patient; or
2. Is performing the service at the request of a physician, physician
assistant or nurse practitioner who has physically seen the patient; or
3. The technology is equal or superior to an personal examination,
regardless of whether the patient has been seen
Ga. Comp. R. & Regs. 360-3-.07
• How can a telemedicine arrangement be structured without implicating
illegal referrals?
• U.S. Office of Inspector General Advisory Opinion No. 11-12
• Issued August 29, 2011
• Neuroscience group sought to become exclusive tele-stroke practice
for hospital system, consulting with hospital patients via telemedicine
and, if necessary, taking neuro emergency transfers
• OIG approved arrangement! Why?
• While hospital could not use other tele-stroke providers, there
was no requirement of referrals to group – could still transfer
stroke patients anywhere
• Primary goal was to save money, reduce transfers, help patients
FRAUD AND ABUSE
FRAUD AND ABUSE
Safe harbor protection: Personal Services Arrangements
• Note: not always necessary to meet safe harbor (e.g. Advisory
Opinion 11-12; no safe harbor protection but still compliant)
• Personal Services Arrangements are always compliant if:
• The agreement is in writing and signed by both parties,
for a term of > 1 year
• The agreement sets forth an exact schedule of services
• The aggregate compensation is set in advance
• Compensation does not reflect value or volume of
referrals
• Other potentially relevant safe harbors:
• Investment interests
• Referrals for specialty services
• Federally Qualified Health Centers
FRAUD AND ABUSE