{"id":31831,"date":"2021-01-26T16:13:28","date_gmt":"2021-01-26T16:13:28","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=31831"},"modified":"2021-01-26T16:13:28","modified_gmt":"2021-01-26T16:13:28","slug":"top-5-telehealth-law-predictions-for-2021","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/top-5-telehealth-law-predictions-for-2021\/","title":{"rendered":"Top 5 Telehealth Law Predictions for 2021"},"content":{"rendered":"\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\"><div 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what does 2021 have in store for telemedicine and digital health policy? A year ago, our team predicted 2020 would bring \u201cnotable expansions in Medicare and Medicaid coverage\u201d and \u201cthe reimbursement landscape looks promising for virtual care services.\u201d Looking back, that was an understatement (if an easy one). Below are five new predictions for what legal changes telemedicine and digital health companies might expect to see this year.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:heading {\\\"level\\\":4} --><\\\/p><h4 id=\\\"h-1-licensing-more-efforts-to-increase-reciprocity-and-laws-that-prioritize-quality-of-care\\\">1.\u00a0 Licensing: More Efforts to Increase Reciprocity and Laws that Prioritize Quality of Care<\\\/h4><p><!-- \\\/wp:heading --> <!-- wp:paragraph --><\\\/p><p>In an effort to balance workload nationally and expand access to health care practitioners during the Public Health Emergency (PHE), many states temporarily\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/03\\\/covid-19-states-waive-licensing-requirements\\\">suspended<\\\/a>\u00a0medical licensing requirements. As these temporary waivers begin to sunset, some state legislatures will seek to make the waivers permanent, allowing practitioners licensed in other states to deliver telehealth services across state lines, provided the out-of-state practitioner follows local state practice standards. While this may be a topic of discussion among policy shops, we expect few states will actually enact such changes in 2021.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:paragraph --><\\\/p><p>Federally, the\u00a0<a href=\\\"https:\\\/\\\/www.phe.gov\\\/Preparedness\\\/legal\\\/prepact\\\/Pages\\\/default.aspx\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">PREP Act<\\\/a>\u00a0allows practitioners to deliver telehealth services across state lines under a licensure exemption for COVID testing and certain limited \u201ccovered countermeasures\u201d (e.g., treatment of COVID-19 infections). The PREP Act also grants certain\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/12\\\/hhs-expands-clarifies-scope-immunity-prep-act\\\">immunities and protections<\\\/a>, preempting state laws during the PHE. Given its Constitutional complexity and political nature, interstate licensing does not have a widely-accepted \u201csolution,\u201d nor does it have the bipartisan support seen in other areas of telehealth. Licensure will be a friction point between virtual care stakeholders and traditional practitioners invested in brick and mortar locations industry. The status quo (i.e., profession-specific interstate compacts and state-by-state patchwork legislative efforts) has left many digital health stakeholders unimpressed, frustrated, and increasingly searching for an alternate solution. Yet, a federal \u201ctop-down\u201d preemption approach will be perceived as an unconstitutional encroachment on states\u2019 rights under the 10<sup>th<\\\/sup>\u00a0Amendment. Keep an eye out for a third channel to thread the needle, perhaps tying federal funds (e.g., Medicaid or COVID relief dollars) to state adoption of certain licensure waivers, enticing states to opt-in to interstate licensure reciprocity rather than federally compel it.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:heading {\\\"level\\\":4} --><\\\/p><h4 id=\\\"h-2-modalities-technology-neutral-state-laws-that-prioritize-quality-of-care\\\">2.\u00a0 Modalities: Technology-Neutral State Laws that Prioritize Quality of Care.<\\\/h4><p><!-- \\\/wp:heading --> <!-- wp:paragraph --><\\\/p><p>In 2020, many states enacted new telehealth laws and rules to change prior practice standards, allowable modalities, or prescribing requirements. Changes included eliminating face-to-face exams, practicing via telephone only, or waiving modality prescribing restrictions on telemedicine. Some of these changes were made by legislation while others by executive order or regulation. Many of the changes were on a temporary basis during the pandemic (with expiration dates that, confoundingly, often did not match the federally declared Public Health Emergency date). These waivers created a telehealth regulatory environment that focused less on technical modalities of care delivery (e.g., audio-video vs. asynchronous) and more on meeting the standard of medical care for a given patient. Aiding in this effort, the American Telemedicine Association (ATA) published\u00a0<a href=\\\"https:\\\/\\\/www.americantelemed.org\\\/wp-content\\\/uploads\\\/2020\\\/10\\\/ATA-_Medical-Practice-10-5-20.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">model policy language<\\\/a>\u00a0for state telehealth rules, to serve as a reference tool for best practices. This trend towards technology-neutral telemedicine laws will continue in 2021, with stakeholders emphasizing the importance of medical standard of care and clinical quality of services, rather than proscriptive modality requirements.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:heading {\\\"level\\\":4} --><\\\/p><h4 id=\\\"h-3-privacy-greater-sensitivity-to-patient-as-consumer-in-digital-health\\\">3.\u00a0 Privacy: Greater Sensitivity to Patient-as-Consumer in Digital Health<\\\/h4><p><!-- \\\/wp:heading --> <!-- wp:paragraph --><\\\/p><p>Telemedicine and digital health companies handling patient information on\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/08\\\/telehealth-substance-use-treatment-state-law\\\">substance use disorder treatment<\\\/a>\u00a0can expect to see favorable\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/12\\\/proposed-hipaa-expands-individual-access-rights\\\">changes to HIPAA laws<\\\/a>, designed to encourage easier sharing of patient data, particularly for treatment purposes. Similar changes are anticipated to regulations under<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2021\\\/01\\\/top-5-telehealth-law-predictions-for-2021\\\">\u00a042 C.F.R. Part 2<\\\/a>\u00a0to ease payment and health care operations. Telehealth companies should also keep an eye on state data privacy laws. More states are expected to enact their own consumer laws to protect data privacy, as California did with its\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2019\\\/12\\\/ccpa-gdpr-a-guide-to-california-businesses\\\">California Consumer Privacy Act<\\\/a>. And the Federal Trade Commission (FTC)\u2014the nation\u2019s top federal privacy regulator\u2014will continue\u00a0<a href=\\\"https:\\\/\\\/www.ftc.gov\\\/news-events\\\/media-resources\\\/protecting-consumer-privacy\\\/privacy-security-enforcement\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">enforcement investigations<\\\/a>\u00a0against organizations that violate consumer privacy rights. Given the proliferation of new telehealth services and startup companies launched in 2020, increased privacy regulation is likely to occur in 2021.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:heading {\\\"level\\\":4} --><\\\/p><h4 id=\\\"h-4-enforcement-oig-doj-will-build-on-prior-investigations\\\">4.\u00a0 Enforcement: OIG\\\/DOJ Will Build on Prior Investigations<\\\/h4><p><!-- \\\/wp:heading --> <!-- wp:paragraph --><\\\/p><p>Building on its 2019 and 2020 criminal and civil investigations, HHS OIG and DOJ will continue its takedown of companies engaged in \\\"<a href=\\\"https:\\\/\\\/oig.hhs.gov\\\/media\\\/documents\\\/Gary_Cantrell_2020_Takedown_Remarks.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">telefraud<\\\/a>\\\": scams that couple aggressive online marketing tactics with telemedicine services to serve as a conduit for illegal kickback arrangements with pharmacies, DME suppliers, and laboratories. Most telemedicine\u00a0<a href=\\\"https:\\\/\\\/oig.hhs.gov\\\/fraud\\\/enforcement\\\/state\\\/index.asp\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">enforcement actions<\\\/a>\u00a0to date have involved kickback schemes and billing for medically unnecessary equipment and diagnostic tests, and few have centered on billing and coding of telehealth professional services. The ATA has commented how these comp\nanies do not represent the industry at large, and\u00a0<a href=\\\"https:\\\/\\\/www.americantelemed.org\\\/press-releases\\\/ata-comments-on-national-health-care-fraud-and-opioid-takedown-and-international-telemarketing-scammers\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">issued a letter<\\\/a>\u00a0articulating hallmarks of legitimate telemedicine providers.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:paragraph --><\\\/p><p>With many traditional in-person providers having newly (and quickly) moved into telehealth in 2020, along with\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/12\\\/top-five-new-telehealth-policies-in-medicare-2021\\\">new temporary waivers<\\\/a>\u00a0of billing and coding rules and a relaxed regulatory environment, the future will likely see more Medicare audits and overpayment claims of telehealth professional services. Some niche areas of enforcement may be marketing\\\/referral arrangements with pharmacies and laboratories, waivers of patient financial responsibility, ordering high-cost genetic tests, billing for practitioners located outside the United States, and arrangements seeking to take advantage of the global pandemic.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:heading {\\\"level\\\":4} --><\\\/p><h4 id=\\\"h-5-payment-continued-expansion-of-telehealth-reimbursement\\\">5.\u00a0 Payment: Continued Expansion of Telehealth Reimbursement<\\\/h4><p><!-- \\\/wp:heading --> <!-- wp:paragraph --><\\\/p><p>The pandemic compelled health plans, both government and commercial, to remove prior restrictions on telehealth and expand coverage for virtual care at a rate previously unseen. The new\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/12\\\/top-five-new-telehealth-policies-in-medicare-2021\\\">policy changes<\\\/a>\u00a0on Medicare reimbursement followed the previously established pathway of coverage, but the pace at which they were made was stunning. CMS also introduced nearly\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/08\\\/covid-19-cms-temporary-telehealth-codes-phe-ends\\\">100 telehealth service codes<\\\/a>\u00a0covered on a temporary basis until the Public Health Emergency expires. Much of 2020\u2019s reimbursement expansion will continue through 2021, as commercial payers follow CMS\u2019 lead. Remote patient monitoring still has plenty of room to grow. Despite the\u00a0<a href=\\\"https:\\\/\\\/www.foley.com\\\/en\\\/insights\\\/publications\\\/2020\\\/12\\\/remote-patient-monitoring-cybersecurity-guidelines\\\">recent payment expansions RPM has seen<\\\/a>, it has yet to have its \u201cbreakout year\u201d in widespread use and payment.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:paragraph --><\\\/p><p>Employers will explore more telehealth services for employees to deal with the stress of the pandemic, focusing on tele-primary care, behavioral health, and specialty care like fertility. As more traditional providers offer telehealth services in addition to in-person care, we may see telehealth increasingly paid on a fee for service basis (rather than a PEPM enterprise model). At the same time, value based models focusing on or centered around virtual care, including bundled payments and shared savings, will grow beyond the pilot phase, as providers begin to \u201cown\u201d certain care pathways.<\\\/p><p><!-- \\\/wp:paragraph --> <!-- wp:paragraph --><\\\/p><p>Time will tell how these five predictions will hold up over the next 12 months. 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