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Innovative Interjurisdictional Practice Models, Marlene Maheu, PhD, AASCB Concerence, January 2014

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  • Not a very good presentation. Could have used more preparation and more thought. Nothing new in the concepts and severely lacking in useful information.

    She also writes at the start and this shows how little confidence she has on what she is presenting. She obviously is not an expert in this field. 'I am an MFT and clinical psychologist, not an attorney, physician, or Information Technology specialist. The information I present is my best attempt to bring you timely and relevant information in a rapidly evolving area. I therefore make no warrty, guarantee, or representation as to the accuracy or sufficiency of the information contained in my training.'
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  • 1. Innovative / nterjurisdictional Practice Models AMERICAN ASSOCIATION OF STATE COUNSELING BOARDS MARLENE M. MAHEU, PH. D. MMAHEU@TELEHEALTH. ORG EXECUTIVE DIRECTOR TELEMENTAL HEALTH INSTITUTE
  • 2. TE EMENTAL HEALTH ((( L I teleheaIth. org I N 5 I I I U T F Disclaimer - I am an MFT and clinical psychologist, not an attorney, physician or Information Technology specialist. The information I present is my best attempt to bring you timely and relevant information in a rapidly evolving area. I therefore make no warranty, guarantee, or representation as to the accuracy or sufficiency of the information contained in my training. - My goal is educational only. I seek to outline the issues and alert you to what's happening, including legal, ethical and other risk management issues. You are encouraged to seek specific advice related to your circumstance from your qualified authorities. 0201! Tttellflnl Heath lnsllla. tar.
  • 3. ( ‘''5.E. f'‘l3‘L‘''‘l", flyflsm <-lI= l’o1’: z-Ilia-xi’ . . _. _. , , . AASCB Slides & References http: //teleheaIth. org/ aascb
  • 4. ~ retooling
  • 5. TELEMENTAL HEALTH y telehealm-org » I N S T I T U T E Telehealth vs. Distance Counseling (working model not to scale) Telehealth Behavioral Telehealth Disciplines, including Distance Counseling, Training & Supervision SI 0201: meuemal mam lnslilz. In:
  • 6. . 7 — Ere. A ' i. -1‘? -=" -1, Models for Distance Services in Counseling and Other What are the Current I I l Disciplines? I I I I , $x _, ,>" - -. -V - * . 'r- - i '_r’, -—’_' _ : §_ -’ -—~-: '"-'-“‘ ’ »' »"'%ga'*= » zzrtghai ‘gay “I: y ‘Ell 1 y: I ll? ’ emu meuemai mam lnstllma. Inca
  • 7. ‘UT-I telehealrlmorq fl Helpouts _ fl fi Browse Helpoutsv ‘ Vour Helpoms v About Helpours I | ] Health Strengths—Based Psychotherapy and Coachrng Short or long-rerm therapy building on your szrengrhs to Improve communlcarlon overcome r: hal| eru_7as, r)rd15cover new lnslghrs an bulld self-av/ arervess I use a varlety of techniques rncludrng mrndiulhess CBT Icogmrwe Beravroral Therapy) DBT (Dlalecru: aI Beravror Therapy) SDMBIIC mtervenrrons and Solurrors-Focused Therapy I $55.00 can work yrlrlw mdlvlduals from ages 7 and up I also work wllh couples ard famllles A1 'v-cur: 3.00 Meet Kale S - Masrers In Sacral ‘r'. 'orI< from Colcmbra Unrversrry S ocral '. 'orI( 0 Lrcersed Clrmcal Socral l'r'orI<er Calrforma Llcens: - Specialized rrammg IVI addresslng ear-ng disorders. trauma amrrery and depresslon Sc Ha ha I Fluerr ll" French - workrng together to achieve pnsm'. ‘e_ suppomve and crearwe sollmnrs Mm avahbie mu 1 2 3: P >. r Cancellarrarr Policy ZJ'l: r.. rs rzrce-s: we: :v Reviews No revrevrs for this Helpom yer
  • 8. ( fit; -’li‘I’-é= Ili‘r’r'. -')'I; §_‘ Traditional Behavioral Telehealth Model
  • 9. TELEMENTAL HEALTH ((( I telehea| th. org N 5 I I I U T F I Traditional Behavioral Telehealth Model - Hub—and—spoke model — Only work with previously identified clients/ patients who have had an in—person assessment — Detailed and documented referral requests — Detailed health record at fingertips of clinician — Client/ patient is at the ”originating site” — Clinician is at the ”distant” site — Community collaborator is available - Client/ patient is pre—trained by staff - Technology is stable — IT staff is available during entire time of connection to client/ patient
  • 10. ‘ ' rm'.1nmx1nMnH (( M , _ _ telehealtlmorg nline Norm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy 2011 Mostly Email & Chat Anonymity Accept self-referral online Disclaim Responsibility w/ Website Disclaimers No Clear Channels for Mandated Reporting No Patient Records Traditional Behavioral Telehealth Video Verify clients/ patients Rely on referrals from clinical offices Use informed consent processes/ documentation Engage in mandated reporting Document as required by law
  • 11. TFLFMENTAI HEHTH ‘ ((( K Y ‘teieneaimorg 3 me orm vs. Traditional Behavioral Telehealth (or Telemental Health) Traditional Online Therapy Traditional Telemental Health - No Contact with Other - Obtain signed releases and Treating Clinicians Collaborate - No Authentication of . . . Consumer / Professional ° Venfy 'dent'fy of both_ Consumer and Professional - No Emergency Backup Procedures - Establish emergency backup - Misunderstanding of plan and personnel prior to Clinical Processes (suicide) delivering Care - Scant Research for Unsupervised Settings
  • 12. General Telepractice Licensure Issues
  • 13. ( <-ii= i/iizmiri. --. -‘ia_r | nter—ju risdictional P ra ctice Licensing Boards that may assertjurisdiction: * The one in the professiona| ’s state(s) of licensure G The one in the client/ client's state of location at time of call ~ Both Safest Practice: G Provide services only where licensed e Require client to attest to his or her location on every call
  • 14. <-—ll: i”oi’: ziii‘o. --. -‘ii; ' ' i; i=! 'i ‘n! ..'#? =e, =. | nter—jurisdictiona| Practice (cont. ) Special telehealth and in many cases, “telemedicine” laws have led the way - Prescription—writing initiatives led to development of laws in the 90's - Reimbursement practices for . Medicare 7 Medicaid 2%. ‘i, ° 32 states now mandate in—person _‘. ‘i"',1i*1,f= ".. assessment prior to distance contact if; j l" ' Special informed consent laws also rapidly evolving -, - fll7‘si . ° Regulatory Case 2'. ’-F} V , ° Oklahoma case of Dr. Trow l A - No in-person ‘ assessment - No informed consent ° No HIPAA-compliant technology (he used Skvioel
  • 15. ( TF1?’-lfNT/ kl HEM TH ( _ teleheaIth. org l’-. ‘—i' Iiii Licensure Requirements for Professional Counselors — 2014 What's New for 2014 (page 4) Distance Counseling, Technology, and Social Media Information In response to the increased use of social media and technology within the counseling profession, state licensure boards continue to develop rules and regulations regarding distance counseling. It should be noted, however, that these guidelines are in their initial stages of development and are therefore changing rapidly; always check with your specific state for comprehensive guidelines before engaging in any distance counseling activities. '3' Seventeen (17) states (Alaska, Arkansas, Califomia, Colorado, Iowa, Louisiana, Massachusetts, Minnesota, Nebraska, New York, North Carolina, Oregon, South Carolina, Ohio, Texas, Utah, and West Virginia) do regulate electronic communications for counselors, but only within their particular state. The general rule is that to practice distance counseling in these states, the counselor must be licensed and follow the regulations of that state. Colorado makes the recommendation that the first session should be face-to-face and to meet periodically face-to-face with the client. 02014 Teleuemal Heilm Insmmz, Inc,
  • 16. ( 7'3.‘1i"l3°V"“" : ":"5.°"': " <-. it: iam1aa. --. -‘ii, ’ ‘Licensure Requirements for Professional Counselors — 2014 What's New for 2014 (page4) °. ° Twenty (20) state counseling boards (Alabama, , Arizona, Connecticut, Delaware, , Florida, Georgia, Hawaii, , Kentucky, , Maine, Michigan, , Missouri, New Hampshire, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington and Wyoming) and the District of Columbia report an absence of any law, rule, or regulation addressing the use of the intemet with clients. It is therefore assumed that these states treat electronic messages between counselor and client the same way that they treat face-to-face communication. o v One (1) state, Arkansas, has an addendum to their licensure requirements specifically geared towards technology assisted therapy: The Technology Assisted Counseling Specialization license requires additional education and supervision. a Five (5) states (Maryland, New Mexico, Tennessee, Virginia and Indiana) specifically state that they do not support electronic communications under their scope of practice for professional counselors. °. ° One (1) state (Mississippi) will only grant licensure to state residents and/ or those who pay state income tax. at One (1) state (Kansas) allows distance supervision provided that the supervision is conducted via confidential electronic communications. ‘I One (1) state (Louisiana) allows for 25 of the required 100 clinical supervision hours to be conducted via videoconferencing. '2' One (l) state (Ohio) defined one continuing education hour as 10,000 words with regards to distance learning courses.
  • 17. Specific Telepractice Licensure Models
  • 18. TELEMENTAL HEALTH ((( I telehealth. org l N S Y l T U T F Special Telehealth Licenses or Certificates Licenses could allow an out of state provider to render services via technology in a foreign state, or it allows a clinician to provide services via telehealth into a state if certain conditions are met (such as agreeing that they will not open an office in that state. ) http: //www. fsmb. org/ pdf/ grpo| _te| emedicine_| icen sure. pdf
  • 19. K <'-ll: lir’: tI(i‘or. -‘thy’ States with Laws Mandating Private Insurance Coverage of Telemedicine Telemedicine Parity Law Proposed Parity Legislation ‘ No Parity I. egisl. ati‘e Action
  • 20. ‘: lT. !'? :"!3‘j"! ”‘—! !r' fE—A~£—e"': } (‘-l H/ Il’: ?=lli'I rd‘) '1!’ . T _. __. , , . g , , Special Telehealth Licenses or Certificates ° Alabama s New Mexico ° Louisiana * Ohio 0 Minnesota * Oregon ° Montana ~ Tennessee ° Nevada * Texas http: //www. fsmb. org/ pdf/ grpo| _te| emedicine _| icensure. pdf
  • 21. <-it: ‘rnzmu‘. .--. -‘i'«_-' Innovative Models ° National Council of State Boards of Nursing (NCSB) ° Federation of State Medical Boards (FSMB) ** Association of State and Provincial Psychology Boards (ASPPB)
  • 22. TELEMENTAL HEALTH ((( I teIeheaIth. org l N S T l T U T F History of Licensure Portability ° 1996 — Telecommunications Act of 1996 — Congress urged the health care industry to develop mu| ti—state licensure models — US Federal Communications Commission ° 2000 — National Council of State Boards of Nursing (NCSBN) instituted the Nurse License Compact (NLC)
  • 23. <-—it: in: miaa. --. -‘: a_r Nurse Compact ° Developed upon the water rights precedent shared by states. ° Within states that have signed the compact, any licensed nurse can apply for a multistate license and practice nursing in all of the included states.
  • 24. -. -.-NCSBN National Council ofstatr Board: ofNum‘ng For Member Boards About NCSBN Events NCLEX NNMP 8‘ MACE Boards of Nursing P°“cV 3‘ N"'5l"9 R°9“'3“°" Research Examination Examinations Legislative Affairs in the US. Nursing Regulation in Q l llursin Re ulation in the U S l Licensure l Nurse Licensure Compact , Te“ 5,25 T T the L‘_S_ _ Nurse Licensure Compact Education l_lC9n5Ufe The Nurse Licensure compact (NLC) enables multistate licensure for nurses. ll Through the NLC: Nurses have the ability to State boards of nursing reach The public enjoys access practice across state lines. new levels of cooperation. to safe nursing care. .. F'hy'sicaIl_v andlor electronically . through a and are still protected through effective streamlined process without additional enforcement oflicensure laws across state applications orfees! boundaries. NLC Member States (click state for contact info) Ll'ill, .l"‘ NLC Topics p ; fl“‘” Eligible Nurses Practice Movin to a New State? internatio al urs s Discipline now nu. works %NLCA nun! ucamnc cuuucr AMI sfufoll ii r‘ main:
  • 25. II-I-NCSBN National Council ofSto1¢ Board: ofNum‘rig ForMember Boards About NCSBN Events NCLEX Nursing Regulation in the Us‘ Education UCSIISUIS Nurse Licensure Corngact FAQs Model Legislation 8. Rules Pending Legislation 3- Additional Details Nursys corn U 8 Nursing Licensure for Foreign—Edui: ated Nurses Uniform Licensure Requirements Practice Discipline NNAAP 8. MACE Boards of Nursing Policy 8. Nursing Regulation Research Examination Examinalncins Legislative Affairs in lIieUS Home Nursing Requlation in the U S I Licensure Nurse Licensure Compact I Pending Legislation &AddtionaI Details 1-ex‘ sizev I T Pending Legislation & Additional Details The Nurse Licensure Compact (NLC) continues to grow. . Nu, “ L, censu, e Compaa States with Pending NLC Legislation in 2013 In order YO? 3 Stitfl IO jOifl thé NLC! 1. bill language must mirror NLC Model Legislation L? 2. the state legislature must pass the legislationthe 3. state board ofnursing must implement the Compact, usually over approximately one year we --ms» Massachusetts jj_2m§§l; _$_1_9§Qi§ Connecticut ELQ| ?.9.$. w.ttB_5215 i§‘ Died 415113. ‘Failed Joint Favorable Deadline. ‘ New Jersey £893 :5’ Legislation contains material differences from the Model. Minnesota La i9 Illlnols §fl 16§1 9: flfifiifi i§ Montana D_§_0_1 i9 Draft filed. (2013 legislative session has ended. ) New York M1 ii? NLC is one offour pans of Military Spouse Act of 201 3. Annual Reports ' )~ 2011 Annual Report ' )- 2010 Annual Report ' A 2009 Annual Report APRN compact ' )~ ' I- APRN Comgact Model Draft Revisions Organizations supporting the NLC In addition to several state nursing association and state hospital associations, these organizations have endorsed or provided letters of support for the NLC.
  • 26. organizations supporting the NLC In addition 10 several state nursing association and state hospital associations, these organizations have endorsed Of provided letters Of support for the NLC. American Academy of Ambulatory Care Nursing -- American Association of Colleges of Nursing — American Association of Occupational Health Nurses (AAOHN) -- American Organization of Nurse Executives (AONE) -- American Nephrology Nurses Association (ANNA) -- American Telemedicine Association (ATA) " Association f0l' V3SOUlal' ACCESS - Association ofcamp NUTSSS (ACN) “ Care Continuum Alliance -- Case Management Leadership Coalition (CMLC) -- Case Management Society of America (CMSA) -- Case Management Society of America, New England Chapter -- Case Management Society of Atlanta -- Case Management Society of Chicago -- Case Management Society of St. Louis -- Center for Telehealth and E—l-lealth Law -- Citizens Advocacy Center (CAC) -- Commission for Case Manager Certification - Emergency Nurses Association (ENA) -- National Military Family Association -- State Alliance for e-Health ofthe National Govemors Association Center for Best Pradices -- Telehealth Leadership Council -- U. S. Department of Commerce NLC 1'imeIine Timeline of the Nurse Licensure Compact 1996 The Delegate Assembly voted to investigate mutual recognition models. 1991 Strategies for implementation developed. Nurse Licensure compact Administrators (NLCA) established to manage compact implementation and to develop compact miss. 1998 Model NLC Legislation adopted bythe Delegate Assembiy on November 6. 2000 On January 1, the NLC was passed into law byttie first participating states: Maryland, Texas. Utah and Wisconsin. AI'IiCIGS 8: RCSOUICGS ' I-l Nurse Licensure Compact Administrators (NLCA| Response to ANA Updated NLC Talking Points [Dec 2011) - grsing Ligensg Mgp i§is a comprehensive resource for nursing licensure information. It provides state—specific information on how to become a nurse, nurse salaries. nursing credentials. nurse certification tests, and nursing compact agreements. ' Al Nurse Licensure Compact 2000 to 2010: Sharing a Decade of Realities ' The Evolving Use And Changing Role Of Interstate Compacts: A Practitioners Guide is? ' Interstate Cooperation: Compacts and Administrative Agreements i§| ' ): l 'MuItistate Nurse Licensure In Case Management" ' ; Ll ‘What Case Managers Need to Know ADOUl the Nurse Licensure COITIQBCI"
  • 27. N C S B N Passport Q Stcurc and my identig mlumgenunlfor members Authorized User Sign In User ID I Email Address: T5-vi-‘E-: t use i . =u—. sc, Rm, 4 Cop}/ Ilghtn§7ZOl3Natiuna| Causal ofszate acarassiiimsing rm: I . I I I N C S B N iicLEx_ NCLEX-RH. NCLEX-PN, uruurp Nursys. TERCAP_ MACE and wcseu are regisxeeea tmuema! -3. and Transition to "'““'“'°""‘“"°/5"“ ’“""°/ """"U Praaioe ti 3 I73-aemant. cf the National Ccuriul 57 51315 3531115 : I Nursing, lm:
  • 28. Fea'z'rzztion of ST 15;; " ' For Immediate Release: November 26, 2013 -r 3 F “" Contact: 0 ew Carlson, (817) 868-4043 -www. fsmb. grg BOARDS State Medical Board Leaders Make Progress Towards an Interstate Compact for Physician Licensure (Eu| ess, Texas, Nov. 26, 2013) - Representatives of state medical boards from around the country announced today that they have moved closer to a new option for medical licensing that would speed up the process of issuing licenses for physicians who wish to practice in multiple states. During a two~day meeting hosted by the Federation of State Medical Boards in Washington, D. C., Nov. 12-13, state board executives and policy experts continued to work out key details of the proposed tem, known as the interstate Medical Licensure Compact. Under the new system, phys‘ ians interested in practicing in multiple states would be able to receive a license in each state a d be under the jurisdiction of the state medical board where the patient is located at the time the medical interaction. Participating state medical boards would retain their licensing and disciplinary authority but would agree 0 share information and processes essential to the licensing and regulation of physicians w 0 practice across state borders. Participation in an interstate compact would be voluntary, fo both states and physicians. The new int rstate compact system is expected to significantly reduce barriers to the process of gaining licen ure in multiple states, helping facilitate licensure portability and telemedicine while wideni g access to health care by physicians, particularly in underserved areas of the nation. A drafting committee of the interstate Compact Taskforce (ICI) is shaping the compact's basic terms of understanding, which will be shared with state medical boards and other stakeholders for further feedback and comment. During the Washington, D. C., meeting, the drafting group discussed key concepts such as physician eligibility, information—sharing between boards,
  • 29. -,3 _ The Association of State and Provincial Psychology Boards EPPPAppllcaIS/ Students ‘ TlirIngDi1EC! DlS Ez‘ly(zeePsycholofl ‘ Psyctioloffi l Public Mobility Program Overview More li'i this Section V ASPPB Mobility Program Overview The ASPPB Mobility Program was established in 1998 to facilitate professional mobility in the psychology profession A unique feature of the ASPPB Mobility Program IS that it functions as both a credentials record and a progressive application for our other mobility services When you start your ASPPB Credentials Bank record you are completing the first steps towards a future Psychology Licensure Universal System (PLUS). lnteriurisdictional Practice Certificate (IPC) or Certificate of Professional Qualification (CPQ) application. Mobility Program Name Mobility Program Description Grad Student, Early Career Trainee or Psychologist Unlicensed? (licensed less than five Psychologist licensed more than five years? SPPB Credentials he ASPPB Credentials Bank provides safe, long term. electronic storage for professional documents United States or Canada currently participating in the PLUS program. Inn IDP m—»mr. - O/ 'rrrrrr| r1i Regulatoryfloadwlerribas Mxmtus Entersearch criteria . Q REGULATORY BOARD USE ONLY E Remember Me SIG! IN “? l'i‘ Forgot your password? EPPP I CPO Log In FAQ: & Latest News more 1011 6/201 3 NEW Telepsychology Guidelines 3/2912013 i am having trouble registering for the EPPP 8/29/2013 How do ltransfer my EPPP score? ASPPB Calendar more 1/5/2014 1116/2014 Telepsych Advisory Workgroup
  • 30. ii -‘ll ltl telehealthoig Association of State and Provincial Psychology Boards (ASPPB) (continued) lnterjurisdictional Practice Certificate he IPC grants temporary authority to practice based on notification to the licensing board of intention to practice emporarily, and verification of one‘s qualifications for such practice by ASPPB, The IPC allows psychologists to provide emporary psychological services in jurisdictions that accept the IPC or at least 30 work days (a day being defined as any pan of a da in which psychological work IS performed) per year without obtaining full licensure in that urisdiction. he purpose of the CPO is to document that the individual holding the certificate has met specific requirements in licensure‘ education, examination and training and has never had disciplinary actions taken against his or her license, Psychology licensing boards that accept the CPQ have agreed to accept the CPQ holder's educational preparation, supervised experience and examination performance for licensure, Note’ 4 indicates you are eligible to apply I eiepsyuii Auiusui y 1 mi Ky! oup 1I31l2014 to 212/2014 Board of Director's Meeting 2J9i’2014 Licensure of Consulting E. lndustrialiorganizational Psychologists Task Force Meeting 2l'21I2014 Mobility Committee Meeting 2l'28I2014 » 31212014 Portability Task Force Meeting me. In:
  • 31. ( f'"’; ”.5:“": " <-ii= ‘inzaiii'. .--. -‘i'«_g' Preferred Model Seem to be Compact ° Association of State and Provincial Psychology Boards (ASPPB) — Received $350k grant for 3 years — Decided on “E. Passport” model — Running into difficulties — Now are working with other groups to develop a collaborative model across disciplines
  • 32. Collaborative Model
  • 33. ((( TELEMENTAL HEALTH teleheaiflmorg I N S l l T U T F Collaborative Effort ° Movement toward collaboration was inspired and is being organized by Bill Hatherill, CEO of Federation of Boards of Physical Therapy ° Organizing CEOs of regulatory associations to approach states to help work with states ° Working with National Governors Association ° ASPPB is meeting in January with Federation of Association of Regulatory Boards (FARBS) and other groups ° Focus of ASPPB Meeting: — What does it take to establish a compact? — How to best move in conjunction with other disciplines to approach state boards? 0201! Ttlellflnl Meailii lnsllla. tar.
  • 34. TELEMENTAL HEALTH ((( I teIehealth. org l N 5 l l I U T F Collaborative Effort ° Talking about compacts and endorsement programs — Endorsement--Where individual practitioner shows they have meet the standard and then convince states to accept credential — Compacts — reciprocal — Nursing — no real way to work around disciplining model — Follow rules in state of citizen, have to agree with comply with hearing and a both boards will impose fine, and practitioner would lose e. passport everywhere — Can't take base license away — Up to home state to impose other sanctions on practitioner for base license 0201! Ttlellflnl Meailii lnsllla. tar.
  • 35. ‘ .41 l ‘It «I V i ‘ l V 5; t‘ V. i , ,-_ fin p l ‘ . i "l , . i 1 l ‘ . ’ / ) Q1 7' r ~ - ‘ ; ‘ I‘ ‘ l" 1’ ‘ , ' ii u v . * ’ 4 i / .. ’ , I f T. ,__) ll / z ; I i fee 1. —. ia. .. :. .._—i__ -_ '____t__ r/ /’ ‘ , 2014
  • 36. (‘-ll= 'lil’: ?=lli‘ai-'. Iii_o' Federal Proposals ~ State Boards are Active ~ Federal (proposals recogni: that Congress has power tc regulate interstate health commerce. ) 1. STEP ACT (2011): allow: DOD providers with a single state license to deliver services across state lines for the military
  • 37. ‘: l;. !'? :"!3‘j"! ”‘—! !r' fE—; ‘~£—u': 'l (‘-l H/ Il’: ?=lli'I {U} '0' . ‘ _. __. , ( . g . 2 STEP ACT STEP ACT is the '_? ?'t _ it Servicemembers’ I ' ' Telemedicine & E-Hea/ th t Portability Act, which , . {i; _ *_ fig; 2 iu. i(. -'3“; expanded the already existing DOD state licensure exemption for health care professionals treating DOD clients.
  • 38. ‘: l;. !'? :"!3‘j"! ”‘—! !r' fE—A~£—u': 'l (‘-l H/ Il’: ?=lli'I mil '0' . . _. __. , ( . g . 3 TELEmedicine for MEDicare Act, 2013 ° HR 3077, the ”TELE-M ED Act” was introduced Sept. 10 in the House by Reps. Devin Nunes, R-Ca| if. , and Frank Pallone, D—N. J. Nicknamed the TELE—MED Act, seeks to update current licensure laws for Medicare beneficiaries, the number of whom is expected to rise to 81 million by 2030
  • 39. TELEMENTAL HEALTH ((( ) teIehea| th. org l N 5 l l T u I F TELEmedicine for MEDicare Act, 2013 ° In the case of a Medicare participating physician or practitioner who is licensed or otherwise legally authorized to provide a health care service in a State, such physician or practitioner may provide such a service as a telemedicine service to a Medicare beneficiary who is in a different State, and any requirement that such physician or practitioner obtain a comparable license or other comparable legal authorization from such different State with respect to the provision of such health care service by such physician or practitioner to such beneficiary shall not apply. ° If passed, the bill will give licensing or authorizing states enforcement powers and require the Secretary of the Department of Health & Human Services to solicit input from ’’relevant stakeholders” in order to provide telemedicine guidance for states. 0201! Ttlellulil Heiilii lrlslllz. Inc
  • 40. 7‘: ii nil . Ii. § . "-Tn: §l.0' €'I, .:»‘HIII . '.‘. ‘i >3 = f«'l. 'r Jr. ‘ " "I: lD, *€y'I{'<,4}' 90 . 'H“m' PRESS RELEASES REP. MIKE THOMPSON INTRODUCES BILL IMPROVING ACCESS TO MENTAL HEALTH CARE Washington. DC. Dec 6 l l »: i:v~imenis ‘-‘ I U 8 Rep I. Ill-Ze Thompson iCi'- introduced bipartisan legislation expanding access to mental health care for IJIECICBIE recipients H R 3662. the ltlental Health = ‘-ccess Improvement i‘~. ct. will addthousands ofhighl, qualified licensed mental health counselors and marriage and family therapists ilvlFTs; to the networi: ofproviders eligible to serve Medicare beneficiaries rllI: :I x l i: . I , . _ . . . money you make. " said Thompson “This legislation will allow thousands of mental health care professionals to 1 ' . »- '4“ as provide quality. affordable care to people on Medicare. and it will save money. Right now. there are more than 600 licensed r. 'IFTs in my congressional district and more than 31.000 licensed l'. 'lFTs in California that can provide '--. ii"-. -o. iii‘—iw quality mental health services. Our goal should be to expand access to these professionals and the comprehensive and quality care they provide. not limit it. " 'Jl'-}~‘. ‘¢I‘T Medicare currently recognizes psychiatrists, psychologists. clinical social woriiers and psychiatric nurses to provide covered mental health services However. mental health counselors and l. lFTs. who have equivalent education and training to clinical social workers and provide roughly 40 percent of mental health services. are not eligible to be SEARCH FOR BILLS reimbursed by Lledicare H R 3662 would fix this discrepancy :12 making mental health counselors and l. lFTs eligible to serve Lleoicare beneficiaries adding more than 165.000 licensed practitioners to the lvledicare program I E—mai| Mike Studies have shown that seniors in the lvledicare program are often at the highest risl: for mental health problems thatare not part ofthe normal aging process such as depression. anxiety. mood disorders and suicide I. ‘I3FIj¢ of these mental illnesses can be diagnosed and properly treated ifthe appropriate care is available. sought and accessed However. if left untreated. it can lead to higher medical costs and negative health effects Currently. I‘. I9dIC3le beneficiaries who were seeiring mental health services from mental health counselors or l. ll-‘Ts priorto their eligibility for l. ledicare. often stop receiving treatment because their existing provider is not under I. ‘IeCIC3T9 Newsletter Signup Thompson s legislation will ensure that seniors have comprehensive access to qualified mental health providers by increasing the pool of mental health professionals that are eligible to serve Medicare beneficiaries Request :2 Flag ‘The National Board forcertified Counselors illBCCI applauds Representative Thompson forhis c
  • 41. SEARCH FOR BILLS E—mail Mike Newsletter Sign»Up Request a Flag Visiting Washington. DC, Help with a Federal Agency Today in Congress t(Ili‘lt‘| .=lt2i' E-NEWSLETTER SIGN-UP hi". Medicare currently recognizes psychiatrists. psychologists, clinical social workers and psychiatric nurses to provide covered mental health services. However, mental health counselors and MFTs, who have equivalenteducallon and reimbursed by Medicare. H. R. 3662 would fixthis discrepancy by making mental health counselors and Ml-‘Ts eligible to serve Medicare beneficiaries, adding more than 155.000 licensed practitioners to the Medicare program. Studies have shown that seniors in the Medicare program are often atthe highest riskfor mental health problems that are notpart ofthe normal aging process such as depression, anxiety, mood disorders and suicide. litany of these mental illnesses can be diagnosed and properlytreated ifthe appropriate care is available. sought and Currently, Medicare beneficiaries who were seeking mental health services from mental health counselors or MFTs priortotheireligibilityforMedicare, often stop receiving treatment because their existing provider is not under Medicare. Thompson's legislation will ensure thatseniors have comprehensive access to qualified mental health providers by increasingthe pool of mental health professionals thatare eligibleto serve Medicare beneficiaries. ‘The National Board forCertified Counselors (NEICC) applauds Representative Thompson forhis commitmentto ensuring a robust mental health workforce for older Americans. ‘ said Thomas W. Clawson, President and CEO of the National Board for Certified Counselors. ‘Medicare provides health care to over 49 million people and research ' ' -s thatfe‘ -erthan 40% ofolderadults with mental or substance use disorders obtaintreatment. The Seniors Mental l r. ess Improvement Act will increase access to needed care by expanding the pool ofqualified mental health profe‘ . ». Adding mental health counselors and marriage andfamilytherapists as eligible providers will make 200.000 licensed professionals immediately available to the Medicare population. This addition will expand . cess and reduce costs by providing care in the community and avoiding expensive inpatientservices. NBCC commens epresen a lie ompson or a ing a eaers ip to e in is impo an egis a ion ’li-lembers ofthe California Association of Marriage and Family Therapists enthusiastically applaud and support Congressman Mike Thompson's bill to provide greater mental health services to our elderly population. ‘ said Guillermo Alvarel, Chairman of the Califomia Association of Marriage and Family Therapists. ‘By allowing Licensed Marriage and FamilyTherapists to become Medicare providers. many Californians will benefitfromtheir expertise in treating a variety of mental health issues. " H. R. 3662 is co-authored by Republican Congressman Chris Gibson (NY-19). The bill has been referred to the House Committees on Energy and Commerce and Ways and Means, of which Thompson is a senior member. Congressman Mike Thompson is proud to represent Calrl'ornia's 5th Congressional District. which includes all orpait of Contra Costa Lake Napa. Solano and Sonoma Counties He is a senior member of the House Ways and Means Committee and the House Permanent Select Committee on intelligence Rep Thompson iS also a member of the fiscally conservative Blue Dog Coalition and chairs the bipartisan bicameral Congressional llline Caucus ###
  • 42. Care CONNECTING THE HEALTHCARE TECHNOLOGY COMMUNITY Home tlews&Commentary Authors Slideshows Video Reports White Papers Events lnterop '-‘ ' ‘ > SOFTWARE SECURITY CLOUD MOBILE BIG DATA INFRA CTURE GOVERNMENT HEALTHCARE ll POLICY & REGULATlON Bill Seeks To Clean Telehealth State gnucA'floNA1_ngsounc Ken Terry Regulations Mess )9 The Big Data Z00 - Taming the Beasts lEllil Puresystems: A family of Expert Integrated Systems Pure Expertise )9 Oracle Exadata and IBM F‘ureData System for Analytics Compared Telehealth regulations differ in each of the 50 states, inhibiting * use of technology to treat patients, say proposed law's sponsors. >9 lBlilTeradata Compared A‘-. Total Cost of Ownership Study >9 Operational Analytics From A to Z Representatives Doris Matsui (D-CA] and Bill Johnson (R—OHfi have introduced a bill in Congress that creates a federal definition of telehealth and that provides guidance to states on how to regulate this burgeoning field VIDE O "Telehealth is a major contributing factor to increased health care quality convenience and lower costs " the announcement of the bill stated "However there currently are 50 separate sets of rules [in different states] as to what type of care can be provided This often leaves both providers and patients in a state of uncertainty The Telehealth Modernization »3Q_will provide guidance to states as they look to utilize telehealth technologies in the safest most secure manner possible” / /Ill (mi mi ' izeibmin i» Move to the Cloud i/ watch lBl. l Business Partners as they talk about how Cloud Computing has trcughtabout transformational change to their clients businesses he lylatsui-Johnson bill grew out of legislation that was recently adopted in California Among other things that state law broadens the definition of telehealth to include store-and»for-ivard technology and home monitoring of patients it also allows the state's Medicaid program to cover doctorpatient communications that take place outside of hospitals physician offices and killed nursing facilities r’-: ~dtu. reQ‘ , i:irifer'it : ,
  • 43. us Resources _ . _ - wt. sdm liitlldti '. Jlll . 9! I I l .
  • 44. tn i »‘» ‘ u ’‘_I‘f—Vl, t;-l_i‘sl; -i”—, |5 : ?t= }€tV1 it i: r= i u: i : Licensure and Scope of Practice L993. & R9gu|3t0y'! v Table of contents - What is ticensure7 - What IS scope of practice? - How do you determiiie if a physician patient relationship has been created when practicing tetemedicine7 - What are State licensure reqtiirernents"/ - What are the exceptions to State licensure requirements? - What are physician-to-physician COHSLHISUOHS7 - What is the ticensure exception for educational pi. irposes7 - What IS the ticensure exception for iriterniresident training’? - What is the ticensure exception regarding Border States’? - What is the hcensure exception for U S Militan; -‘Veterans Administration-‘Public Heatth SENICE Otficers practicing in Federal settings? - What are the hcenstire exceptions for rnedicat emergencies (Good Samaritan) or natural disasters? - ts State authority to regulate heatth care absolute? - ts there an authority for Federal Licensing of health professionals? - What about Regii: iriatr‘MLiIti-State authorities? - Is there a national standard’? - What are some alternative models to reduce the licensure barriers to telehealth? - References
  • 45. Center for Connected Health Policy Telehealth is the use of digital technologies to deliver health services by connecting multiple users in separate locations. Learn More >> TELEII EALTII SPOTLIGHT CCHP Awarded $253,540 for Telehealth Study The Blue Shield of California Foundation (BSCF) awarded the Center for Connected Health Policy (CCHP) a $253,540 grant to examine telehealth's capacity to improve health care delivery, quality and efiiciency over an eighteen month period. Partnering with select California» based federally~qualit‘ied health centers (FOHCS). CCHP will assess telehealth cost data before, About CCHP What is Telehealth? AT THE CENTER Telehealth Experts Join Forces for Training Module Series The National Telehealth Policy Resource Center and South Central Telehealth Resource Center - known for their exceptional training and educational resources - are collaborating on a series of comprehensive telehealth policy training modules beginning in early 2014, Read the full press release here. CA Telehealth Policy CCHD Projects IIIEALTHBEAT 12.17.13 New York State Creates Online Database of Hospital Charges » 1217,13 Firms Tap Data Mining Tools To Aid Clinical Trial Recruitment Process » 12.17.13 ONC Releases Findings From Patient Data Matching Study a 12.17.13 Report: Global Telehealth Market To Grow by18.5% Through 2013 »
  • 46. Home About Fxpeilise Fverus Publitalioris Membership Coiimu The Senate Finance Committee approved important telehealth legislation during the Committee's consideration of the Sustainable Growth Rate (SGRS repeal and replace bill, the SGR and Medicare Beneficiary Access improvement Act, Senator John Thune (R—SD) offered two amendments dunng Finance Committee consideration 0! the bill. The first amendment accepted by the Committee is the Fostering Independence Through Telemedicine Act (FITU I: l iii! .1 Talelderlal 3llPl Il'lSK1l. ‘.Eu ll'lC
  • 47. v'«l l-l telehealtnorg TE‘LiViSE$T| ATL ISETALETH HOME ABOUT IEILOG SERVICES TRAINING RESOURCES Register for the Telemental Health News Register Now for Your Weekly Copy of the TeIeMental Health News FUIL N»’5.ii‘i. [ F‘l'-‘i| N’Al'-IY E. Vil'-ill Not only will you receive news about the week's most im portant developments, but you'll also. .. ‘ Freehcoss ‘ -/ Receive our analyses of current events and links to other keytelemental health ltelepsychiatryi telepsychology, distance counseling and online therapy) resources 4/ Receive news about our bonuses and special discounts forTMH lnstitutetraining and consulting services To make it even better, you will also. .. J Receiveyour own FREE copy ofthe Telemedidne Reimbursement Handbookwithin nanoseconds of subscribing. It contains pivotal information about who can be reimbursed fortelehealth services, and which services and procedure codes (CPTJ are reimbursable. (CPT codes have not yet been updated in this document for 201 3, but the Handbook will tell you information that will help you with billing immediately nonetheless. ) We will protect your privacy and never share your address with anyone. Join us today!
  • 48. (C? "5‘3§’§’l. "’f3?! 'f3’? ‘§’“ we-«= rs-iii‘-i-. -'»'ce: Te/ ellflental Health ’,1 ii lnonfi Institute, Inc. now. G Send email to: info@te| ehealth. org Visit website: www. te| ehealth. org

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