Telemedicine Licensure in Michigan
•Download as PPTX, PDF•
2 likes•496 views
This presentation provides an overview of current licensure requirements for telemedicine in Michigan. In addition, this presentation discusses how state licensure requirements present barriers to telemedicine practice in Michigan and strategies to overcome barriers in the state.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Telemedicine Licensure in Michigan
Similar to Telemedicine Licensure in Michigan (20)
Recently uploaded
Recently uploaded (20)
Telemedicine Licensure in Michigan
- 1. Becky Glitman Andrea Lee May 9, 2018 Presentation to the Health Care Law Section of the State Bar of Michigan
- 4. 4 STATISTICS *Survey conducted by National Business Group By 2018, there will be over 7 million telehealth users, which is up from just 350,000 users in 2013. 66% of Americans are willing to see a doctor over video 96% of large employers will make telehealth services available. *Survey conducted by Teladoc *Survey conducted by Teladoc *Survey conducted by American Well 76% of U.S. hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018. 76% of organizations without a consumer telehealth program indicate it is a high strategic priority for their organizations. 76 % 24 % 10 0 % 96 % 4% 10 0% 10 0%
- 5. 5 STATE LAW DEFINITIONS ▪ Telehealth (MCL 333.16283) The use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. ▪ Telemedicine (MCL 500.3476) The use of an electronic media to link patients with health care professionals in different locations. The health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided.
- 7. 7 METHODS ▪ Synchronous “Real time” communication (e.g., TeleICU) ▪ Asynchronous “Store and forward” (e.g., Teleradiology) ▪ Telemonitoring/Remote Patient Monitoring
- 9. 9 PHYSICIAN AND PROVIDER LICENSURE REQUIREMENTS ▪ Provider must be licensed in the state where patient is located. • For Michigan insurance reimbursement: Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. MCL 500.3476; 550.1401k ▪ Would the provider be licensed to provide the service in person? ▪ Has the provider established a provider-patient relationship? Have the patient and the provider met face-to-face? Is audio communication sufficient? ▪ Does the provider’s physical location matter? ▪ Consultation exception.
- 10. 10 OTHER STATES AND MEDICAL LICENSURE COMPACT ▪ Some states offer special purpose telemedicine licenses. ▪ New Michigan laws (e.g., patient-prescriber requirements) considering the impact of telehealth. ▪ Interstate Medical Licensure Compact • Current Legislation: House Bills 4066 and 4067 • Increase access to physicians and providers via telehealth across state lines. • Voluntary for physicians and state medical board where adopted. • MI legislation only applies to Board-certified MDs and DOs. • MI legislation has different definition of “physician” than the MI Public Health Code.
- 12. 12 ENFORCEMENT ▪ Does the Michigan Board of Medicine enforce telemedicine requirements against out of state physicians? • Recent physician enforcement action (2014-2017) ▪ Licensed in MI, provided prescriptions to patients located in MI based on patient responses to an on-line form. ▪ Physician located in GA. ▪ Also licensed in WV, website based in WV. ▪ MI Board of Medicine suspended license and issued a fine. ‒ No patient/provider relationship established, therefore prescribing was negligent and incompetent. ‒ Physicians should consider appropriateness of care provided via telemedicine. ▪ WV Board of Medicine decision considered action by the MI Board of Medicine. ▪ Would the MI Board of Medicine consider other states’ requirements laws for physicians located in MI and providing telemedicine services to patients in other states? ▪ MCL 333.16286 – physicians may face restrictions if violating telehealth prescribing rules
- 13. 13 PRIVILEGING ▪ Joint Commission Requirements: • Credentialed by the originating site, or specific acknowledgment of reliance on the distant site’s credentialing procedures. Joint Commission Standard MS.13.01.01 • Also requires a written telemedicine services agreement As a practical matter, facilities should determine how they will credential these physicians located remotely (e.g., will they be limited to physicians who also provide in-person services? Limited based on particular arrangements) Impacts hospitals that are originating sites without a prior relationship with the physician providing services.
- 15. 15 MEDICARE REIMBURSEMENT ▪ Covers synchronous, not asynchronous telemedicine ▪ Geographic Location • Originating site (where the patient is) must be in either: ▪ a rural Health Professional Shortage Area (HPSA) or ▪ a county outside of a Metropolitan Statistical Area (MSA) • Federal telehealth demonstration project qualifies regardless of location • Medicare Telehealth Payment Eligibility Analyzer https://datawarehouse.hrsa.gov/tools/analyzers/geo/Telehealth.aspx
- 16. MEDICARE REIMBURSEMENT (CONT.) 16 Originating Sites Offices of physicians or practitioners Hospitals Critical Access Hospitals Rural Health Clinics Federally Qualified Health Centers Hospital-based or CAH-based Renal Dialysis Centers (including satellites) (historically not Independent Renal Dialysis Facilities) Skilled Nursing Facilities Community Mental Health Centers Distant Site Practitioners Physicians NPs PAs Nurse-midwives Clinical nurse specialists Certified registered nurse anesthetists Clinical psychologists and clinical social workers Registered dietitians or nutrition professionals
- 17. 17 MEDICARE REIMBURSEMENT (CONT.) ▪ Covered Services • CY 2018 ▪ Telehealth consultations, emergency department or initial inpatient ▪ Follow-up inpatient to beneficiaries in hospitals or SNFs ▪ Office or other outpatient visits ▪ Kidney disease education ▪ ESRD related services (must furnish at least one “hands on” visit each month to examine the vascular access site) ▪ Nutrition therapy ▪ Behavioral therapy ▪ Psychoanalysis/psychotherapy ▪ Critical care consultations • Full list - https://www.cms.gov/Medicare/Medicare-General- Information/Telehealth/Telehealth-Codes.html
- 18. 18 OIG REPORT ▪ April 2018 OIG report found that 31% of audited telemedicine claims did not meet Medicare conditions of payment for telemedicine services. ▪ OIG recommends that CMS conduct telemedicine periodic post payment reviews.
- 19. 19 BIPARTISAN BUDGET ACT OF 2018 ▪ Telestroke (2019). Geographic and type requirements waived for telehealth consultations ▪ ESRD (2019). Patients can receive telehealth visits without geographic requirements if face-to-face is once every three months ▪ MA Plans (2020). May offer additional telehealth benefits ▪ ACOs (2020). May expand telehealth services and allow the home to be an originating site – eliminates geographic location criteria
- 20. 20 MICHIGAN MEDICAID ▪ Permitted when travel by the patient is prohibitive or causes an “imminent health risk” (50-mile rule no longer applies). ▪ Store-and-forward services are not reimbursable. ▪ Only specific services included. ▪ Patients must be located at one of the facilities listed in the Medicaid manual. ▪ Both sites and all providers must be enrolled in Medicaid for reimbursement. ▪ The originating site can only bill Medicaid for medically necessary services. ▪ Like Medicare, specific coding modifiers are required. Medicaid Manual, Section 17
- 21. 21 MICHIGAN INSURANCE CODE ▪ Interactive video or audio required, but not necessarily face-to-face contact. ▪ Another healthcare professional must be physically present and able to interact with the patient. ▪ Insurers have discretion for which telemedicine services they will reimburse and for how much. ▪ Noted trend in increased list of telehealth services available for reimbursement.