OHCA Spring/Summer 2019

The Oregon Caregiver SPRING/SUMMER 2019 www.ohca.com 18 LEGAL & REGULATORY T elehealth is the provision of health care and monitoring of a patient’s condition remotely by means of telecommunications technology like video conferencing or phone calls. This service has become an increasingly important component in the delivery of health care both in Oregon and nationally. Telehealth can make quality care more accessible and convenient, especially in areas with provider and clinician shortages. As telehealth grows in usage throughout the health care spectrum, the benefits to long term care are becoming evident. Three clear benefits to long term care communities include opportunities to: • Reduce preventable resident hospitalizations and readmissions by allowing physicians and other acute care providers to monitor a resident’s condition and vital signs remotely rather than transport the resident, • Quickly show a particular health condition to an expert provider remotely, and • Free up on-site nurses and other staff to spend more time providing direct care. State and Federal Regulation Those interested in telehealth should be aware that it is heavily regulated on the state and federal level. As a general proposition, telehealth between a patient and provider is only available when there is an established treatment relationship. Also, telehealth requires a specific informed consent, and federal require- ments associated with Medicare reim- bursement have historically been a significant limiting factor. For example, Telehealth: Emerging Opportunity Medicare beneficiaries are eligible for telehealth services only if they are presented from a qualified “originating site.” The originating site is the location of an eligible Medicare beneficiary at the time the service was furnished via telehealth. This could be a skilled nursing facility but cannot be a commu- nity-based care community and only includes locations in a county outside of a “Metropolitan Statistical Area,” which typically means that the location must be a rural health professional shortage area. Even if the “originating site” qualifica- tion is met, Medicare still only covers specified, and limited, telehealth services. In late 2018, however, the Centers for Medicare and Medicaid Services (CMS) finalized new rules that may open up telehealth opportunities. The new rules say that some services provided remotely, like interactions between a medical professional with a patient by remote connection technology, should not be considered “Medicare telehealth services” and should not be subject to the reim- bursement restrictions associated with those services. Pursuant to this interpre- tation, CMS will reimburse for virtual check-ins, remote evaluations of pre-re- corded patient information, and inter- professional internet consultations. Those interested in these new rules should read them in their entirety online. CMS also released a proposal to allow Medicare Advantage Plans to provide “additional telehealth benefits” to benefi- ciaries and treat telehealth benefits as basic benefits under Medicare fee-for- service. Services provided pursuant to this coverage would be subject to specified restrictions, such as services offered through telehealth must also be offered as in-person services. In addition to these federal regulations, the State of Oregon regulates reimburse- ment for telehealth. Currently, Oregon’s telehealth rules are not specific to long term care or community-based care, and we rely on the requirements that apply to health providers generally. Oregon defines “telemedicine” as the use of telephonic or electronic communication of medical information from one site to another to improve a patient’s health status and may encompass different types of programs, services, and delivery By Gwen Dayton, J.D., Oregon Health Care Association Oregon defines “telemedicine” as the use of telephonic or electronic communication of medical information from one site to another to improve a patient’s health status and may encompass different types of programs, services, and delivery mechanisms for medically appropriate covered services.