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        As the Department of Health and Human Services (HHS or the Department) continues the process of transitioning from COVID-19 emergency policies, the Department wants to clarify future federal telehealth and remote control flexibilities to ensure patients can continue to receive and get the help they need. Below is a fact sheet outlining what will change for patients and healthcare providers when the HHS Secretary declares a Public Health Emergency (PHE) for COVID-19 pursuant to Section 319 of the Public Health Service Act (see below) ), which will remain unchanged as “COVID”. -19 PHE”). PHE ends. Congress passed the Omnibus Appropriations Act of 2023, extending many of the health plan telehealth flexibilities that people have come to rely on during PHE COVID-19 through the end of 2024. HHS to share additional guidance for updates and deadlines related to maintaining these flexibilities In addition, the Health Resources and Services Administration (HRSA) operates the HHS website www.Telehealth.HHS.gov, which will continue to serve as a resource for patients, health care providers and states for telemedicine information such as telemedicine best practices, policy updates and reimbursements, interstate licenses, broadband access, funding opportunities, and events.
        Medicare and Telehealth During PHE, people with Medicare have broad access to telehealth services, including in their homes, without generally applicable geographic or location restrictions due to the Clerk of Appropriations Act issuing Supplements to the Appropriations Preparedness and Response Act for Telemedicine 2020 and Coronavirus. Aid, Relief and Economic Security Law. Telemedicine includes services delivered through telecommunications systems such as computers and allows health care providers to provide care to patients remotely rather than in person at the office. The Consolidated Appropriations Act of 2023 extends many Medicare telemedicine flexibilities through December 31, 2024, such as:
        In addition, after December 31, 2024, when these flexibilities expire, certain ACOs may offer telehealth services, allowing ACO participating physicians and other medical practitioners to care for patients without an in-person visit, regardless of whether where they live. If a health care provider participates in an ACO, people should check with them to find out what telehealth services may be available. Medicare Advantage Plans must cover Medicare-covered telehealth services and may provide additional telehealth services. Individuals enrolled in a Medicare Advantage plan should check their telehealth coverage with their plan.
        States with Medicaid, CHIP, and Telehealth have considerable flexibility in coverage of Medicaid and the Children’s Health Insurance Program (CHIP) services provided through telehealth. As such, telemedicine flexibility varies by state, with some tied to the end of COVID-19 PHE, some tied to the state’s PHE announcement and other emergencies, and some were provided by the state’s Medicaid and CHIP programs long before the pandemic. After the termination of the federal PHE plan, Medicaid and CHIP telehealth rules will continue to differ by state. The Centers for Medicare and Medicaid Services (CMS) encourages states to continue paying for Medicaid and CHIP services provided through telehealth. To assist states in continuing, adopting, or expanding telehealth coverage and payment policies, CMS has released the State Medicaid and CHIP Telehealth Toolkit, as well as an additional document outlining policy topics that states should address to promote telehealth mainstream adoption: https:// www.medicaid. gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
        Private Health Insurance and Telemedicine As is currently the case during PHE COVID-19, once PHE COVID-19 ends, coverage for telemedicine and other remote care services will vary by private insurance plan. When it comes to telemedicine and other remote care services, private insurance companies may apply cost sharing, prior authorization, or other forms of medical management of such services. For more information about the insurer’s approach to telemedicine, patients should contact their insurer’s customer service number located on the back of their insurance card.
        During PHE COVID-19, for the first time, healthcare providers subject to the HIPAA Privacy, Security, and Breach Notice Rule (HIPAA Rule) are seeking to communicate with patients and provide telehealth services using off-the-shelf remote communication technologies that may not yet be fully understood. HIPAA Compliant Require. The HHS Office of Civil Rights (OCR) has announced that as of March 17, 2020, it will exercise its discretion and will not impose fines on health care providers who do not comply with HIPAA rules. Providers using any remote monitoring technology can use them without the risk of OCR being penalized for non-compliance with HIPAA rules. This discretion applies to telemedicine services provided for any reason, whether or not the telemedicine services are related to the diagnosis and treatment of a medical condition related to COVID-19.
        On April 11, 2023, OCR announced that due to the expiration of PHE COVID-19, this Enforcement Notice will expire on May 11, 2023 at 11:59 pm. OCR will continue to support the use of telemedicine after PHE by giving covered health care providers a 90-day transition period to make any necessary changes to their operations to provide telemedicine in a confidential and secure manner in accordance with the requirements of the HIPAA medical regulations. During this transitional period, OCR will continue to enforce its discretion and will not penalize covered health care providers for failing to comply with the HIPAA Telemedicine Fair Practice Rules. The transition period will begin on May 12, 2023 and end on August 9, 2023 at 23:59.
       For more information, please visit the OCR website for expiration notices for certain enforcement notices issued due to the COVID-19 public health emergency.
        Telebehavioral Health in Opioid Treatment ProgramsSince the launch of PHE, the HHS Substance Abuse and Mental Health Services Authority (SAMHSA) has released regulatory flexibility guidance for multiple opioid treatment programs (OTPs) to help address the health effects of social distancing in OTP and its patients . .
        Personal Medical Examination Waiver: SAMHSA waives the OTP requirement for an on-site medical examination for any patient who will receive OTP buprenorphine, provided that the program physician, primary care physician, or authorized healthcare professional is monitored by the Physician’s Decision Program. An adequate assessment of the patient’s condition can be carried out using telemedicine. SAMHSA has announced that this flexibility will be extended through May 11, 2024. The extension will take effect May 11, 2023, and SAMHSA is also proposing to make this flexibility permanent as part of its Notice of Proposed Rulemaking, which will be published in December 2022.
        Home Doses: In March 2020, SAMHSA issued an OTP waiver, under which states can require a “general exemption for all stable patients in OTP to receive up to 28 days of home doses of opioids. Medications for Substance Use Disorders. States can also “require up to 14 days of home medication for patients who are less stable but who the OTP determines can safely handle this level of home medication.”
        In the three years since this waiver was granted, states, OTPs, and other stakeholders have reported that it has resulted in increased patient engagement in treatment, increased patient satisfaction with care, and relatively fewer incidents of substance abuse or diversion. SAMHSA concluded that there is sufficient evidence that this exemption strengthens and encourages the use of OTP services in the face of a significant increase in fentanyl-related overdose deaths. In April 2023, SAMHSA completely updated the guidance, revising the criteria applicable to OTP provisions for unsupervised use of methadone.
       This newly revised April 2023 guidance will become effective after the expiration of the PHE and will remain in effect for one year after the end of the PHE or until HHS issues a final rule amending 42 CFR Part 8. A Notice of Proposed Rulemaking Proposing Amendments to Part 8 of 42 CFR (87 FR 77330), titled “Medications for the Treatment of Opioid Use Disorders”, which SAMHSA is working on finalizing.
        The April 2023 updated guidance exempts the requirement to take home medication without supervision under 42 CFR § 8.12(i) under the conditions below. In particular, the TRP may use this waiver to provide unsupervised doses of methadone to the home in accordance with the following standard treatment times:
        SAMHSA previously announced that this flexibility will be extended through May 11, 2024. States will need to affirmatively register their consent to this particular exemption in order for State OTPs to use it. States or state opioid treatment agencies authorized to act on behalf of the state may register their consent to this exemption by mailing a written consent form to the Division of Pharmacological Therapeutics mailbox at any time after the publication of this guideline. To ensure a smooth transition to this guidance from the flexibility released during the COVID-19 public health emergency, states are encouraged to do so no later than May 10, 2023. If the state has not previously used the March 16, 2020 exemption, the state may still provide written consent.
        SAMHSA is also proposing to make this flexibility permanent as part of its December 2022 Notice of Proposed Rulemaking. Since the waiver has been granted, states, OTPs and other stakeholders have reported that this flexibility has increased patient satisfaction with treatment and improved patient engagement. Support for this flexibility has been overwhelmingly positive, with reports from state opioid treatment agencies and individual OTPs suggesting that the measure encourages and improves care while reducing stigma associated with opioid use disorder (OUD).
        Drug Enforcement Administration (DEA) and PHE regulations As of March 2020, HHS and DEA allow practitioners to prescribe Schedule II-V (“Controlled Substances”) controlled substances based on a telehealth visit without an initial on-site medical examination. In addition, the DEA has removed the requirement for a practitioner to be registered with the DEA in the patient’s state if the practitioner is eligible to prescribe controlled drugs via telemedicine in the state where the practitioner is registered with the DEA and in the United States. Patient status. Collectively, they are referred to as “Controlled Medication Telemedicine Flexibility”.
        In March 2023, the DEA is seeking comments on two proposed rule development notices for controlled drug telehealth flexibilities. These proposals are designed to promote greater access to controlled medicines, including for individuals who have entered treatment with flexibility. The DEA, in collaboration with SAMHSA, plans to issue a final rule by November 11, 2023.
        At PHE’s conclusion, the DEA and SAMHSA issued an interim rule extending telemedicine flexibility for controlled substances until November 11, 2023, while considering changes to the proposed rule based on public feedback. In addition, practitioners who established relationships with patients via telemedicine on or before November 11, 2023 may continue to prescribe controlled medications to these patients without an in-person medical examination and regardless of whether the practitioner is on the patient’s state DEA registration prior to November . 11, 2024.
        Telebehavioral Health Licensing During COVID-19 PHE, many health care providers may provide interstate telehealth services through a state-issued licensing waiver. To maximize the use of telemedicine, states can facilitate the provision of interstate telemedicine through license portability. License portability refers to the ability of a medical professional licensed in one state to practice medicine in another state with minimal hurdles and restrictions through the transfer, confirmation, or issuance of a license. Increasing the ability to transfer licenses expands access to healthcare services and helps improve continuity of care for patients.
        Among other benefits, license portability allows states to retain regulatory power, allowing health care providers to serve more patients, allowing patients to receive care from a wider network of health care providers, and helping states improve access to communities of care for rural and low-income populations. . Licensing agreements are agreements between states that simplify the process and allow service providers to submit a single application to practice in participating states. Licensing agreements can ease the burden and reduce waiting times for healthcare providers to practice out of state, maintain state regulatory oversight, and save healthcare provider fees for state licensing boards. Licensing documents are useful for both personal and telemedicine services. Existing licensing contracts include: Interstate Treaty on Audiology and Speech Pathology, Counseling Treaty, Emergency Medical Care Treaty, Interstate Medical Licensing Treaty, Nurse Licensing Treaty, Occupational Therapy Treaty, Physical Therapy Treaty, and Inter-Jurisdictional Psychology Treaty, with potential to expand into other careers.
        The behavioral health crisis and the shortage of mental health care providers, including treatment for substance use disorders, point to the need for increased licensing efforts across states. There are many opportunities for states to use federal resources to support the expansion of telemedicine through interstate licensing:
        HHS tripled its support through HRSA to the Federation of State Medical Councils and the Association of State and Provincial Psychological Councils, which created the Interstate Medical Licensing Treaty, Provider Bridge, Psychological Inter-Jurisdictional Treaty, and Multidisciplinary Licensing Resources, respectively, through the License Transfer Grant. Program.
        In addition, new licensing resources contain the latest information on interstate licensing, licensing agreements, and licensing for behavioral health professionals. This resource provides up-to-date guidance on how to legally and ethically practice out of state and encourages the adoption of licensing models that expand access to health care.
        Broadband Access Broadband Internet connections play a key role in helping low-income communities and individuals use telemedicine services. To expand broadband access in homes and states, Congress passed the 2021 Consolidated Appropriations Act to allocate $3.2 billion to the Federal Communications Commission (FCC) to create the Emergency Broadband Benefits Program (EBB Program) to help low-income households pay for broadband access and network devices.
        November 15, 2021 The Infrastructure Investment and Jobs Act (IIJA) provides $65 billion in broadband funding, of which $48.2 billion will be managed by the National Telecommunications and Information Administration (NTIA) of the Department of Commerce in the newly created Connectivity Authority to the Internet. and grow. IIJA also provided the FCC with $14.2 billion to upgrade and expand (the EBB program) the Affordable Connectivity Program (ACP) and $2 billion to the USDA to establish cooperatives to provide broadband.
       These broadband plans will help improve patients’ access to internet services and devices needed for telehealth services, reducing disparities and financial burdens in accessing technology-enabled video and health services.