13 Updates Plus Analysis of 2024 Reimbursement with the Release of the MPFS Proposed Rule

Greetings! We’re in the hottest part of summer, and it just got steamier with the recent release of the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2024. As you probably know, what Medicare pays for leads the way in what other payors reimburse, so it’s smart to have your eye on this.

In addition to today’s breakdown of state changes, we’ve also got a first look at the Proposed Rule and what it means for you. Click to learn more about the 2024 MPFS Proposed Rule regarding Telehealth and Remote Monitoring. 

Whether you like what you see or want changes before it’s finalized, click here to learn how we can help you give your feedback to CMS during the public comment period, which ends on September 11, 2023.

Now, on to the updates!

ALASKA

Removes Physical Limitation for Remote Pharmacies

TLDR: Effective July 15, 2023, Alaska Department of Commerce removed the requirement that remote pharmacies cannot be within ten road miles of a non-remote pharmacy site. This statutory change will expand business opportunities for telepharmacies to open in the state with the potential to increase pharmacy access to rural communities. Check out the full revisions here.

FLORIDA (3)

Enters Psychology Interjurisdictional Compact

TLDR: Effective July 1, 2023, Florida entered the Psychology Interjurisdictional Compact (PSYPACT). This enables licensed psychologists in Florida to practice in other Compact states, and enables psychologists licensed in other Compact states to practice psychology in Florida. 

Key Takeaways: 

• Under the Compact, psychologists licensed in member states have the right to practice psychology in any member state via telehealth.
• Check out the full revisions here.

Includes Telehealth in Medicaid Coverage of Continuous Glucose Monitors

TLDR: Effective October 1, 2023, Medicaid now guarantees diabetic patients coverage for continuous glucose monitors under the program’s pharmacy benefit if (i) their physician has prescribed the device and insulin, and (ii) the patient participates in regular follow-up care (which can be accomplished via telemedicine visits). This expanded benefit will increase access to chronic diabetic care and monitoring for Florida’s Medicaid population. Check out the full revisions here.

Allows Telehealth Medical Cannabis Certification Renewals

TLDR: Effective July 1, 2023, Florida allows physicians to conduct subsequent patient assessments through telehealth after an initial in-person physical examination to determine whether a patient continues to have a qualifying medical condition in accordance with the state’s medical cannabis program. Physicians must evaluate existing qualified patients once every thirty (30) weeks before issuing a new physician certification. This removes barriers for patients for whom traveling to obtain medical cannabis recertification is difficult or prohibitive. Check out the full revisions here.

HAWAII

Reimburses Audio-Only Telehealth Services

TLDR: Effective June 22, 2023, through December 31, 2025, Hawaii Medicaid will reimburse telehealth delivered via two-way audio-only communication. Healthcare providers must conduct an in-person visit or a telehealth visit that is not audio only within six months prior to the initial audio-only visit or within twelve months prior to any subsequent audio-only visit. 

Key Takeaways: 

• HI Medicaid will reimburse two-way audio-only communication to better serve those living in rural areas as well as those with limited digital literacy.
• Providers offering audio-only services relating to diagnosis, evaluation, or treatment of a mental health disorder will be reimbursed eighty percent of the in-person rate if services are provided in the patient's home.
• Check out the full revisions here.

ILLINOIS (2)

Amends Medicaid to Include Telehealth Services for Adults with Developmental Disabilities

TLDR: Effective July 1, 2023, Illinois Medicaid covers telehealth services for persons with intellectual and developmental disabilities receiving services under the Home and Community-Based Services Waiver Program. This change will expand access to care for adults with developmental disabilities in the State. Check out the full revisions here.

Allows Community Integrated Living Arrangement Agencies to Provide Remote Supervision

TLDR: Effective May 31, 2023, Community Integrated Living Arrangement (“CILA”) agencies can provide remote supervision. CILA is a living arrangement for adults in a group home, family home or apartment where no more than eight unrelated adults with developmental disabilities live under supervision of the community developmental services agency. Remote monitoring and supports will increase residents' independence and daily living skills as well as increase the methods agencies can use to monitor residents. 

Key Takeaways: 

• Remote monitoring will be based on an assessment measuring the individual’s needs. 
• Remote monitoring increases how agencies can facilitate 24-hour on-call availability. 
• Check out the full revisions here.

KENTUCKY (3)

Authorizes Veterinarian use of Telehealth 

TLDR: Effective June 29, 2023, Kentucky passed its Veterinary Practice Act, which allows telehealth in veterinary practice. The Veterinarian-client-patient relationship (“VCPR”) includes the following types of telehealth: telemonitoring, telesupervision, telemedicine or connected care. In addition, telehealth is permissible without a VCPR if it is in a teleadvice, teleconsulting or teletriage format. 

Key-Takeaways:

• Kentucky established which telehealth practices in the state do versus do not require a Veterinarian-client-patient relationship (“VCPR”).
• Check out the full revisions here. 

Allows Telehealth Medicaid Provider Enrollment Without a Kentucky Address 

TLDR: Effective June 28, 2023, Medicaid services and Medicaid managed care organizations may not require a health professional (a physician, physician assistant, nurse, doctor of chiropractic, behavioral health professional, optometrist, dentist, or allied health professional who is licensed in Kentucky) or medical group that exclusively offers services via telehealth to keep a physical location or address in Kentucky in order to be eligible for enrollment as a Medicaid provider. 

Key Takeaways:

• This change enables telehealth providers to offer services to individuals located in Kentucky without establishing a physical location in the State, expanding residents’ access to a larger pool of telehealth providers.
• Check out the full revisions here.

Offers Exception for In-Person Written Certification for use of Medical Cannabis

TLDR: Effective June 29, 2023, an authorized physician or advanced practice registered nurse may provide written certifications for the use of medical cannabis based on a bona-fide practitioner-patient relationship that can be maintained via telehealth. Although a practitioner-patient relationship must be established in-person and the initial written certification for the use of medical cannabis must occur in-person, subsequent written certifications may be offered electronically or through telehealth consultation. Check out the full revisions here. 

LOUISIANA

Enters Occupational Therapy Licensure Compact 

TLDR: Effective January 1, 2024, Indiana will enter the Occupational Therapy Licensure Compact. This will enable licensed occupational therapists in Louisiana to practice in other Compact states, and will enable occupational therapists licensed in other Compact states to practice in Louisiana, without the need to obtain additional licenses. 

Key Takeaways: 

• Under the Compact, occupational therapists who are licensed in member states have the right to practice in any member state via telehealth.
• Check out the full revisions here.

Reduces Barriers to Initiating Telehealth Encounters

TLDR: Effective January 1, 2024, with the exception of prescribing any controlled dangerous substance, Louisiana will not require a healthcare provider to conduct an in-person patient history or physical examination of the patient before engaging in a telehealth encounter. In addition, the provider may use interactive audio, without video, as long as upon evaluation of the patient’s medical records, the doctor determines that he or she can meet the same standard of care as would have been provided in person. Notably, a health coverage plan may limit occupational therapy services provided via telehealth if such services are only provided via telephone. In addition, a health coverage plan does not have to offer coverage or reimbursement for certain procedures or services offered through telehealth, including: a format that is a type of electrical, thermal, or mechanical energy; or manual therapy, massage, dry needling, or other invasive procedures.

Key Takeaways:

• With the exception of prescribing a controlled dangerous substance, a healthcare provider no longer has to conduct an in-person patient history or physical examination prior to the first telehealth encounter. 
• A health coverage plan may limit telehealth occupational therapy services and reimbursement for certain telehealth invasive procedures.
• Providers may use interactive audio that does not include video if the provider determines that he or she can offer the same standard of care as an in-person visit. 
• Check out the full revisions here.

Allows Telehealth Occupational Health Service Coverage to be Equivalent to In-Person Coverage

TLDR: Effective August 1, 2023, health coverage plans issued on or after January 1, 2024 must pay for covered occupational therapy services offered through telehealth. Coverage and payment via telehealth must be equivalent to coverage and payment for the service provided in person; unless the provider and coverage plan have contractually agreed to an alternative payment for telehealth services. Deductible, copayment or coinsurance for services provided through telecommunications technology should not be more than the deductible, copayment or coinsurance that the plan requires for the same service provided in person. A health coverage plan shall not require a previously established in-person relationship or the provider to be present in person unless the provider finds that the service should be provided in person. 

Key Takeaways

• Unless an alternative contract exists between the provider and the coverage plan, coverage and payment via telehealth shall be equivalent to coverage and payment for the in-person service. 
• A health coverage plan shall not require a previous established in-person relationship, unless the provider believes the service should be provided in-person. 
• Check out the full revisions here.

MAINE

Enters Audiology and Speech-Language Pathology Interstate Compact

TLDR: On June 26, 2023, Maine entered the Audiology and Speech-Language Pathology Interstate Compact. The Compact will enable licensed audiologists and speech-language pathologists in Maine to practice in other Compact states, and will enable audiologists and speech-language pathologists licensed in other Compact states to practice in Maine, without the need to obtain additional licenses. 

 Key Takeaways: 

• Under the Compact, audiologists and speech-language pathologists who are licensed in member states have the right to practice in any member state via telehealth.
• Check out the full revisions here. 

NEVADA (2)

Allows Supervising Physician to Oversee Physician Assistant More Efficiently

TLDR: Effective June 2, 2023, new regulations clarify that physicians who supervise physician assistants may fulfill the requirement that they spend part of one day a month observing the PAs at a location from which the PA provides services if such physicians are present at a location from which a PA provides telehealth services. Check out the full revisions here.

Expands Licensed Optometrist Telehealth Service Capabilities 

TLDR: Effective October 1, 2023, a licensed optometrist may engage in synchronous optometric telemedicine to perform a non-comprehensive examination of a new patient, as long as the licensed optometrist has access to a record of a comprehensive examination that either an optometrist or ophthalmologist conducted within the immediately preceding 2 years. Similarly, as long as the licensed optometrist has completed a comprehensive examination within the 2 immediately preceding years, the licensed optometrist may engage in remote patient monitoring of a patient for the purpose of: 1) obtaining data about the health of the patient; 2) assessing changes in previously diagnosed health conditions; 3) confirming the stability of the health of the patient or; 4) confirming expected therapeutic results. 

Key Take-aways

• Provided certain conditions are met, a licensed optometrist may now conduct a non-comprehensive examination of a new patient via synchronous optometric telemedicine and may now engage in remote patient monitoring for select purposes.
• Check out the full revisions here.

NEW YORK (2)

Ensures Telehealth Services are Included in Protections for Reproductive Health Care Services

TLDR: Effective June 23, 2023, “telehealth” and “telehealth services” are explicitly included in New York’s definition of “reproductive health services.” This statutory language change ensures NY providers of reproductive health care services offering telehealth care are included in existing safeguards and protections from extradition, arrest and legal proceedings in other states related to reproductive health care services.

 Key Takeaways: 

• Telehealth services are now included in NY’s reproductive health care provider safeguards.
• Check out the full revisions here.

Workers Compensation Board Permits Telehealth Visits

TLDR: Effective July 11, 2023, NY worker’s compensation board-authorized physicians, podiatrists, nurse practitioners, and physician assistants may use telehealth to treat patients. The provider must be able to meet the claimant at the provider’s office if necessary and be within a reasonable travel time and distance from the claimant’s residence. As defined in the rule, telehealth treatment includes two-way audio and visual electronic communication as well as audio-only communication. 

 Key Takeaways: 

• NY Workers Compensation Law now includes the option for telehealth visits. 
• Check out the full revisions here.

OHIO

Vision Professionals Board Clarifies Telehealth Provisions

TLDR: Effective July 2, 2023, the Ohio Vision Professionals Board, which oversees optometrists, opticians, and ocularists in the state, changed their telehealth communication provisions. These changes expand on the standard of care and clarify existing definitions including the definition of telehealth services. The new definition of telehealth services incorporates previously excluded asynchronous interactions as well as telephone calls as long as calls meet the standard of care and are not routine information calls. Additionally, the Board explicitly included the standard of care for a telehealth visit is the same as the standard of care for an in-person visit.

 Key Takeaways: 

• Asynchronous communication is included under the new definition of telehealth services.
• If a patient is experiencing a potential ocular health emergency, an optometrist may provide telehealth services to that patient regardless of where the patient is located.
• Check out the full revisions here.

TENNESSEE

Eliminates Initial In-Person Requirement for Behavioral Health Evaluations

TLDR: Effective April 24, 2023, Tennessee licensed behavioral healthcare service providers can conduct initial telemedicine behavioral health evaluations without first needing to conduct an in-person evaluation. The amendment to Title 56 of the Tennessee Annotated Code eliminates the previous requirement where providers needed to first conduct an in-person evaluation within the prior sixteen (16) months before conducting a subsequent telehealth evaluation. This opens the door for 100% virtual behavioral health models in the state. Check out the full revisions here.

TEXAS

Allows for More Providers and Patients to Participate in Home Telemonitoring Services

TLDR: Effective May 26, 2023, Texas Medicaid adopted new home telemonitoring service rules that expand reimbursement for remote patient monitoring. Medicaid reimbursement decisions for home telemonitoring services will now take into consideration patients with end stage renal disease. In addition, rather than necessitating two or more risk factors to be present before providing reimbursement for home telemonitoring services, now patients only have to have one risk factor. Finally, the state will not impose a time limit on documented history of falls, expanding the eligibility for individuals with a history of falls outside of the former 6-month period of consideration. The state did impose a new requirement that providers establish a plan of care with outcome measures for patients who receive home telemonitoring services under this section. Those outcome measures must be shared with the recipient’s physician. 

Key Takeaways

•  Texas will expand the scope of Medicaid eligibility for patients using home telemonitoring services.
• Check out the full revisions here. 

VERMONT

Enters Counseling and Audiology Interstate Compacts

TLDR: Effective July 1, 2024, Vermont will enter the Professional Counselors Licensure Compact and the Audiology and Speech-Language Pathology Interstate Compact. These Compacts will enable Licensed Professional Counselors (LPCs) and licensed audiologists and speech-language pathologists in Vermont to practice in other Compact states, and will enable LPCs, audiologists, and speech-language pathologists licensed in other Compact states to practice in Vermont, without the need to obtain additional licenses. 

 Key Takeaways: 

• Under the Compacts, LPCs, audiologists, and speech-language pathologists who are licensed in member states have the right to practice in any member state via telehealth.
• Check out the full revisions here for LPCs and here for audiologists and speech-language pathologists.

And that brings another issue to a close.

As always, know that if you’re a client of Nixon Gwilt Law, then we’re keeping tabs on all of these law and policy changes for you.

You don’t have to worry about tracking all these updates on your own or making key business decisions without fully understanding the evolving landscape.

(And with 50 states and multiple federal agencies, something is always changing).

If you’re not yet a Nixon Gwilt Law client, you can explore how we help businesses like yours innovate by clicking here.

And if you're not getting our monthly email for healthcare innovators, you can check out the latest one by clicking here. If you like it, there's a big subscribe button at the bottom.

See you next time!