Detroit Medical News - March 2021
The COVID-19 pandemic continues to demonstrate the importance and effectiveness of telemedicine as a means of providing patients with access to safe and quality medical care through the use of technology. In order to expand and encourage the use of telemedicine, state and federal legislation has been enacted to relax various requirements for healthcare professionals utilizing telemedicine to provide care to patients. In addition, the standards for reimbursement for telemedicine services by Medicare, Medicaid and other third-party payors have continued to evolve to further permit coverage for services rendered to patients from distant sites in lieu of in-person encounters.
Physicians who incorporate telemedicine into their medical practices should be aware of existing telemedicine laws and any coverage and reimbursement criteria imposed by applicable payors when providing telemedicine services. In addition, physicians should monitor for updates or changes to any waivers and other guidance that have been issued for the duration of the federally declared COVID-19 public health emergency, which is presently in effect through at least the end of April 2021.
Michigan Telemedicine Licensing and Consent Laws
Michigan law does not require Michigan licensed or registered healthcare professionals to obtain special licensing or other certifications to provide telemedicine services to patients located in Michigan. If the patient is located in a state other than Michigan, the healthcare professional must comply with the licensure, registration, certification or other authorization requirements of the other state.
In addition, before providing telemedicine services to a patient, Michigan law generally requires the healthcare professional to directly or indirectly obtain the patient’s consent for treatment via telemedicine. The patient’s consent should be documented in the patient’s medical record for the telemedicine encounter regardless of the patient’s location.
Michigan Laws for Prescribing Medications via Telemedicine
Michigan law permits a healthcare professional to prescribe a patient a drug via telemedicine if the healthcare professional is acting within the scope of his or her practice in prescribing the drug, and meets certain additional requirements, such as referring the patient for geographically accessible health care services (including emergency care services) if medically necessary, and either referring the patient or making the healthcare professional (or a person acting under his or her delegation) available to provide follow-up health care services.
Importantly, if the healthcare professional is prescribing a controlled substance, the healthcare professional must meet the Public Health Code’s requirements applicable to the healthcare professional for prescribing a controlled substance (e.g., controlled substance license, establishing a bona fide prescriber-patient relationship, obtaining and reviewing the patient’s
MAPS report, etc.). Consideration should also be given to compliance with federal controlled substance laws, including whether such laws are applicable during the declared COVID-19 public health emergency. For example, the Drug Enforcement Administration has confirmed that the federal Controlled Substance Act’s requirement to perform at least one in-person medical
evaluation before prescribing controlled substances via the internet does not apply during a declared public health emergency, such as the current COVID-19 public health emergency.
Recent State and Federal Legislation and Rules Expanding Access to and Coverage for Telemedicine Services
The Michigan Insurance Code prohibits health insurers and HMOs from requiring face- to-face contact between a healthcare professional and a patient for services which are appropriately provided through telemedicine, as determined by the insurer or HMO. On June 24, 2020, the Michigan legislature enacted a series of bills intended to further expand access to and
coverage for telemedicine services. For example, Public Act 97 of 2020 amended the Insurance Code’s definition of “telemedicine” to include services rendered through “store and forward online messaging” and to remove the requirement that healthcare professionals use “real-time”
telecommunications systems which enable patients to interact with the off-site healthcare professional “at the time the services are provided.” In addition, Public Acts 100 and 101 of 2020 require the Michigan Department of Health and Human Services (MDHHS) to provide, through the Medicaid and Healthy Michigan programs, coverage for remote patient monitoring and
telemedicine services which meet certain criteria.
For Medicare beneficiaries, the federal Coronavirus Preparedness and Response Supplemental Appropriations Act was enacted to permit the U.S. Department of Health and Human Services (HHS) to waive certain Medicare telehealth payment requirements during the COVID-19 public health emergency, including permitting the use of telephones with audio and
video capabilities and allowing beneficiaries in all areas of the country (not just rural areas) to receive telehealth services, including from their homes. In addition, in December 2020, the Centers for Medicare & Medicaid Services (CMS) released its annual Physician Fee Schedule final rule, which adds more than 60 telehealth services that will be covered by Medicare even
beyond the end of the declared COVID-19 public health emergency.
Importantly, telemedicine services must still comply with all requirements specified by the applicable insurer or other payor in order for the services to be covered by the payor. Physicians should check each payor’s coverage and reimbursement criteria and requirements, including any required CPT codes, modifiers or other conditions for payment, and monitor for changes to any temporary coverage and reimbursement criteria imposed during the COVID-19 pandemic.
This article originally appeared in the First Quarter 2021 edition of the Detroit Medical News.