Note: Public law 21-133 was amended on July 7, 2021. The article below incorporates these changes and replaces our previous article on this subject.
With the proliferation of new digital platforms and growing consumer demand, Connecticut suppliers could at the very least take a crash course in the contours of the new. telehealth law signed by Governor Ned Lamont on May 10, 2021, Public Act 21-9 (the “Act”), as since amended by Public law 21-133, Articles 3 and 4. The law was passed as a temporary law in effect until June 30, 2023 and codifies aspects of telehealth-related executive decrees issued by the governor during the COVID-19 pandemic. The amended law includes new Medicaid coverage and reimbursement requirements that do not expire in 2023, meaning they will still apply after that date.
What do providers need to know about the new law?
Here are some highlights:
1. Who is a telehealth provider under the new law?
The term “telehealth provider” as used in the law encompasses a wide range of healthcare professionals, from physicians to art / music therapists who are (1) network providers or (2) registered providers in the program. Connecticut medical assistance (that is, Medicaid and CHIP) and, in certain circumstances, may include licensed providers out of state.
The covered suppliers are identified in section 1 (a) (13), section 3 (a) (7), section 4 (a) (7) and section 5 (a) (4) of the Act.
2. What does it mean to be “in a network”?
An analysis of the law prepared by the Office of Legislative Research (“OLR”), as well as the wording of previous executive decrees that the law replaces, explicitly require that a telehealth provider be part of a network for fully funded plans. insured. (Providers looking to provide telehealth services to beneficiaries of self-insured plans should consult the terms of their provider contracts for guidance on telehealth service requirements.)
3. Does the new law still allow “audio only” telehealth?
Yes, Section 1 telehealth providers covered by the new law can continue to provide audio-only services. OLR analysis of the law indicates that for CMAP purposes, audio-only services only apply to “established CMAP patients”. No such restriction appears in the Act.
4. What about the HIPAA requirements? Has the law changed them?
The provision of telehealth services and health records maintained and disclosed as part of the telehealth interaction must comply with HIPAA. The law specifically permits telehealth providers to use additional information and communication technologies that comply with HIPAA and in accordance with any HIPAA guidelines, amendments or revisions relating to remote communications in telehealth, in accordance with the guidelines of the United States Department of Health and Civil Rights Office.
5. Where should I be when providing telehealth services?
Telehealth providers covered by the Act can provide covered telehealth services from any location.
6. What should I tell patients about the telehealth services offered?
The law states that at the time of their first telehealth interaction, providers must inform the patient of the treatment methods and limitations of treatment using telehealth and the time limits of public law. The wording of the law seems to require that this information be provided to the patient during the first telehealth visit that takes place after the date of entry into force of the law on May 10, 2021, even if the supplier transmitted the information before.
A telehealth provider must also obtain patient consent to provide telehealth and document the consent in the patient’s medical record. A telehealth provider should ask the patient if they consent to the provider’s disclosure of records regarding the telehealth interaction to the patient’s primary care provider.
In addition, a telehealth provider must provide the patient with their license number, if applicable, and contact information.
7. What does the law provide for reimbursement of telehealth services?
If the provider determines that the patient has coverage for telehealth services, providers are required to accept as full payment the amount that the patient’s coverage reimburses for those services plus any co-pay, co-payment, deductible, or other imposed disbursements. by the cover. If the patient does not have health coverage, the provider is limited to collecting the amount Medicare reimburses for these services.
Section 4 (c) of Public Law 21-133 now requires the Connecticut Commissioner’s Department of Social Services (DSS) to provide the same reimbursement for telehealth services covered by Medicaid and CHIP as if the services were provided in person . This requirement extends indefinitely after June 30, 2023.
Under section 4 (b) of PA 21-133, DSS will cover audio-only telehealth to the extent permitted by federal law (1) when clinically appropriate, as determined by the DSS Commissioner; (2) if it is not possible to provide comparable covered audiovisual telehealth services; and (3) when provided to individuals who are unable to use or access comparable and covered audiovisual telehealth services. This provision is not expected to end on June 30, 2023.
8. Anything else to know?
Yes a lot. The 20 pages of the new Connecticut law include specific provisions, among other things, covering the writing of prescriptions, the conduct of the review of the use of telehealth services by health insurers and similar entities, and a section allowing doctors and advanced practice nurses to issue written medical marijuana certifications. and providing follow-up care using telehealth.
Providers who use telehealth should consult their lawyers about all requirements of public law and other laws and regulations governing telehealth.