Telemedicine: Has the Future of Healthcare Delivery Arrived? Nathaniel M. Lacktman

Transcription

1 Telemedicine: Has the Future of Healthcare Delivery Arrived? Nathaniel M. Lacktman Attorney Advertising Prior results do not guarantee a similar outcome Models used are not clients but may be representative of clients 321 N. Clark Street, Suite 2800, Chicago, IL Overview Telehealth Arrangements Payment and Reimbursement Opportunities Legal and Regulatory Compliance Issues 1

2 Telehealth Provider Arrangements Hospital Telemedicine Contracts 4 Payment + Reporting Originating Site Hospital Distant Site Hospital Services + Credentialing 2

3 Institutional Contracts 5 Direct to Consumer Contracts 6 3

4 Telehealth Sources of Revenue Government FFS (Medicare, Medicaid) Medicare Advantage, Medicaid MCOs Commercial Health Plans Employer Self-Funded Plans Employer Pay (OOP) Institutions, Providers Patient Self-Pay/Cash Cost Savings and Cost Avoidance 7 Telehealth Reimbursement Medicare Coverage Reimburses for Telehealth Services when the originating site (patient location) is in a HPSA or a county outside a Metropolitan Statistical Area (MSA). Originating site must be a medical facility and not the patient's home (e.g., practitioners' offices, hospital, and rural health clinics). Only covers face-to-face, interactive video consultation services where the patient is present. (S&F in AK and HI). Limited set of covered services. 8 4

5 Telehealth Reimbursement Medicaid Coverage 48 states offer some form of Medicaid reimbursement for telemedicine or telehealth services Generally live audio-video Minority of states cover store & forward or remote monitoring 9 Telehealth Reimbursement Medicare Advantage MA plans are encouraged to develop and implement innovative services and benefit design. MA plans are free to contract with providers to cover telehealth services. They can do so as a supplemental health care benefit per Social Security Act section 1852(a)(3)(A). One reason some MA plans choose not to is because CMS has historically taken the position that telemedicine must be a supplemental benefit for MA plans, which means it cannot be categorized as a basic benefit cost when the plans submit their bids. The CMS Innovation Center is considering a demonstration project that would allow Medicare Advantage plans to offer telemedicine services as a basic benefit. 10 5

6 Telehealth Reimbursement Medicaid Managed Care Most Medicaid MCOs are free to contract with providers to cover telehealth services. Most Medicaid MCOs may also provide expanded services to its members outside the FFS coverage conditions. 11 Telehealth Commercial Insurance Laws Arizona Georgia Michigan New Mexico Virginia Arkansas Hawaii Minnesota New York Washington California Indiana Mississippi Oklahoma Colorado Kentucky Missouri Oregon Connecticut Louisiana Montana Tennessee DC Maine Nevada Texas Delaware Maryland New Hampshire Vermont 6

7 Telehealth Commercial Insurance Laws Credit: ATA s State Telemedicine Policy Center (July, 2015) 13 Legal and Regulatory Compliance Issues Licensure (or exceptions); but see FSMB Compact Practice Standards Establish valid doctor-patient relationship In-person exam required? Modality of communication (RT vs. SF) Nature of exam and technology requirements Remote prescribing (incl. controlled substances) Record keeping and record-sharing 7

8 Legal and Regulatory Compliance Issues Informed Consent Patient Choice of Provider Disclosures Malpractice Considerations Privacy & Security Credentialing Legal and Regulatory Compliance Issues Fraud & Abuse Concerns Anti-Kickback Statute Physician Self-Referral Civil Monetary Penalty Law State Laws Fee-Splitting Laws Patient Brokering Corporate Practice of Medicine Insurance Laws 8

9 What to Expect in 2016 Expanding Reimbursement and Payment Opportunities Uptick in International Arrangements Continued Momentum at the State Level Retail Clinics and Onsite Health Centers on the Rise More ACOs Using Technology to Improve Care and Cut Costs 18 TELEHEALTH: RIDE THE WAVE OR Or Get GET Lost LOST at AT Sea SEA 9

10 Speaker Contact Nathaniel Lacktman Foley & Lardner LLP News & Resources (DigitalHealth Lawyer) 19 Additional Resources Statutes Regulations/Admin code Board Guidance and Policy Statements CMS Medicare Handbooks Medicaid Handbooks and Policies Enforcement Trends ATA and FSMB Policies/Standards 10