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Ray Dizon

Federal Bill Would Ease Telemedicine Prescribing Requirements for Substance Use Treatment

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

The Mainstreaming Addiction Treatment (MAT) Act (S 2074) was introduced earlier this month in the Senate by Senators Maggie Hassan (D-NH) and Lisa Murkowski (R-AK).  The bill would amend the definition of the “practice of telemedicine” to allow for its use to prescribe narcotic drugs in schedule III, IV or V (such as buprenorphine) while the patient is being treated by a community health aide or community health practitioner.  The bill describes the terms community health aide or community health practitioner as having the same “meanings within the meaning” of Section 119 of the Indian Health Care Improvement Act. The prescription could only be made for maintenance treatment or detoxification treatment without being registered with the DEA if the drug is prescribed by a practitioner through the practice of telemedicine.  The bill would also prohibit a state from placing a requirement that a community health aide or community health practitioner be licensed by the State in order to dispense narcotic drugs.
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FCC Releases Proposed Rule on Connected Care Pilot Program

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Last week the Federal Communications Commission (FCC) voted to adopt a notice of proposed rule establishing the Connected Care Pilot Program to support the development of telehealth services and delivery for low-income Americans, especially among rural and veteran populations. A Notice of Inquiry for comments on the program was originally made in July 2018.  The goals of the program are to incentivize participation from a wide range of eligible health care providers and broadband service providers, provide meaningful data and provide insight into how universal service funds could better promote the adoption of connected care services.
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Guidance to States and School Systems on Addressing Mental Health

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS) issued a Joint Informational Bulletin to provide information about addressing mental health and substance use issues in schools.  The guidance includes some innovative approaches for mental health and substance use disorder (SUD) treatment services in schools and Medicaid programs, and summarizes best practices.  The guidance identifies telemental health as a method to expand access to mental health services across settings, and in particular when access is difficult.  It also suggests the use of telehealth care extension strategies including the Extension for Community Health Outcomes (ECHO) model.  It directs readers to HRSA’s National Consortium of Telehealth Resource Centers, as well as the Center for Connected Health Policy for additional information.

To learn more, read the full bulletin.

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FCC to Vote on Connected Care Pilot Program Proposed Rulemaking

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

In July 2018, Federal Communications Commission (FCC) Commissioner Brendan Carr announced the establishment of the “Connected Care Pilot Program” to support the development of telehealth services and delivery for low-income Americans, especially among rural and veteran populations. At that time the FCC issued a Notice of Inquiry requesting comments regarding their authority to establish this program and supporting information to assist with the program’s design. Recently, Commissioner Carr announced at an event hosted by the Virginia Telehealth Network on June 19th, 2019 that the FCC will hold a vote on a Notice of Proposed Rulemaking for the program during its July 10th meeting.

The Notice of Proposed Rulemaking being voted on July 10th will request comments on various aspects of the proposed Connected Care Pilot Program.  The program would provide $100 million in support for health care providers to offset the costs of telehealth services for low-income patients.

Additionally, the pilot program would provide for the following:

  • Targeted support for pilot projects responding to a variety of specific health challenges, including, but not limited to, diabetes management, opioid dependency, and high-risk pregnancies.
  • 85% discounts on qualifying services for a three-year period with controls to measure and verify the benefits, costs, and savings associated with connected care technologies

Collection of data to inform stakeholders of the impact of telehealth and consider broader reforms that can support the trend toward connected care.

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Senate Proposes to Establish New Consumer Privacy Protections for Devices, Services, Applications & Software

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

A new bill proposed in the Senate seeks to establish privacy protections for consumer devices, services, applications and software that collect personal health data.  The legislation further defines these types of technology as including direct-to-consumer genetic testing services; cloud-based or mobile technologies that are designed to collect individuals’ personal health data such as wearable fitness trackers; and internet-based social media sites designed to collect or use personal health data or share health conditions and experiences.  Many of these innovations did not exist at the time the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created, and therefore privacy protections for these technologies are not currently addressed in law.  The legislation explicitly excludes products that collect personal health data derived from other information that is not personal health data (such as GPS systems) or products primarily designed for HIPAA covered entities and business associates.

Specifically, the bill establishes a National Task Force on Health Data Protection and requires the Task Force to submit a report on its findings related to the privacy and security of the consumer devices, services, applications and software no later than one year after enactment.  Six months following submission of the report, the Chairman of the Federal Trade Commission, the National Coordinator, relevant stakeholders and heads of other appropriate federal agencies would be required to promulgate regulations to strengthen the privacy and security of protections for consumers of personal health data that is collected, processed, analyzed or used by consumer devices, services, applications and software.  Requirements and considerations for such regulations include the following:

  • Account for differences in the nature and sensitivity of the data collected or stored by these devices, services, applications and software.
  • Include definitions for relevant terms.
  • Consider the findings of the report titled: “Examining Oversight of the Privacy and Security of Health Data collected by Entities Not Regulated by HIPAA”.
  • Consider other regulations and guidance issued by the Federal Trade Commission (FTC) and other regulations under HIPAA, including subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH).
  • Consider uniform standards and exceptions for consent related to the handling of genetic data, biometric data and personal health data.
  • Consider appropriate minimum standards of security that may differ according to the nature and sensitivity of the data collected, processed, transferred or stored.
  • Consider appropriate standards for de-identification of personal health data.
  • Consider appropriate limitations on the collection, use or disclosure of personal health data.
  • Consult with the National Coordinator, the Commissioner of Food and Drugs and the Chairman of the FTC.
  • Provide for initial and ongoing outreach regarding regulations affecting industries, businesses and individuals to ensure awareness of consumer privacy and security protections.

The Secretary would be required to review and update its regulations, although the frequency of such reviews are not specified.  The Department of Health and Human Services would be required to prominently display clear and concise information about available resources related to the regulation on its website for the public.

To learn more, read the full text of the proposed bill.

Texas Establishes Statewide Telehealth Center for Sexual Assault Forensic Medical Examination

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

In early June, Texas governor signed SB 71, which establishes a statewide telehealth center for sexual assault forensic medical examination.  Effective Sept. 1, 2019, the Texas attorney general is required to establish the center for the purpose of expanding access to sexual assault nurse examiners for underserved populations.  The duties of the center will include facilitating the provision of the following services, either in person or virtually:

  • Training or technical assistance to a sexual assault examiner
  • Consultation services, guidance or technical assistance to an examiner during an examination on a survivor
  • Facilitate the use of telehealth services during a forensic medical exam
  • Deliver other services as requested by the attorney general

The center will be required to develop operation protocols on telehealth services, standards of professional conduct and care, maintenance of records, technology requirements, data privacy and security of patient information, and the operation of a telehealth center.  The bill’s language also allows, but does not require the attorney general to enter into contracts to help implement the center.  Likewise, the bill does not guarantee funding, as it suggests that the legislature can appropriate money for the center, but does not require it.

A mHealthIntelligence article on SB 71 points out that use of a virtual care platform will allow the 357 sexual assault nurse examiners in the state of Texas to reach far more victims, and specifically those living in rural and remote areas that would not otherwise have access.  The program is modeled after the Sexual Assault Forensic Examination Telehealth (SAFE-T) Center from Pennsylvania State University’s College of Nursing.  Additionally, the Massachusetts Department of Public Health has also operated a Sexual Assault Nurse Examiner (SANE) model via telehealth through the National Telenursing Center since 2012 and New York currently has pending legislation, AB 3060, to establish a similar program as well.  On the federal level, a bill titled the Survivors’ Access to Supportive Care Act (S. 2948) was introduced by Senator Murray (D-WA) in the 2015-2016 legislative session, and proposed to utilize telemedicine to enhance training and continuing education for sexual assault medical forensic examinations.  However, the bill did not advance past the Senate.

To learn more about the newly established Texas statewide telehealth center for assault forensic medical examination,
see the full text of SB 71.  

Telehealth Policies and Programs Expanding Nationwide

By | Center for Connected Health Policy

Original Source: Center for Connected Health Policy

Research Finds No Reported Cases of Medical Malpractice in Direct-to-Consumer Telehealth

 

An article published in the April edition of JAMA: The Journal of the American Medical Association examines reported cases of medical malpractice in direct-to-consumer telehealth. Among 551 reported cases of malpractice involving direct-to-consumer (DTC) telehealth services, no cases were reported as malpractice as evidenced by a court decision. However, the researchers acknowledge that approximately 1 in 4 medical malpractice claims are associated with a court decision, there may exist instances of malpractice claims without court decisions which were not captured in the study.

They suggest that the absence of reported cases of malpractice may be a result of the types of services being provided via DTC telehealth, including conditions such as “sinus problems, respiratory infections, allergies, and flu symptoms,” which they say are already unlikely to result in instances of malpractice. Specialties that are generally associated with a higher malpractice risk are also often unavailable through telehealth. Additionally, DTC telehealth providers may be operating in ways which lower their risk of malpractice by not providing services that are otherwise associated with a higher malpractice risk.
The full article is available at JAMA and will be available on PubMed in October.

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