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Centers for Medicaid Services (CMS) Revises Telemedicine Rule

Telemedicine credentialing laws received a boost in revisions to regulations from CMS.

The Centers for Medicare and Medicaid Services (CMS) issued in the May 5 Federal Register (76 Fed. Reg. 25550) a final rule revising the process hospitals and critical access hospitals (CAHs) use for credentialing and granting privileges to physicians and practitioners providing telemedicine services. CMS said in a press release:

For Immediate Release: Monday, May 02, 2011
Contact: CMS Office of Public Affairs
202-690-6145



MEDICARE FINALIZES A NEW RULE FOR TELEMEDICINE SERVICES TO KEEP BENEFICIARIES IN RURAL
AND REMOTE AREAS DIALED IN THROUGH TELEMEDICINE

The Centers for Medicare & Medicaid Services (CMS) today announced that it has finalized a rule for telemedicine services to ensure that patients in rural or remote areas will continue to receive the most cutting-edge medical care from many of their local hospitals. 

The final rule changes the process that hospitals and critical access hospitals (CAH) can use for credentialing and granting privileges to physicians and practitioners who deliver care through telemedicine.  Specifically, the rule simplifies how hospitals and CAHs partner with hospitals and non-hospital telemedicine entities (such as teleradiology facilities) to deliver care to their patients.  The streamlined process will be particularly beneficial to patients of small hospitals and CAHs in rural or remote areas that may lack staff or resources to deliver specialized clinical expertise to their patient populations. 

“Today’s final rule is the result of close collaboration with hospital and telemedicine care experts,” said CMS Administrator Donald M. Berwick, MD. “We at CMS want to be sure that as we develop rules to protect the safety and quality of care at America ’s hospitals and CAHs, we also devise policies that reflect the most innovative practices in delivering care to all patients, especially patients in rural or remote parts of the country through telemedicine practices.”

Before today’s final rule, CMS regulations required hospitals and CAHs to grant practice privileges to remote-site doctors and other practitioners already credentialed in distant-site facilities, after their own individualized consideration of the practitioner’s qualifications, on a practitioner-by-practitioner basis.  This meant that these practitioners could not provide care via telemedicine unless they were granted practice privileges both by their home hospital as well as by the remote hospital or CAH to which the telemedicine services were being delivered. 

Privileging decisions are currently made based upon the recommendations of a hospital’s staff after the staff has thoroughly examined and verified the credentials of the practitioners and also used specific criteria to determine whether privileges should be granted.

As part of credentialing, hospitals research the qualifications of licensed healthcare professionals and assure that these qualifications are appropriate and legitimate.  Privileging considers a practitioner’s credentials, including a license or ability to legally practice in a state, the practitioner’s training and experience, any special certifications the individual may hold from a medical specialty board, as well as the individual’s clinical skills and abilities. 

The final rule aims to reduce the burden of the traditional credentialing and privileging process for Medicare-participating hospitals and CAHs, both those that provide telemedicine services and those that use such services. In particular, the rule extends the option of a streamlined credentialing and privileging process to those small hospitals and CAHs that use the telemedicine services of practitioners from distant-site telemedicine entities, both Medicare- and non-Medicare-participating, in order to improve access to specialty services for patients while further reducing the regulatory burden imposed on hospitals and CAHs.

A hospital or CAH that furnishes telemedicine services to its patients via an agreement with a “distant” hospital or telemedicine entity may now rely upon information furnished by the distant hospital (often a larger medical center) or telemedicine entity when making credentialing and privileging decisions for the physicians and practitioners at the distant site that will furnish the services. 

Telemedicine is the use of electronic information and telecommunications technologies to provide professional health care services. Telemedicine is often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or CAHs, which are typically located in more remote locations.  Telemedicine can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.

The final rule was developed in response to concerns about the urgent need to preserve access to telemedicine for patients.

Today’s final rule updates the conditions of participation for hospitals and CAHs. Conditions of participation are rules that apply to health care organizations that seek to begin and continue participating in the Medicare and Medicaid programs. The conditions are the baseline health and safety standards and are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS implements these standards through state departments of health and accrediting organizations recognized by CMS (through a process called "deeming"), which review provider practices to assure they meet or exceed Medicare’s condition standards.

More information about the finalized rule is available on CMS’ website at http://www.cms.gov/CFCsAndCoPs/06_Hospitals.asp and http://www.cms.gov/CFCsAndCoPs/03_CAHs.a

 

 

The final rule allows a hospital or CAH that furnishes telemedicine services to its patients pursuant to an agreement with a “distant” hospital or telemedicine entity to rely on the credentialing and privileging process of the “distant” hospital or telemedicine entity for practitioners at the distant site who will furnish the services.  This considerably eases the credentialing burden for telemedicine services.  It also increases access to medical services by distant sites in more remote, rural areas.

* * *

The final rule makes some revisions to the proposed rule, which was issued in the May 26, 2010 Federal Register (75 Fed. Reg. 29479), based on comments that the proposal did not go far enough in restructuring privileging and credentialing requirements for telemedicine providers.

 

Michael H. Cohen is an experienced business law and health care law attorney.  He has taught health care law and policy at Harvard University and counseled many different kinds of practitioners and businesses, including:

  • entrepreneurial start-up ventures in many different industries
  • physicians (MD's and DO's)
  • physician groups, hospitals, and clinical facilities
  • integrative medicine centers
  • professional health care educational institutions and associations
  • dentists
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  • massage therapists
  • homeopathic physicians and homeopaths
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  • energy healers, hypnotists, medical intuitives
  • dietary supplement manufacturers and distributors
  • cosmetics manufacturers
  • entrepreneurs and start-ups
  • publishers
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  • herbalists
  • bio-energy companies
  • medical device inventors
  • telemedicine enterprises
  • many different businesses

As an attorney  at the cutting edge of health care and business law, he represents enterprises whose leaders are conscious and committed to a better world.  He provides legal and regulatory expertise to a multitude of businesses and corporations, as well as to attorneys and law firms involved in various health care legal issues including:

  • fee-splitting, Stark and anti-kickback
  • corporate practice of medicine (including New York, California, Massachusetts, D.C.)
  • medical board disciplinary proceedings and other professional discipline
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  • telemedicine, tele-psychiatry and telehealth
  • litigation (plaintiff's counsel and defense) and negotiation
  • other legal and regulatory compliance issues.

To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about laws and legal issues for entrepreneurs and new enterprises that are seeking legal advice, contact attorney Michael H. Cohen today.

 

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