Dr. Rheuban opened the discussion by providing background information on the genesis of the rule for the audience. Since 2004, the Joint Commission (JC), a not-for-profit hospital accreditation and certification organization, has applied standards developed in conjunction with the telehealth community (JC accreditation is voluntary, but every hospital that receives Medicare and Medicaid must be certified) to providers who participate in telehealth services. The JC’s standards allowed for credentialing and privileging by proxy.
But in 2009, CMS enforced the standards relating to credentialing and privileging by proxy. CMS’s regulations required hospitals and critical access hospitals receiving telemedicine services to privilege each practitioner providing such services as if he or she worked on site. To retain its hospital deeming authority, The JC is statutorily required (through the Medicare Improvements for Patients and Providers Act of 2008, or (“MIPPA”)) to be in compliance with CMS’s rules on CoP.
Thus, the JC was obligated to enforce CMS’s CoP’s. This created a great deal of concern within the telehealth community. Many believed that CMS’s regulation would place an undue burden upon hospitals and providers participating in telehealth. Moreover, small hospitals would likely be disproportionately affected by the regulation as they often lack the resources required to undertake extensive credentialing and privileging procedures for every doctor providing telemedicine services.
In response to negative industry feedback, CMS delayed The JC’s requirement to implement CMS telemedicine standards for both general and critical access hospitals until March 2011 and issued a new proposed rule on May 26, 2010, that revises the CoPs for hospitals and critical access hospitals to allow new credentialing/privileging processes for physicians and practitioners providing telemedicine services. According to Ms. Miller, the essence of the proposed rule would allow a hospital which is the recipient of telemedicine services for its patients to rely on the credentialing and privileging decisions of the distant-site hospital, rather than conduct its own individual appraisal and examination of the credentials of each distant-site physician or practitioner. However, at a number of points throughout the teleconference, Ms. Miller stressed that the proposed rule will in no way prohibit hospitals from conducting their own privileging and credentialing if they so choose. Furthermore, it is important to note that the CoP applying to hospitals are separate and distinct from the CoP applying to critical access hospitals.
The comment period is open until July 26, 2010, and Mr. Greg Billings, Senior Director to CTeL, Dr. Rheuban, and Ms. Miller all encouraged the teleconference participants to actively engage CMS on its new proposed rule.
The Brown Bag Seminar concluded with a question and answer period, where Dr. Rheuban and Ms. Miller solicited inquiries from the audience. In the first question directed to Ms. Miller, the participant asked, “What comes next after the proposed rule is approved?” Ms. Miller responded that CMS will go through all comments, summarize them, and respond to them. CMS will then make revisions and draft a final rule which will be submitted to the U.S. Department of Health and Human Services (“HHS”) and will be vetted through all agencies within HHS. The proposed final rule will then go to the Office of Management and Budget (OMB), which holds the power to approve the rule for publication. After the OMB has given approval, the proposed final rule will be published in the Federal Register. The effective date will depend on the number of comments received. Because CMS wants to move as quickly as possible, Ms. Miller expressed hopes that a final rule would be published prior to March 1, 2011.
Another question, directed at Ms. Miller, inquired, “Does the telehealth provider have to be licensed in the state where the patient is located?” Dr. Rheuban responded in the affirmative: “The requirement is that the telemedicine provider must be licensed in the state where the patient is. This goes back to accountability and assurance for the patient. In the future, if we’re in a place where there’s reciprocity, then CMS will consider revisions to the rule.”
The seminar ended with Mr. Billings thanking Dr. Rheuban, Ms. Miller, and the audience for attending the June Washington Live! Brown Bag Telehealth Seminar and reminding everyone to sign up for the next Brown Bag, to be held on July 19, 2010.
We are looking forward to seeing you all next month! Please stay tuned for important information regarding our next Brown Bag Telehealth Seminar…
For more information on how to receive a copy of this Brown Bag recording, please contact us at info@ctel.org. Please stay tuned for our next Washington Live! Brown Bag Telehealth Seminar in July!
