The COVID-19 pandemic has created opportunities for the growth of telemedicine to address patient care needs and the removal of a number of roadblocks. Here is a list of the waivers and orders put into place to ease some of the requirements associated with telehealth services.

The Louisiana Telehealth Access Act defines telehealth as “a mode of delivering healthcare services that utilize information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from healthcare providers. Telehealth allows services to be accessed when providers are in a distant site and patients are in the originating site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” La. R.S. 40:1222.3(6). “Synchronous interaction” means communication through interactive technology that enables a healthcare provider and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. La. R.S. 40:1222.3(5). A “healthcare provider may utilize interactive audio without the requirement of video if, after access and review of the patient’s medical records, the provider determines that he is able to meet the same standard of care as if the healthcare services were provided in person.”

CMS Broadens Access to Telehealth during COVID-19 Pandemic:

CMS has broadened access to telehealth services for Medicare beneficiaries during the COVID-19 health emergency. CMS has announced several waivers which implement the following:

• Waiver of the originating site and geographic site restrictions on Medicare telehealth services, allowing delivery of telehealth services in all areas of the country and location, including the patients home
• Providers may now use telehealth services for diagnosis and treatment for new and established patients for COIVD-19, as well as conditions unrelated to the health crisis.
• Providers may now use communication platforms, such as Skype or FaceTime, to provide telehealth services during the COVID-19 pandemic, and not be subject to HIPAA penalties.

CMS has broadened such access to care and telehealth services so that Medicaid beneficiaries can receive a wider range of services without having to travel to see a provider.

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet;

https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf.

State of Louisiana Health Care Facility Notice Order #2020-COVID-19-ALL-007:

The Louisiana Department of Health has issued a new order directing and requiring all licensed healthcare facilities in Louisiana to transition into delivering medical services via telehealth when medically appropriate. Such services can only be provided through a telehealth mode when the same standard of care can be met as an in-person visit.

http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-UPDATED-Notice-Med-Surg-Procedures32120.pdf

Louisiana Medicaid Provider Update:

Louisiana Medicaid published provider guidance encouraging the use of telemedicine/telehealth services, when appropriate, to decrease the amount of in person visits. If a provider does not have a synchronous audio/video system, such as FaceTime or Skype, a provider can use audio only (telephone) without the requirement of video to provide telehealth services, as long as the same standard of care is met and the need for the audio only must be documented in the patient record. Medicaid does not have a limitation on the originating site as to where such services can be provided. If a provider does not have a HIPAA compliant platform, they may use everyday communication platforms during the COVID-19 emergency.

http://ldh.la.gov/assets/medicaid/COVID-19/COVID-19.Provider.Update3.17.2020.pdf

Stay tuned! Telehealth services will continue to be the “standard of care” used during the pandemic and we expected to see more regulatory movement to facilitate the provision of these services.

Written By: Judith W. Giorlando & Christine M. Colwell

The Louisiana Department of Insurance (LDI) issued Emergency Rule 37, a package of regulations to address COVID-19 issues. The regulation applies to all HMOs, MCOs, PPOs, TPAs, PBMs and all other entities licensed by the LDI. It provides for the following:

For geographic accessibility requirements, the LDI waives plan’s obligations to comply with those requirements except for:

1. Emergency services
2. Services related to the testing or treatment of COVID-19, and
3. Services that have not been ordered postponed by Healthcare Facility Notice #2020-COVID19-ALL-006 on March 18, 2020, and
4. Services ancillary to any of the above.

Continue reading →

The Louisiana Department of Health Office of Public Health (“LDH”) issued HEALTHCARE FACILITY NOTICE/ORDER NOTICE #2020-COVID19-ALL-007(“Updated Notice”) on Saturday, March 21, 2020 to all licensed healthcare facilities and all healthcare professionals licensed by any board or authority in Louisiana DIRECTING AND REQUIRING any and all medical and surgical procedures to bepostponed until further notice.

There are two exceptions in the Updated Notice to this directive to postpone all medical and surgical procedures: (1) medical and surgical procedures to treat an emergency medical condition defined in 42 C.F.R. § 489.24; and (2) medical and surgical procedures to avoid further harms from an underlying condition or disease.

Healthcare Services, Other than Medical and Surgical Procedures. In this Updated Notice, LDH also (1) directed all healthcare providers to transition all in-person healthcare services to a telehealth mode of delivery when medically appropriate and the standard of care can be met as an in-person visit; and (2) to postpone all in-person healthcare services that can be safely postponed for 30 days.

This Updated Notice was effective on the date it was issued – MARCH 21, 2020.

A copy of the Updated Notice is accessible here.

The LDH previously issued on March 18, 2020 HEALTHCARE FACILITY NOTICE/ORDER NOTICE #2020-COVID19-ALL-006 (“Initial LDH Memo Re Medical and Surgical Procedures”) to all licensed healthcare facilities and all healthcare professionals licensed by any board or authority in Louisiana DIRECTING AND REQUIRING any and all medical and surgical procedures to be postponed for a 30-day period from March 19, 2020 through April 21, 2020 if such medical and surgical procedures can be safely postponed in the medical opinion and judgment of the physician or other appropriate healthcare professional.

A copy of the Initial LDH Memo Re Medical and Surgical Procedures is accessible here.

Written By: Clay Countryman

Following the President’s declaration of a national emergency due to COVID-19 on Friday, March 13, 2020, and in conjunction with HHS Secretary Azar’s declaration of a public health emergency on January 31, 2020, the Centers for Medicare and Medicaid Services (CMS) has issued the first round of blanket 1135 waivers to temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements for providers and suppliers. Continue reading →

The U.S. Department of Health and Human Services (HHS) has issued blanket waivers for certain healthcare regulatory requirements effective 6:00 p.m. on March 15, 2020, and they are retroactive to March 1, 2020.  These waivers issued by HHS are in addition to the waivers issued by CMS on Friday, 3/13/2020.  Included in the HHS waivers are the following: Continue reading →