This article delves into the complex landscape of telehealth licensing, credentialing, and regulations, offering insights into the dynamics of virtual care provision.

In a recent article by Managed Healthcare Executive, we find enlightening statistics from FAIR Health regarding the national trend in telehealth usage. The data reveals a modest decline of 3.9% in telehealth medical claims from November to December 2023. Particularly, the western region of the U.S. recorded the most notable reduction at 9.7%. Conversely, audio-only telehealth services experienced an upward trend nationally and across all regions.

However, alongside the benefits, telehealth introduces considerable regulatory and reimbursement challenges. Healthcare providers and organizations must remain abreast of both federal and state regulations while navigating the intricate reimbursement frameworks that often trail behind technological advancements.

This article delves into the complex landscape of telehealth licensing, credentialing, and regulations, offering insights into the dynamics of virtual care provision.

The Evolving Landscape of Telehealth Licensing

Telehealth providers navigate a complex regulatory environment, adhering to both federal and state mandates. The federal government sets the bar for healthcare quality and safety and oversees the Medicare and Medicaid programs. State governments, on the other hand, are in charge of licensing healthcare professionals, disciplining them if necessary, and setting the rules for practice and telehealth delivery.

Providers must be licensed in both the state where they are located, known as the "distant site," and the state where their patient is, called the "originating site." For example, a healthcare provider based in Washington offering telehealth services to a patient in Florida needs licensure in both states.

To facilitate the provision of telehealth services across state lines, some states offer specific licenses for out-of-state practitioners. These special licenses might come with fewer requirements and lower fees than standard licenses, but they could limit the provider's patient interactions.

For broader practice, telehealth providers might consider joining interstate licensure compacts. These agreements between states recognize a single license across member states, easing the way for cross-border practice. Notable examples include:

  • Physical Therapy Compact: Allows physical therapists and assistants to practice in member states, reducing administrative hassles.

While compacts offer benefits like reduced administrative work, broader care access, and enhanced provider collaboration, they also present challenges, such as additional fees and the need to adhere to varied state regulations.

To streamline the licensing process further, the Uniform Application for Licensure offers a digital solution, eliminating repetitive data entry for providers seeking licensure in multiple states. This application gathers necessary information for credential verification and meets specific state board requirements, available in participating states.

Telehealth Credentialing Pathways and Practices

To offer telehealth services, a provider needs not only to be credentialed but also to have privileges at their designated facility, even if they're not physically present. Navigating the credentialing landscape can be daunting due to varying requirements across states, hospitals, and licensing boards. Traditionally, verifying licenses and completing credentialing have been labor-intensive, involving manual data entry, result checking, and continuous monitoring. This process often leads to delays, sometimes stretching over weeks or months, which hampers healthcare organizations' efforts to expand their provider networks and meet patient demands efficiently.

This challenge is particularly acute for dynamic telemedicine and virtual care organizations eager to broaden their networks swiftly to cater to growing patient needs and carve out a significant market presence. These organizations, often starting from the ground up with modern tech infrastructures, prioritize integrating provider data seamlessly into their primary systems. They strive to offer a streamlined onboarding experience to attract and retain top clinical talent.

There are two main pathways for credentialing: the traditional method handled in-house and the increasingly popular approach known as credentialing by proxy. Endorsed by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC), credentialing by proxy enables a facility to accept another entity's credentialing and privileging decisions for a telehealth provider. This approach necessitates a detailed agreement that spells out the responsibilities of each party, including adherence to regulatory standards, quality assurance, and information sharing on any incidents or feedback.

Rural health facilities face the same credentialing procedures as urban counterparts but stand to gain significantly from credentialing by proxy. This method allows smaller community and critical access hospitals to leverage the credentialing efforts of larger, distant telehealth sites, facilitating smoother integration of telehealth services into rural healthcare delivery.

Telehealth Credentialing Strategies

As we navigate through 2024, healthcare professionals and their practices are already experiencing significant shifts in credentialing regulations. Here's a rundown of the key developments:

  • Embrace of Digital Credentialing

The move towards digital systems is revolutionizing credentialing, making processes more efficient, reducing the need for paperwork, and improving accuracy. Digital platforms are now automating the verification of qualifications, providing 24/7 monitoring of credentials, and offering instant updates on compliance. It's crucial for healthcare professionals to become proficient with these digital systems through focused training.

  • Focus on Data Security and Privacy

With the increased use of digital tools, safeguarding data security and privacy in credentialing has become paramount. Healthcare practices must implement robust cybersecurity protocols to protect sensitive credentialing information. Adherence to updated privacy regulations, including HIPAA and GDPR, is essential for protecting patient information and maintaining trust.

  • Telemedicine Credentialing Requirements

For those involved in telemedicine, specific credentialing requirements tailored for remote healthcare delivery have become a reality. This includes ensuring telemedicine training is verified, understanding licensure requirements, and following telehealth regulations meticulously.

  • Commitment to Quality Improvement

Credentialing now emphasizes not just competency assessment but also continuous professional development. A more dynamic and adaptable credentialing process is being adopted, highlighting the importance of ongoing education and a commitment to delivering the highest standards of care.

  • Navigating Regional and Specialty-Specific Standards

Credentialing standards vary significantly across different regions and medical specialties. It's vital for healthcare providers to stay informed about these diverse requirements and adapt their credentialing practices to meet them effectively.

State-by-State Telehealth Regulatory Updates

States across the U.S. are rapidly updating their telehealth regulations, reflecting the evolving nature of healthcare delivery. Here's a closer look at the key changes and updates:

  • Alaska: A pivotal move by Alaska Medicaid now ensures tribal facilities can continue receiving reimbursement for a variety of telehealth services, including live video and telephonic consultations, reinforcing the commitment to accessible healthcare for tribal communities. Meanwhile, the state's nursing board has made a significant regulatory change by repealing a provision that previously allowed the prescription of buprenorphine without a healthcare provider's direct presence during emergencies.

  • Illinois: The state has taken a significant step forward by enacting the Counseling Compact through SB 2123, broadening the scope for counseling professionals. This legislation introduces a range of new protocols, from practice privileges to enhanced mechanisms for oversight and enforcement, aiming to streamline cross-state counseling services and support military personnel.

  • Maine: In a move to enhance collaborative care, MaineCare Services has issued guidance enabling medication management providers to bill for interprofessional consultations. This initiative aims to foster a more integrated approach to patient care, allowing various healthcare professionals to contribute their expertise more efficiently.

  • Minnesota: The Minnesota Department of Human Services has updated its guidelines to permit billing for telehealth labor and delivery doula services, provided the doula is fully available to the patient throughout the process. This adjustment recognizes the critical support doulas offer during childbirth, ensuring they're compensated even when providing remote assistance.

  • North Dakota: North Dakota Medicaid's latest update clarifies that telehealth services provided by Out of State providers to local members are not considered out-of-state care, simplifying authorization requirements and facilitating easier access to telehealth services across state lines.

  • California: AB 2566 marks California's entry into the Interstate Counseling Compact, greatly expanding the ability of professional counselors to practice across member states. Additionally, California Medicaid has introduced new telehealth policies, including ensuring patient choice in telehealth modality and guaranteeing access to in-person services, thereby enhancing patient autonomy and care continuity.

  • District of Columbia: The Department of Health Care Finance has rolled out emergency rules revamping billing criteria for Assertive Community Treatment (ACT). These updates clarify what constitutes a service contact, introduce telehealth as a viable medium for needs assessment, and outline the requirements for providers to earn monthly payments. Additionally, the district is expanding services for individuals with developmental disabilities, facilitating the use of technology in delivering care. Moreover, a groundbreaking rule from the Alcoholic Beverage and Cannabis Administration now permits practitioners to offer telehealth medicine services, including medical marijuana recommendations, adhering to existing medical practice laws and regulations.

  • Indiana: Following the Indiana House Enrolled Act 1352, the Indiana Health Coverage Programs (IHCP) has unveiled a novel telehealth-only provider enrollment. This initiative caters to providers dedicated to telehealth services, sans a physical patient interaction site, ensuring they meet specific licensure and operational criteria detailed by the state. This pathway is now accessible via the IHCP Provider Healthcare Portal, signaling Indiana's commitment to enhancing telehealth accessibility.

  • Nevada: Nevada is breaking barriers in telehealth by updating its Manual to abolish previous restrictions on audio-only telehealth for behavioral health. This modification permits audio-only sessions under medically necessary conditions and with documented appropriateness for the recipient, broadening the spectrum of telehealth services across the state.

  • New York: New York Medicaid has announced it will start reimbursing for eConsults, marking a significant step forward in telehealth services. Furthermore, legislative progress with S 8058 introduces a legal definition for gender-affirming care, expanding the scope of telehealth to include prescriptions for abortion medication to out-of-state patients, showcasing New York's progressive stance on healthcare.

  • North Carolina: North Carolina Medicaid has updated its Dental Services manual to include synchronous and asynchronous dental telehealth services for certain codes. This change, alongside updates to the Traumatic Brain Injury Appendix K Flexibilities, allows a notable portion of care (up to 25% of authorized weekly service hours) to be delivered via telehealth, enhancing service accessibility for individuals with traumatic brain injuries.

  • Oregon: Oregon has made amendments emphasizing its stance on telehealth payment policies, particularly clarifying that payments will not extend to services rendered by financial institutions or entities outside the United States. Additionally, Oregon has relaxed licensure requirements for out-of-state physicians or physician assistants with an established provider-patient relationship, facilitating temporary or intermittent follow-up care via telehealth for Oregon residents temporarily out of state.

  • Washington: In a forward-thinking move, the Washington State Health Care Authority has enhanced its Telehealth Manual to prioritize inclusivity and equity in telemedicine. This update includes guidance on ensuring all patients have access to necessary assistive devices for virtual care and emphasizes the use of technology that supports diverse patient needs. Furthermore, Washington has been proactive in adjusting the coding for audio-only telehealth services and broadening Medicaid coverage to make home health services more accessible via telemedicine. Notably, several legislative pieces, including SB 5821, have been introduced to streamline the criteria for establishing patient-provider relationships in the realm of audio-only telehealth, making it simpler for patients to receive care.

  • Colorado: Looking ahead, SB 24-168 sets the stage for Colorado to enhance its telehealth offerings by July 1, 2025, focusing on remote monitoring for outpatient services and support for continuous glucose monitors. This bill also introduces a grant program aimed at bolstering telehealth services in rural and underserved areas, ensuring that quality care reaches every corner of the state.

  • Connecticut: With HB 5198, Connecticut expands the definition of a telehealth provider to include a wider range of healthcare professionals, such as physician assistants and genetic counselors. This legislation also ensures telehealth services are accessible and affordable, requiring providers to offer services at Medicare reimbursement rates if the patient lacks health coverage, thereby reducing barriers to care.

  • Kentucky: SB 255 introduces comprehensive standards for social work services delivered via telehealth, including requirements for informed consent, confidentiality, and appropriate care standards. Starting July 1, 2024, social workers will need to complete specialized training on telehealth, ensuring they are well-prepared to meet their clients' needs effectively and safely.

Key Federal Telehealth Legislative Updates

  • Telehealth Modernization Act of 2024 (HR 7623): This pivotal legislation secures the advancements in Medicare reimbursement for telehealth services initiated during the public health emergency. Key provisions include designating patients' homes as valid originating sites for receiving telehealth services, removing geographical limitations, and broadening the scope of professionals eligible to deliver telehealth services. Additionally, it clarifies that services provided through Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) via telehealth are eligible for reimbursement under the same financial mechanisms as in-person services, solidifying the foundation for audio-only telehealth services within the Medicare framework.

  • Primary and Virtual Care Affordability Act (HR 7681): This act proposes amendments to the Internal Revenue Code to extend the exemption of telehealth services from certain rules applicable to high deductible health plans, thereby fostering a more accessible environment for primary care services delivered via telehealth. It also mandates a comprehensive study to assess the impact of these exemptions, spotlighting the act's commitment to understanding and optimizing telehealth's financial and healthcare implications.

  • Healthcare Enhancement And Learning Through Harnessing Artificial Intelligence Act (HEALTH AI Act, HR 7381): This forward-thinking bill directs the National Institutes of Health to spearhead a grant program aimed at harnessing generative artificial intelligence in healthcare. The program's ambition is to catalyze research that could revolutionize healthcare delivery - from enhancing clinical note-taking to streamlining insurance processes, showcasing a proactive approach to integrating AI in improving healthcare efficiency and patient care.

  • Advancing Access to Telehealth Act (HR 7711) and Telehealth Modernization Act (S 3967): Both acts share a common goal - to cement the telehealth flexibilities introduced during the pandemic as a permanent fixture within the Medicare program. By doing so, they aim to ensure that telehealth remains a vital, accessible option for patient care, reflecting a long-term commitment to evolving healthcare delivery in response to technological advancements and patient needs.

Credential Management in Telehealth: Revolutionizing Provider Verification

In the dynamic world of telehealth, managing the myriad credentials of providers is no small feat. Credential management systems are technological lifelines, simplifying the complex and often drawn-out processes of managing licenses, certifications, and practice privileges. These digital systems are crucial for telehealth services, ensuring providers are credentialed swiftly and accurately.

Credsy stands at the forefront of this technological advancement. Within the context of expanding telehealth services and navigating the intricate landscape of state-specific regulations, our credentialing software emerges as a pivotal tool. We've successfully streamlined the credentialing process for healthcare entities across the United States, dramatically reducing administrative burdens by 100,000 hours, cutting onboarding times by 80%, and speeding up the credentialing of providers by 65%.

Our commitment extends beyond efficiency. We ensure the secure monitoring and storage of your organization's data, keeping you in compliance and safeguarding against penalties. Whether you're aiming to affiliate with a particular hospital or healthcare system, Credsy is your ally. We manage the application process, securing the necessary privileges so you can concentrate on delivering exceptional telehealth services.

With Credsy, you transcend the administrative complexities of telehealth credentialing, focusing instead on what truly matters: expanding access to care and embracing the potential of digital health solutions.

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