March 2020 marked the release of the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule by the Department of Health and Human Services (HHS). This has been a five-year process and a promise for improvement and progress in the United States health care system.

In December 2016, the Office of the National Coordinator for Health IT (ONC’s) Cures Act was signed into law by Congress and has been under revision so that the newly issued Final Rule supports modern-day technology. The Cures Act is designed to accelerate medical product development, information innovation and advancements in access to patient information. A goal of the Cures Act is to establish the means by which the market takes the lead and drives development – to not wait on legislation and regulations in order to make improvements.

Ray Barrett interviewed Kelly Koch from Compliancy Group. In this informative conversation, Ray and Kelly delve into the steps required by healthcare providers to remain compliant with HIPAA law when working with third-party vendors. Kelly was able to help dispel much of the confusion surrounding this important topic and layout some clear “does and don’ts” when it comes to HIPAA and working with other organizations.

The Interstate Medical Licensure Compact (IMLC) allows physicians from 43 different Medical and Osteopathic boards to practice medicine across state lines. Interstate compacts exist so that governing agencies from different states or jurisdictions are able to define an agreement which allows for members of their respective regions to operate under a mutual set of regulations.

The Nursing Licensure Compact (NLC) allows nurses to have one license to practice in multiple states. An interstate compact allows multiple states to join together and uniformly address common issues and establish guidelines that cross state boundaries to maintain regularity between governing agencies. 

The Florida legislature has passed Chapter 2019-137, Laws of Florida. Signed into law by the governor and effective July 1, 2019, Chapter 2019-137 clarifies the definitions for healthcare providers who use or plan on using telehealth services in Florida, as well as the steps needed to provide ethical, legal, and competent services within the state. The full text of Chapter 2019-137 can be downloaded on the home page.

It is now mandatory for practitioners who are licensed out-of-state and do NOT hold an additional Florida license to be registered with the state in order to perform telehealth services for patients located in Florida. (Licensed Florida providers are already allowed to practice telehealth with patients, and they would be able to see them face-to-face.)

JAMIA recently published their study on the US Department of Veteran Affairs (VA) initiative to bring telehealth to Veterans in serious need of healthcare and with barriers to accessing care. Eighty-six VA facilities provided tablets with telehealth capabilities to 6,745 patients.

In January 2019, the International Society for Telemedicine & eHealth published an article by Nathaniel Lacktman, Esq. and Dr. Neil Nerwich entitled, “Teleconsultation Services for the Mobile Workforce- Considerations and Guidelines for the Provision of Global Services in Compliance with Regulations and Best Practice Clinical Standards of Care.”  The International Society for Telemedicine & EHealth (ISfTeH), founded in 2011, is a “nongovernmental and not-for-profit society that services primarily as the umbrella association for national Telemedicine and eHealth organizations,” advising on international standards and best practices for telemedicine.  

As of December 2018, the Federal Communication Commission (FCC) has adopted an official ruling that text messages will be considered an informational service (such as emails) versus a telecommunication service (such as telephone calls). Click here for the ruling.  This distinction is highly relevant, as communications classified as “telecommunication services” must be transmitted by cellular carriers and are not permitted to be blocked or altered, whereas informational services can be.

As text messaging has grown in popularity over the last decade, texts have carried an ambiguous status; this ambiguity has allowed cellular carriers to make independent decisions regarding transmission, with many carriers defaulting to handle texts as informational services.  For the December ruling, the FCC took into consideration that cellular providers have already been filtering text messages (in an effort to minimize spam) and that allowing all texts to go through could burden consumers.

In Opinion 19-02, the Office of Inspector General declares its support for allowing drug manufacturers to temporarily loan smartphones to low-income patients who are prescribed antipsychotic digital medications. A sensor is embedded in the medication and, once taken, transmits a signal to a patch worn by the patient. The patch records the ingestion of medication, rest, and activity levels and uploads the data to a smartphone app via Bluetooth. The patient has the ability to add more detailed information (moods, sleep quality) to the app, and then the app syncs with secure, cloud-based data banks.

Telehealth is a constantly evolving mode of healthcare, and there are numerous aspects of the field in need of clarification so that statutes, policies, and practices follow the same guidelines. Telehealth is not a type of health care, rather it is the manner in which care is given. As the standards for that care become more defined and the use of this mode more prevalent, so will the need for caregivers who are adequately trained and licensed to deliver telehealth.

In 2016, the State of Florida created the Telehealth Advisory Council in order to survey, research and recommend changes to telehealth in order to better serve those living in the state.  The increase in both access and use of telehealth will also require an increase in health care practitioners offering telehealth services.

Vendor Management and Video Chatting Clients

HIPAA compliance for telebehavioral health professionals is essential to running your business in the digital age.

According to HIPAA regulation, telebehavioral health professionals must be fully HIPAA compliant in order to avoid serious violations and government fines.

BA and Vendor Management

One of the most common mistakes healthcare professionals can make is improper vendor management. The HIPAA rules here affect telebehavioral health professionals in particular because of the electronic and digital mediums by which care is given.

Telemental health is defined as the provision of behavioral or mental healthcare when the clinician and the client are in different locations at the time of services. Behavioral health services provided when the client and clinician are in the same location are often referred to as "face-to-face", "on-site", "in-person" or "in-office" sessions.