In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes well-beyond Medicare’s limitation of reimbursement at new off-campus outpatient hospital departments under Section 603 of the Bi-partisan Budget Act of 2015. Since Massachusetts’ state health reform law was the model on which the Affordable Care Act was based, many other jurisdictions look to Massachusetts to see how the state is addressing the “cost” component of the equation, especially now that the “access” component is addressed by the ACA and state initiatives. Massachusetts has taken several swings at the cost conundrum, including the latest legislation introduced in October of 2017. This recent legislation includes a provision that would essentially eliminate a large number of hospital outpatient costs, both on-and off-campus.
Telemedicine rules in the District of Columbia underwent a second round of revisions as the District of Columbia Department of Health issued a new set of proposed rules . The newly-revised proposed telemedicine rules, issued in July, replace the Department’s first draft of telemedicine regulations issued in early 2016, and incorporate comments submitted by a number of telehealth industry advocates. Other than a 2014 policy statement, the D.C. Medical Board’s current laws are silent as to telemedicine practice.
The Ohio Medical Board just published new FAQs and guidance on practicing via telemedicine, addressed to Ohio physicians and physician assistants. The FAQs follow the Ohio rules for telemedicine prescribing of drugs and controlled substances adopted by the Board in March 2017. The guidance should be welcome news to providers who deliver healthcare services via telemedicine. Although frequently referred to as the “telemedicine prescribing” rule, the regulation applies in all situations where the physician or physician assistant is in one location and the patient is in another and the physician or physician assistant has never personally examined the patient.
Telehealth services are now required to be covered by health plans in the Cornhusker State. Nebraska telemedicine providers, entrepreneurs, and patients can enjoy telehealth insurance coverage, joining the national majority. Championed earlier this year by Nebraska Senator Mark Kolterman (R) as LB92 and signed by Governor Pete Ricketts (R) in late April, the new law just recently became effective on August 24, 2017. While the law contains a telehealth coverage provision, it does not require payment parity for telehealth services.
Efforts to replace the Affordable Care Act (ACA) with the Graham-Cassidy legislation were unsuccessful as lawmakers rushed to meet the September 30th deadline when the Senate would have lost its current reconciliation vehicle. Changes to the bill were incorporated in order to gain Republican support from a number of holdouts, but with Senator Susan Collins (R-ME) announcing she will not vote for the current proposal, Senate Republicans conceded today since they were short of the 50 votes required to pass the measure. Senate Republicans are currently discussing potential paths forward, including future reconciliation vehicles that would allow for ongoing efforts to repeal and replace the ACA. Efforts to stabilize the insurance exchanges were thwarted by Senator Mitch McConnell (R-KY) in order to advance Graham-Cassidy.