COVID-19 and Telehealth

Telemedicine allows patients to continue to receive the care they need to manage chronic conditions or minor illness from the safety of their own home. During this public health crisis, allowing patients to receive health care in their homes is safer for the patient as well as the practitioner and their staff.

Larger practices and systems currently using telehealth technology are working to scale up those services as demand for COVID-19 testing increases. Smaller and midsized physician practices may want to consider adopting telehealth, which is recommended by the Centers for Disease Control and Prevention to help mitigate the impact and prevent the spread of COVID-19. Telehealth can:

• Enable people to access care and initial screenings from their home.
• Minimize the demands on in-person primary care offices, urgent care centers, and emergency departments.
• Minimize the use of personal protective equipment like gloves and masks.
• Reduce the risk of exposure to patients and medical care teams.
• Ensure that treatment is available for high-need patients.

Setting up telehealth at your practice

Toolkits

The Provider Page (of the HHS Telehealth Toolkit for Providers and Your Patients) contains comprehensive guidance on how to get started, plan your telehealth workflow, and prepare patients. You will also find information on legal considerations, and billing and reimbursement.

The AMA has created a Telemedicine Quick Setup Guide in response to the COVID-19 national emergency.

Additional Telehealth setup guidance and resources:

• AMA COVID-19 Telehealth Guidance webpage
• Washington State DSHS Telehealth Guidebook, which includes a checklist for implementing a new telehealth system.
• HCA Apple Health, PEBB, and SEBB offer a telemedicine and telehealth brief (updated April 28, 2020), along with information and multiple webinars on behavioral health telehealth
• CMS State Medicaid & CHIP Telehealth Toolkit
• ACP Incorporation of Video Visits Checklist
• ACP CME activity - "Telemedicine: A practical guide for incorporation into your practice"
• Comagine Health telehealth resources webpage provides information and resources (including toolkits and FAQs) on Medicare, Medicaid, regulatory changes, and more to promote and support the rapid adoption of telemedicine.
• Northwest Regional Telehealth Resource Center provides technical assistance, program support, education and information
• Washington State Telehealth Collaborative provides a forum for collaboration and sharing of resources to help increase public awareness of telehealth. The collaborative offers a clinician's FAQ guide to telehealth and a list of telehealth resources.

Technical resources

The Health Care Authority has purchased a limited number of licenses for Zoom, a video conferencing technology that can help physicians provide virtual care. The HCA will distribute the licenses free of charge to physicians and providers who have a meaningful need and who don't already have access to telehealth technology, including physicians in smaller practices. Visit the HCA website to apply. We believe this offer by the HCA is a direct result of our advocacy on behalf of our small practice physicians, and we thank the agency for making these available. (March 20, 2020)

Comcast announces comprehensive COVID-19 response for physicians or providers with patients who lack or have limited internet access. Comcast's new temporary policies may help facilitate access to telehealth services. Learn more. (March 13, 2020)

HIPAA

On March 17, The HHS Office for Civil Rights (OCR) relaxed HIPAA regulations for covered health care providers using telehealth during the public health emergency due to COVID-19, effective immediately. This change allows for the use of any non-public facing remote communication product (video chat applications) to provide telehealth services. This includes Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype.

The OCR has issued FAQs about its use of enforcement discretion related to HIPAA and telehealth

See the HHS HIPAA and COVID-19 website for all OCR HIPAA announcements and guidance.

Stark Law

On April 21, 2020, CMS issued an explanatory guidance document of the Stark Law blanket waivers (issued March 30, 2020). Retroactive to March 1, the blanket waivers provide protection from the Stark Law as long as the financial relationship pertains to at least one COVID-19 purpose. (Note: Stark Law waivers are not the same as Stark Law exceptions. Be certain to consult with your health care lawyer in connection with application of the blanket waivers and the OIG policy statement.)

Prescribing controlled substances

Federal

DEA-registered practitioners may now issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided certain conditions are met. Read the DEA announcement. (March 16, 2020)

DEA COVID-19 Information Page

SAMHSA: DEA Information on Prescribing for Controlled Substance by Telemedicine

State

Emergency rule change for Schedule II prescribers: On April 21, 2020, the Pharmacy Quality Assurance Commission temporarily eased the regulations on practitioners who prescribe Schedule II substances due to the COVID-19 public health emergency. The emergency rule increases the amount of time a practitioner has to deliver a signed prescription when authorizing an emergency prescription of a Schedule II substance to the pharmacy from seven days to fifteen days. The emergency rule also allows for a practitioner to accomplish the "signed prescription" requirement through paper, electronic transmission, facsimile, photograph, or scanned copy. The emergency rule is effective immediately and will remain enforce for 120 days.

Substance use disorder treatment

SAMHSA has offered flexibilities to states to ensure that individuals being treated with medication for opioid use disorders can continue to receive their medication during the the COVID-19 pandemic. See their website for complete information.

On March 31, 2020, SAMHSA and DEA released guidance providing flexibility to prescribe buprenorphine to new and existing patients with opioid use disorder via telephone.

SAMHSA FAQs: Provision of Methadone and Buprenorphine for the Treatment of Opioid Use Disorder in the COVID-19 Emergency.