Highlight on Louisiana: State loosens telemedicine requirements for physicians

Effective June 17, 2016, physicians engaging in the practice of telemedicine in the state of Louisiana need not have a physical practice location in the state, nor are they required to enter into an arrangement with a physician who does have a Louisiana practice location to provide for referrals and follow-up care. The new telemedicine law, which also allows physicians to utilize interactive audio without video in certain circumstances, was proposed in reaction to regulations issued by the State Board of Medicine in 2015, which created the physical practice requirement.

In-state practice location

In November 2014, the American Telemedicine Association (ATA) issued comments to the Board, stating that its then-proposal to require physicians to maintain a physical practice location or enter into arrangements with in-state physicians “would be the most anti-telemedicine in the nation, especially for patients needing medical experts outside the borders of Louisiana or in an [sic] natural disaster,” and went on to opine that the proposal “reflect[ed] more of a concern of protecting economic markets rather than having anything to do with providing health services to the residents of Louisiana.”

The new law eliminates the physical practice requirement but retains the Board rules stating that physicians need not conduct an in-person physical examination or patient history prior to providing telemedicine services as long as they hold unrestricted licenses to practice medicine in the state and have access to patient records with consent.  However, it adds requirements for doctors to create a medical record for each patient and make it available to the Board upon request and, when necessary, to provide a referral to an in-state physician or otherwise arrange for in-state follow-up care.

Audio communications

The 2015 Board rules also required physicians to provide telemedicine services via simultaneous two-way video and audio communications. The new law, however, allows doctors to utilize interactive audio communications without video communication, provided that they first access and review a patient’s records and determine that they can meet the same standard of care as if they were providing face-to-face services.

Controlled substances

The new law did not affect existing Board rules prohibiting physicians from prescribing controlled substances via telemedicine services unless the physician has had at least one in-person, in-state medical visit at a practice location within the past year, the prescription is entered for a legitimate medical purpose, it conforms with the in-person standard of care, and is otherwise permitted by state and federal laws and regulations.

 

Medicaid plans as shifting as the sands, states weighing options

State Medicaid programs continue to change in response to various factors, from Florida changing its hepatitis C treatment policy to favor patients, to non-expansion states considering the financial impact of potential options. Louisiana just began enrolling the newly eligible this week, and the state projects that many more will seek coverage. South Dakota’s governor is employing some creative techniques to argue that expansion will not cost the state additional funds, and North Carolina is trying to shift plan oversight to outside organizations.

Florida and Hepatitis C

Florida is now providing vital medications to Medicaid patients with hepatitis C at an earlier stage of the disease. In the past, patients have only been offered the drug when they were at fibrosis level three or four, which indicates a high level of scar tissue in the liver and is sometimes the point where patients are in need of a transplant. These drugs are expensive to the program, costing as much as $31,000 each month. Florida amended its program criteria on June 1, 2016, removing the fibrosis level from the criteria.

Louisiana, welcome to Medicaid expansion

Louisiana opened its enrollment process to those newly eligible under the program’s expansion on June 1. The Department of Health and Hospitals (DHH) projects that about 375,000 individuals will eventually receive coverage under the expansion, although the department has been communicating with about 175,000 people about qualification. It is uncertain what effect this will have on other Louisiana health issues, such as doctor training programs. Budgetary problems, including proposed cuts to hospitals, is causing residents to go out of state for training- where they are likely to stay. Safety net hospitals, which treat many poor and uninsured patients, are particularly concerned about the reduction in funding as the state legislature attempts to resolve a budget shortfall.

Utah’s expansion comes with much less fanfare

After Utah’s legislature decided to pass a very reduced expansion plan, one that Democrats bemoaned as a “cruel trick” and “fiscal insanity,” little has been said about the matter–an extreme contrast to years of fighting over the plan of action. The plan will provide coverage to somewhere around 10,000 citizens, a reduced estimate from the original 16,000 tally. Officials expect that the money to be invested in the expansion will not stretch far to cover very many residents due to the high health costs associated with those who have gone without care. Although there has been an opportunity for hearings and public comment, the state has received little input. Some blame the timing of hearings, which would require those interested to come in during a workday, while others believe that the public feels that the legislature is uninterested in their opinions.

North Carolina seeks waiver

North Carolina is requesting that CMS allow it to transfer Medicaid oversight to three managed care organizations and provider-led entities. Although a representative felt that the state provider community has embraced the plan, the state legislature is less than united. The state Senate recently unanimously rejected House changes to its reform bill, which would require the state agency to provide progress reports and disclose a work plan for changes to be made to state health care programs.

South Dakota wants to expand Medicaid without spending more money

South Dakota Governor Dennis Daugaard (R) believes that he can figure out how to expand the state’s Medicaid program to cover about 50,000 more citizens without increasing state spending. Although he believes the math can work if the federal government shoulders more Medicaid costs for Native Americans in the state, the governor is concerned about pushback from the legislature.

State Election Results Impacting Healthcare

Earlier this week the voters of Louisiana passed an amendment to the state constitution to protect the state’s Medicaid Trust Fund for the Elderly from cuts in the event of a projected deficit. The state constitution requires the legislature to make adjustments to the budget whenever it expects revenue will not cover existing appropriations. The amendment added the fund to the lists of funds that the state constitution exempts from these legislative budget “sweeps.”

 The amendment was introduced in the state legislature as Senate Bill No. 82. It was one of nine proposed amendments that the legislature directed to be placed on the ballot for the November 6, 2012 election. The Medicaid Trust Fund for the Elderly is targeted to nursing home services.

 Further North, Michigan voters rejected an option to establish a council on home health care that would be responsible for creating a registry and training workers. The home health workers would have had the right to bargain collectively with the council.

Patient Recruiter Sentenced to 18 Months in Prison for Medicare Fraud

A Louisiana judge sentenced a patient recruiter to 18 months in prison for her part in a scheme that resulted in the submission of more than $21 million in fraudulent claims to Medicare, the Department of Justice (DOJ) Announced in a press release. Karen T. Rayburn also received a sentence of two years of supervised release and was ordered to pay restitution amounting to $3.18 million.

Rayburn worked as a patient recruiter for three Louisiana-based healthcare companies that falsely billed Medicare for durable medical equipment from 2004 to 2009. Along with other recruiters, she gathered information from Medicare beneficiaries and falsified prescriptions for equipment. Rayburn’s participation in the scheme resulted in the fraudulent submission of more than $6 million in claims.

The case was filed and prosecuted through the joint efforts of the U.S. Department of Justice, Criminal Division and the Department of Health and Human Services and more specifically, the Medicare Fraud Strike Force. The Strike Force teams federal, state, and local investigators from various agencies together to combat Medicare Fraud. It was expanded to nine locations, encompassing the Baton Rouge, Louisiana unit that prosecuted this case. According to the DOJ, the Force has charged 1,330 defendants who have falsely billed Medicare for more than four billion dollars.