Due north Carolina has drastically expanded its telehealth services during the COVID-19 pandemic in order to give individuals increased access to remote care.  The following article outlines many of the important changes implemented.

Licensure

On March 10, 2020, Governor Roy Cooper issued Executive Order No. 116 (available here) waiving the requirement that healthcare and behavioral healthcare personnel be licensed in Due north Carolina in order to provide healthcare services to individuals within the state.  The Guild broadly references "healthcare services," presumably including the provision of telehealth services. Out-of-state healthcare professionals must submit information to the applicable licensing board (e.g., physicians must submit an Emergency Disaster License Awarding  to the Northward Carolina Medical Board to obtain authorization to practise within North Carolina; (available here) out-of-state licensed advanced practice registered nurses (APRNs) must hold an unrestricted license in whatever Nurse Licensure Compact State, perform medical acts under the supervision of a licensed North Carolina doctor, and notify the Northward Carolina Nursing Board in writing of the name, location, and phone number of the principal supervising doctor).

Additionally, the Due north Carolina Medical Lath adopted and implemented several emergency procedures and orders including the following:

  • Emergency procedures (21 NCAC 32B.1707) assuasive physicians and physician assistants (PAs) who inactivated their North Carolina licenses inside the by 24 months to render to practice for a period of 90 days or 30 days after the emergency declaration is withdrawn or ends. PAs must practice under the direct supervision of an onsite physician who is either licensed in North Carolina or otherwise canonical to do in Northward Carolina during the country of emergency. An inactive medico or PA seeking to obtain an emergency license may practice so by submitting an online awarding. (Bachelor here).
  • Waiver of the notice requirement to the Board when a PA is temporarily reassigned to a new do surface area to meet a disquisitional need by a hospital, health system, or multi-specialty group practice, provided certain requirements are met (g., PA only performs medical tasks within his/her expertise; reasonable and firsthand access to a physician (either in-person or electronically) if a medical issue arises; compliance with all applicable rules and conference with a doc on at to the lowest degree a monthly basis to ensure meaningful supervision).
  • Approval of fellows with resident preparation licenses to apply for a Limited Emergency license to obtain a temporary full and unrestricted medical license.

Similarly, the North Carolina Nursing Board (Nursing Board) appear on March 24, 2020, the following relaxations to existing licensure requirements and intends to issue internal processes and an emergency rule with farther guidance:

  • Temporary permits volition be issued for retired or inactive nurses to allow them to re-enter the workforce; and
  • Registered nurse (RN) and license practical nurse (LPN) students who are eligible for graduation are eligible to use for a "graduate" temporary license and temporarily practice under the supervision of a licensed North Carolina registered nurse.

Telemedicine and Telenursing Do Requirements

The Medical Board has not relaxed whatever existing requirements regarding the provision of telemedicine or teleprescribing services. Even so, different many other states that have recently expanded the definition of "telemedicine" or "telehealth" to include audio-only communications, the NC Medical Board's current broad definitions of "telemedicine" and "telenursing" (as defined below) likely already include audio-only communications.

On March 17, 2020, the Medical Lath reminded licensees of their obligations to provide telehealth services with the aforementioned standard of care as in-person services and in accord with the Lath'due south existing Telemedicine Position Statement. (Bachelor here). The existing Board Telemedicine Position Statement broadly defines "telemedicine" to include the exercise of medicine using electronic advice, data engineering science, or other means betwixt a licensee in one location and a patient in another, which presumably includes the use of audio-just (i.eastward., phone) communications. Under the existing telemedicine guidance, licensees must, amongst other things, ensure staff members are trained on the use of applied science to evangelize care; provide an appropriate evaluation prior to diagnosing or treating a patient, which may exist performed using technology sufficient to adequately diagnose and care for the patient; place the proper licensee and his/her credentials and the patient'due south identity; and maintain the privacy and security of patient medical records.

APRNs, RNs, and LPNs are authorized to practise nursing using telehealth/telenursing (i.e., use of electronic communication, it, or other means between a licensee in one location and a patient in some other) modalities inside their telescopic of practice. These nursing professionals must comply with the Nursing Board'due south existing Telehealth/Telenursing Position Argument. (Available here).

Teleprescribing Requirements

Similarly, the Medical Lath has non needed to relax its teleprescribing requirements considering prescriptions may be issued without an in-person test under existing Medical Board guidance. The existing Medical Board'due south Position Statement on prescriptions (available hither) permits a licensee to issue a prescription to a patient whom the licensee has non personally examined under certain circumstances including in a telemedicine encounter where the threshold information to make an accurate diagnosis has been obtained. For guidance on the prescription of controlled substances via telemedicine, the Medical Lath refers licensees to review the federal Drug Enforcement Administration'southward guidance regarding the prescribing of controlled substances via telemedicine during the COVID-19 pandemic. (Available here).

Medicaid Updates

On March thirty, 2020, NC Medicaid (Division of Health Benefits) issued temporary changes to its Telemedicine and Telepsychiatry Coverage Policy to expand the availability of telemedicine services during the pandemic. (Available here). The changes are retroactive to March 10, 2020 and volition proceed until Northward Carolina cancels its declaration of a state of emergency or until this policy is rescinded.  The existing Medicaid do and reimbursement policy (available here) continues to apply, which provides for the reimbursement for telehealth or telepsychiatry services at the same charge per unit as in-person services.

For Medicaid purposes, the following modifications regarding telehealth services apply:

  • Waiver of Prior Potency and In-Person Examination Requirement: A prior say-so and initial in-person examination are no longer required prior to a patient receiving telehealth or telepsychiatry services.
  • Eligible Devices: Telehealth (including telepsychiatry) services may be provided through video cell telephone interactions using HIPAA-compliant, secure technology with audio and video capabilities, including, for example, smart phones, tablets, and computers consequent with the federal guidance issued by the Office of Ceremonious Rights. Of note, NC Medicaid continues to exclude telephone sound-only communications from its permitted telehealth interaction methods.
  • Originating & Distant Sites: The originating site may include any location where the patient is located. Previously, patients had to be located at a Medicaid enrolled provider location such as a provider'due south function, hospital, or wellness clinic. Similarly, the distant site provider may be located in any location; all the same, providers need to ensure that patient privacy continues to be protected.
  • Eligible Providers: The types of providers who may provide telehealth services is now expanded to include the post-obit: clinical pharmacists, licensed clinical social workers, licensed clinical mental health counselors, licensed spousal relationship and family unit therapists, licensed clinical addiction specialists, and licensed psychological associates. Previously, just the post-obit providers could provide telehealth services: physicians, nurse practitioners, nurse midwives, dr. assistants, avant-garde do psychiatric nurse practitioners, advanced practise psychiatric clinical nurse specialists, licensed psychologists (doctorate level), licensed clinical social workers, and community diagnostic assessment agencies.
  • Mental Health Treatment.
    • For Federally Qualified and Rural Health Centers, phone assessment and management codes may be billed for telehealth services provided by sure licensed mental wellness professionals (g., clinical habit specialists, clinical mental health counselors, psychologists).
    • Only licensed prescribing providers such as physicians, physician assistants, and nurse practitioners may bill Medicaid using the psychiatric diagnostic evaluation and psychotherapy codes.

Expanded Coverage by Individual Third Party Payors

The Northward Carolina's Insurance Commissioner issued guidance to individual third party insurers to review existing telehealth policies to meet increased need but has not issued whatsoever orders or rules related to coverage for telehealth services.

However, many private tertiary party payors including, only no limited to, Blue Cross Blueish Shield, Aetna, and Cigna are waiving price sharing amounts for certain telemedicine visits.  Providers should review specific coverage and reimbursement policies of the various private third party payors as the expansion and waivers related to telehealth may vary (e.1000., limited in duration or to COVID-19 related telehealth services).

Please review our previously issued articles on federal and other country telehealth updates issued in response to the COVID-19 crunch. For questions or more data for these new and developing telehealth requirements and implications in North Carolina, delight contact any fellow member of the Akerman Healthcare team.