Policy Regulation and Payment

Laws and Policies by State

RDNs ask about regulations and accreditation standards as part of how they need to facilitate Telehealth and Telenutrition services in their work environments. A comprehensive list of all of the state policies and regulations is available from the Center for Connected Health Policy. Additional information about state laws and policies include:

• "On Telehealth License Portability, Each State Follows its Own Path," article from mHealthIntelligence.com
• State Telepractice Requirements from the American Speech-Hearing-Language Association
• "The Out-of-State Practice of Telemedicine: Licensure Challenges and Opportunities," article from the National Law Review
• Academy's Licensure Map by State

Regulations and Accreditation Standards

Below is background information to assist RDN practitioners:

The May 5, 2011 final rule, effective July 5, 2011 revises the Conditions of Participation (CoPs) for both hospitals and critical access hospitals (CAHs) to: 1) make current Federal requirements more flexible for rural and/or small hospitals and for CAHs; and 2) encourage innovative approaches to patient-service delivery. This final rule permits hospitals and CAHs to implement a new credentialing and privileging process for physicians and practitioners providing Telemedicine services.

RDNs should be aware of the potential impact of three provisions in the final rule. Interpretive Guidelines from 482.11(c) in the Hospital CoP further clarify that when telemedicine is used, and the practitioner and patient are located in different states, the practitioner must be licensed and/or meet the other standards required by State and local laws in both the state the practitioner is located, and where the patient is located. Second, many insurers, including Medicare, place limits or restrictions on their payment for Telehealth services to a more narrowly defined set of locations than affected by this final Telemedicine rule. Third, the final rule clarifies that it applies only to inpatients of hospitals and CAH, not other individuals who make use of the facilities for other Telemedicine services.

Licensing

As you delve into Telehealth practice, licensure requirements can be challenging and complicated. Considerations need to be explored, such as:

• If all of your patient/client interactions are within the State in which you are licensed or certified, and you maintain your licensure in good standing, and you are in compliance with recognized standards, you are unlikely to have any significant licensure issues.
• If you electronically interact with patients/clients in other states, you must be licensed or certified (check State-specific regulations) in each State in which you electronically practice.
• If the current license is with a State of equal or higher standards, some States’ laws provide for reciprocity. It is important to note though that this may qualify a licensee to obtain licensure but it may still be required to file the form and pay the fee. The ability to practice in a State prior to obtaining a license varies from State to State and should be reviewed.