In June of 2016, Missouri established telemedicine practice standards, including explicitly allowing for the delivery of health care services using electronic information and telecommunication technology. Those practicing telemedicine still needed to be aware of and incompliance with HIPAA requirements.
Telemedicine became a critical and necessary part of practice for a number of health care providers due to the Covid 19 outbreak. Many healthcare providers have found that telemedicine is an ideal method for managing the several challenges facing our healthcare system in response to this global infectious disease. Telemedicine was being used to address the ongoing healthcare needs of patients to reduce in-person clinic visits and thereby reduce human exposure both to the healthcare worker and the patient. The state of Missouri, by executive order 20-04, (signed on March 13, 2020), temporarily suspended certain provisions of the Telemedicine statutes to allow physicians to decrease the risk of exposure to healthcare providers and patients.
The Federal Government even relaxed enforcement or suspended penalties for violation of the HIPAA Privacy, Security and Breach Notification Rules that occurred in the good faith provision of telehealth during the Covid 19 nationwide public health emergency. Telemedicine Healthcare services provided in good faith still required a private setting for both the provider and the patient, with a remote communication product that allowed only the intended parties to participate in the communication. During the public health emergency, this would include such video platforms as Apple FaceTime, Facebook Messenger, Google Hangouts video, Zoom and Skype. Texting applications may also be used, such as Facebook messenger, Signal, Jabber, Google Hangouts, or iMessenger. These platforms typically employed end-to-end encryption allowing only the individuals communicating to see the transmitted information. Also, these platforms supported individual user accounts, logins, and passcodes to limit access and verify participants.
The Governor’s Executive Order has now expired. Healthcare providers must now once again adhere to all the provisions contained in Missouri Revised Statute 191.1145 -191.1146., so physicians must establish in person patient-physician relationship prior to telehealth or utilize technology sufficient to make an informed diagnosis as though the interview and examination had been performed in person.
The Federal Government has extended the suspension of enforcement and penalties for violation of HIPAA for the ninth time since being put in place January 19, 2021. The extension goes through mid- July 2022. This extension provides a temporary reprieve, allowing providers to continue to use telehealth in the manner it was used during the pandemic. Many are advocating for a more permanent extension of some of the telehealth waivers as they have been integrated into the practice during the public health emergency. However, if healthcare providers desire to continue to provide telehealth services in the treatment of their patients in the future, they will need to develop a comprehensive plan that will allow them to be in compliance with HIPAA mandates. As the above listed video and texting platforms may not be in HIPAA compliance, healthcare providers need to educate themselves on HIPAA compliant platforms and the costs associated therewith. Healthcare providers should also review and revise their office policies and procedures to mitigate the risks associated with telehealth. They will also need to monitor federal guidelines on telehealth. They can do so by going to the HHS homepage and reviewing the guidance and frequently asked questions pages. That website is www.hhs.gov.
Taking steps now to prepare your practice, will allow you to continue to use telehealth into the future.