Navigating the Complexities of Current Shifts in Disaster and Telehealth Privileging

Author: Joe Morris, Writer, HealthStream

This blog post is based off of an Industry Insight Webinar: Disaster and Telehealth Privileging During the COVID-19 National Emergency

When it comes to licensing and credentialing physicians and other healthcare professionals, there are clear guidelines, and most people involved like it that way. Now, however, the COVID-19 pandemic has upended everything in healthcare from basic services delivery to the credentialing and licensure process, says Vicki Searcy, Vice President, Consulting Services, at VerityStream.

“It’s hard for people that work in the credentialing profession,” Searcy adds. “A lot of us don't like gray areas. We like things to be very defined and we are in a time right now where we are in some gray areas.”

For instance, the very real issue of getting providers into the field, where their expertise is desperately needed to care for rising numbers of patients. Given the numbers needed, onboarding these providers quickly would be a heavy lift. It has been made somewhat easier by the ground-breaking changes that have come as result of the National Emergency declaration on March 13:

Certain requirements with regards to background checks and other kinds of requirements to vet providers to enroll them in Medicare also were waived. There are two types of these “blanket” waivers:

• Provider Locations. CMS has waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state.
• Enrollment in Medicare. CMS is allowing new non-certified Part B suppliers, physicians, and non-physician providers to expeditiously obtain temporary Medicare billing privileges. CMS is also waiving certain application fees, criminal background checks, and site visits with respect to provider enrollment.

Understanding new uses of existing terminology

One result of the COVID-19 pandemic is that well-known healthcare terminology is being readapted:

Licensure is someone's ability to be able to provide certain services, and the ability to grant that licensure is controlled by states.

Emergency privileges are privileges that are commonly defined in medical staff bylaws and are granted to an institution. There may be additional policies related to emergency privileges, and often provisions for emergency privileges are on a privilege form so that when a provider requests privileges, there is an acknowledgement that in case of emergency he or she can do whatever is needed to save the patient.

Disaster or temporary privileges are defined by the Joint Commission and are granted during some type of a declared disaster when an organization puts in place its emergency plans and can be granted to individuals.

Telehealth and telemedicine privileging, which are in a state of change now because states and the government are trying to make it easier for telemedicine privileges to be exercised.

“There are many concrete examples of what all this looks like, with more happening every day”, says Todd Sagin, President and National Medical Director, Sagin HealthCare Consulting.

“In Texas, the medical board has said that retired physicians, if they have not been retired for more than two years, can return immediately to active status during this disaster,” Sagin says. “On their website, they list the requirements and exemptions that they're going to make available to facilitate the return of retired physicians. They address out of state physicians and indicate they'll be allowed to obtain a limited emergency license which will last no more than 30 days unless they extend the authority. They have set up fast-tracking mechanisms to facilitate this, and they outline a variety of tools that they are going to require to make sure that these out-of-state physicians actually come with a degree of competence.”

Telehealth gains prominence as restrictions are loosened

Another major shift in care delivery has been the skyrocketing use of existing telehealth operations and deployment of new or expanded ones. Already seen as an efficient, cost-effective way to enhance care, telehealth now can be close the physical gap between providers and patients who may be nearby but cannot leave home.

And once again, the National Emergency declaration provides some good news:

• HIPAA guidelines have been relaxed for this national emergency.  HHS has announced that it will exercise “enforcement discretion” and will not impose penalties for noncompliance with regulatory requirements during the “good faith provision of telehealth” services during the COVID-19 national emergency.
• Telehealth regulations around billing for Medicare for Medicare services to Medicare patients have been waived under Section 1135 of the Social Security Act, and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 provided for $500 million in telehealth reimbursements.

The challenge will be not just to stand up a telehealth service, but also explore how changed and relaxed rules affect service delivery — and who can provide services, another element of a changed credentialing and licensure landscape.

“The telemedicine regulations are state specific,” Sagin says. “They vary a great deal. Common practice is a provider must be licensed in the state where that patient resides. CMS has waived this requirement for Medicare patients and many states have waived it for Medicaid patients and in numerous states this requirement has been waived for all patients.”

“There is a definite need for a certain tolerance for uncertainty in this time”, he says, noting that all the issues and concerns are not being addressed at the same time as people struggle to quickly cope with this crisis. But to refer to an old adage, now’s the time to document, document, document.

“If you're going to take latitude and liberties in this time of crisis, keep some documentation on what you are doing,” he advises “If you are authorizing someone to provide telemedicine services, make sure you capture the dates and the circumstances. If you're granting temporary privileges, make sure you document what you're doing as you would with any grant of temporary privileges. As long as you can indicate that you've taken a specific action with intent in order to accommodate the exigencies of this crisis, you'll be in a much better position afterward if anybody asks what the justification was for the actions you took.”