Delaware General Assembly Passes Telemedicine Bill

Written By Joanne Ceballos

On May 14^th the Delaware General Assembly passed HB 69 amending Title 18, the state’s Insurance Code, and Title 24, governing health care professions and occupations, to facilitate the use of “telehealth” and “telemedicine” in the delivery of health care to patients located in Delaware. The bill defines “telehealth” as “the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.”  “Telemedicine” is defined as “a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing [to] facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient.”

The proposed amendments to the Insurance Code would require health insurers to cover telehealth and telemedicine services at the same reimbursement rates as in-person consultations.  The proposed amendments to the Medical Practice Act, Chapter 17 of Title 24, include a new section 1769D authorizing physicians to practice telehealth and telemedicine.  Under section 1769D, diagnosis and treatment via telemedicine is only permitted if  (1) the physician has previously conducted an in-person examination of the patient, (2) there is another Delaware-licensed healthcare provider present with the patient, (3) the diagnosis is based on both audio and visual communication, or (4) the service meets the standards for establishing a physician-patient relationship pursuant to guidelines established by major medical specialty societies, such as radiology or pathology.

The bill also authorizes the professional boards of the following health care professions to promulgate regulations governing the use telehealth and telemedicine by such professionals:  physician assistants, respiratory therapists, genetic counselors, podiatrists, chiropractors, dentists, nurses, occupational therapists, optometrists, pharmacists, mental health and chemical dependency counselors, psychologists, dietitians and social workers.  A bill authorizing the use of “telehealth” in the practice of physical therapy was previously signed by the Governor in August 2014 (see December 3, 2014 DE Health Law Blog regarding the regulations proposed by the Examining Board of Physical Therapists pursuant to that bill).  

The full text of HB 69 can be viewed by clicking here.

Physical Therapists’ Board Proposes Telehealth and Dry Needling Regulations

Written by Joanne Ceballos 
In August of this year Governor Markell signed a bill overhauling Chapter 26 of Title 24 relating to the practice of physical therapy and athletic training.  Among other things, the legislation expanded the scope of practice to include telehealth and dry needling.   Further to the legislation, the Examining Board of Physical Therapists and Athletic Trainers has proposed regulations regarding standards and requirements for the practice of telehealth by physical therapists, athletic trainers, and physical therapist assistants, as well as prerequisites for the performance of dry needling by physical therapists.  Proposed Regulation 14.0 restates the statutory definition of “telehealth” as “the use of electronic communications to provide and deliver a host of health-related information and health-care services, including physical therapy and athletic training-related information and services, over large and small distances.  Telehealth encompasses a variety of health care and health promotion activities, including education, advice, reminders, interventions, and monitoring of interventions.”  The proposed regulation provides that a Delaware-licensed physical therapist, athletic trainer or physical therapist assistant may conduct a telehealth session with a patient who is located in Delaware at the time of the session after obtaining the patient’s written informed consent specifying at a minimum the risks and limitations of the use of electronic communications in the provision of care, the potential disruption of electronic communication during the telehealth session, and the potential for breach of confidentiality of protected health information using electronic communications.  The proposed regulation requires the licensee to “ensure that the electronic communication is secure to maintain confidentiality … as required by HIPAA and other applicable Federal and State laws.”  Finally, the proposed regulation specifies that all evaluations (initial, reevaluations, discharge), and every other supervisory visit, must be performed in person as opposed to via telehealth.    

Proposed regulation 15.0 related to dry needling quotes the statutory definition, i.e., "an intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying muscular tissue, connective tissues and myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments; is based upon Western medical concepts; and requires a physical therapy examination and diagnosis," and clarifies that dry needling is not within the scope of practice of  athletic trainers, physical therapy assistants or physical therapy aides.  To perform dry needling, a physical therapist must have no less than two years of active clinical experience as a PT and must complete 54 hours of in-person dry needling education in a Board-approved program (PTs who have completed 25 hours of such education at the time the regulation is enacted may continue to practice dry needling but must complete the required 54 hours of education within two years).  The proposed regulation requires a physician’s referral specific for dry needling, specifies the minimum contents for written informed consent (which must include the PT’s “level of education regarding supervised hours of training in dry needling”), and addresses documentation requirements. 

A complete version of the proposed regulations can be viewed by clicking here. 

A public hearing on the proposed regulations will be held on January 27, 2015 at 4:30 p.m. in the second floor conference room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware.  Written comments may be submitted to Sandra Wagner, Examining Board of Physical Therapists and Athletic Trainers, 861 Silver Lake Boulevard, Dover, Delaware 19904, by February 11, 2015.