CMS issues NPRM to credential telemedicine

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Telemedicine provides access to neurologists with expertise in stroke care. Image Source:  

The Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking (NPRM) to revise the conditions of participation (CoPs) for both hospitals and critical access hospitals to allow a new credentialing and privileging process for physicians and practitioners providing telemedicine services.

The proposed rule, published in the May 26 Federal Register, would apply to all hospitals and critical access hospitals participating in the Medicare and Medicaid programs.

“CMS has become increasingly aware, through outreach efforts and communications with the various stakeholders in the telemedicine community…of the urgent need to revise the CoPs in this area so that access to these vital services may continue in a manner that is both safe and beneficial for patients and is free of unnecessary and duplicative regulatory impediments,” stated the NPRM.

The proposed revisions to the hospital CoPs for the credentialing and privileging of telemedicine physicians and practitioners are contained within two separate CoPs: “Governing body” and “Medical staff.”

According to the NPRM, the governing body CoP would require the hospital’s governing body to ensure that, when telemedicine services are furnished to the hospital’s patients through an agreement with a Medicare-participating hospital (a "distant-site hospital"), the agreement must specify that it is the responsibility of the governing body of the distant-site hospital providing the telemedicine serves to meet the existing requirements in regard to its physician and practitioners who are providing telemedicine services.

“The proposed requirements would allow the governing body of the hospital whose patients are receiving the telemedicine services to grant privileges based on medical staff recommendations[;] a more efficient means of privileging the individual distant-site physicians and practitioners providing the services,” the NPRM stated.

The proposed “medical staff” CoP requirement would provide a basis on which the hospital’s governing body could choose to have its medical staff rely on information furnished by the distant-site hospital when making recommendations on privileges for individual physicians and practitioners providing such services.

“This option would allow the hospital’s medical staff to rely upon the credentialing and privileging decisions of the distant-site hospitals…and not prohibit a medical staff from continuing to perform its own periodic appraisals of telemedicine members of its staff, not would it bar them from continuing to use the traditional credentialing and privileging process required under the current regulations.”

According to the NPRM, the proposed requirements for critical access hospitals are modeled after the hospital requirements with little difference in regulatory language. "[W]e would make a minor change to the critical access hospital CoPs that do not have an equivalent provision in the hospital CoPs," the NPRM said. "We are proposing...a new requirement that would allow the distant-site hospital to evaluate the quality and appropriateness of the diagnosis and treatment furnished by its own staff when providing telemedicine services to the critical access hospital."

CMS will receive public comment on the NPRM until 5:00 pm Eastern Time July 26.