REGULATORY INTELLIGENCE

YEAR-END REPORT - 2021

Health Policy Tracking Service - Issue Briefs
Healthcare Providers & Facilities
Healthcare Information Technology

This Issue Brief was written by Julie A. Fleming, a compliance
attorney on the Publisher's Staff and a member of the Minnesota bar.

12/20/2021
I. Introduction

Health information technology, or health IT, has become a critically important tool in facilitating the exchange of patient healthcare
information between different providers and between those providers and their patients. Health IT has the potential to improve the
efficiency and effectiveness of the U.S. healthcare system by reducing medical errors and redundancies in the delivery of healthcare
services as well as providing patients with healthcare information. Efforts to establish nationwide health IT began with a 2006 executive

order !FN2] issued by President Obama's predecessor George W. Bush that called for development of a national health information
network by 2014.

However, the cost burden and concerns about protecting the private medical information of individuals have posed significant
challenges to widespread adoption of health IT. Recognizing these challenges as well as the benefits of health IT, President Barack
Obama signed into law the American Recovery and Reinvestment Act (ARRA) of 2009, an economic recovery measure to preserve and
create jobs and invest in the nation's infrastructure, including the healthcare system. The act included $19 billion in funding for health IT,
which will help achieve the nationwide objective to expand the ability to share crucial medical information electronically. Passage of the
ARRA sustains the momentum toward a nationwide health information network and is indicative of the need and desire for innovation in
reforming the U.S. healthcare system.

Previously, the National Conference of State Legislatures (NCSL) listed Health Information Exchanges (HIEs) as one of the top

legislative issues for 2012. [FNS] According to the NCSL, a major focus will be how to get health care providers, especially those
participating in the Medicaid program, to adopt certified electronic health records (EHRs). In addition, states are responsible for building
and implementing health information exchanges where health care providers can access EHRs. By mid-year 2012, every state should
have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by
deadlines attached to federal cooperative agreements.

This issue brief highlights federal and state legislative and programmatic activity affecting medical information and efforts to store
a9nd exchange such information electronically. Topics covered include privacy issues affecting medical records and prescription
information, electronic health records (EHRs), health information exchanges (HIEs), telehealth/telemedicine, and electronic prescribing
(e-prescribing). Reports of studies that could influence future policy, activities of major players in the private sector and state and
federal initiatives are also highlighted in this issue brief.

ll. Privacy and Security of Personal Medical Information

With efforts underway to digitize paper medical records, the security of confidential medical information is under full scrutiny as reports
of medical identity theft are on the rise. Since August 2009 when the Breach Notification Rule requiring that HIPAA-covered entities to
report any breach involving the personal health information of more than 500 individuals to the Office for Civil Rights there have over

65,000 breaches [FN4] and over 32 million people have had protected health information compromised. [FNS]

These alarming findings indicate a critical need to assess and improve measures to protect medical information. The Healthcare
Information and Management Systems Society (HIMSS) announced in February 2014 the results of its sixth annual Security Survey.

[FN] ty creating the survey, HIMSS surveyed 283 information technology and security professionals employed by hospitals and

 
  

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physician practices. The results of the survey show that 92% of all respondents reported that their organizations perform a risk
assessment to evaluate the risks to patient data. The number of physician practices doing so increased from 65% in 2012 to 78% in
2013. Over half of the respondents said their organization has tested their data breach response plan. Of those respondents two-thirds
said their plan was tested annually. More than 50% reported their IT budget had increased over the previous years. The survey also
found the physician practices tend to spend more on security than hospitals.au

An October 2012 report by Verizon examining cyber-attacks found that hackers either guessing or using caused 72% of the attacks
on health care organizations in 2011 and 2012 automated systems to guess the passwords that allowed them access to computer

systems. IFN7] The report found smaller organizations represented the majority of data breach victims and that of all the breaches
studied for the report 7% of them involved healthcare providers. That number was up from 1% in 2011. The authors of the report
believe that healthcare providers are attacked not because they of the fact that are in the health industry but because they are
vulnerable and have financial and personal information that can be used to create fraudulent accounts. Under HIPAA and CMS's
meaningful use rules healthcare providers are required to make security assessments that can create a baseline and show areas,
such as password protection, which need improvement. The Verizon report also found that point-of-sales systems, such as a machine
connected to a credit card skimmer, are the most targeted systems. The report recommends that smaller businesses, such has health
care providers, should: (a) implement a firewall or Access Control List on remote access services; (b) change the default credentials
of point-of-sales systems and other internet-facing devices; and (c) if a third-party has been hired to handle IT security, make sure that

they have actually done the first two items. [FNS]

Another report also raises questions about security. CORL Technologies, a provider of Vendor Security Risk Management solutions,

recently announced the results of its first Vendor Intelligence Report. IFNS] The report, which analyzed the practices of 150 vendors from
June 2013 to June 2014, found that most of healthcare vendors lack minimum security. Under the report, 58% of vendors scored in

'D" grade range for their culture of security and 8% scored in the 'F" range. These poor grades reflect a lack of confidence based on
demonstrated weaknesses with their culture of security. The report found that only 4% of vendors scored in the 'A" high confidence
grade range, 16% scored in the 'B" moderate confidence grade range and 14% scored in the 'C" indeterminate confidence grade range.
The report also found that healthcare organizations are failing to hold vendors accountable for meeting minimum acceptable standards
or otherwise mitigate vendor-related security weaknesses. The report found that only 32% of vendors have security certifications. Such
certifications include FedRAMP, HITRUST, ISO 27001, SSAE-16, SOC 2 and SOC 3.

In light of the growing concerns about protecting the privacy of personal information, it will be imperative that the development of a
nationwide health IT system incorporates rigorous measures to protect confidential medical data. Lawmakers and government agencies
are pressing forward with measures to secure the privacy of personal medical information. In addition, in an effort to increase patient
confidence in electronic health records, an HHS advisory panel recommended in October 2010 that healthcare providers should
provide patients with layered and easy to understand notices of how health information exchanges will use and protect their medical

information. *N"°l The panel suggested that a summary notice be included the required HIPAA privacy practices summary. They
recommended that the summary notice be written so that 90 percent of patients can understand it. In addition, the panel recommended
that physicians have face-to-face discussions with their patients about information exchange practices, especially when a third party
handles the transport of personal data and could trigger the need for consent. The underlying principle of the recommendations is that a
patient should not be surprised by what happens to his or her information.

The Office of the National Coordinator of Health IT announced in September 2011 the development of a Personal Health Records

(PHR) Model Privacy Notice. IFN11] The Notice is designed to be a standardized template that a web-based PHR company can use to
inform consumers about its privacy and security policies. The Notice is intended to be like other consumer-oriented labels that have
been developed for other industries, such as the nutrition facts label for food and the Model Privacy Notice developed for the financial
services industry for compliance with the Gramm-Leach Bliley Act. It was created to focus only on some important information and is
not intended to substitute for more comprehensive privacy policies.

In December 2012, HHS launched a new education initiative and set of online tools provide health care providers and organizations
practical tips on ways to protect their patients' protected health information when using mobile devices such as laptops, tablets, and

smartphones. "4! The initiative is called Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health
Information and is available at www.HealthIT.gov/mobiledevices. It offers educational resources such as videos, easy-to-download fact
sheets, and posters to promote best ways to safeguard patient health information. 'The use of mobile health technology holds great
promise in improving health and health care, but the loss of health information can have a devastating impact on the trust that patients
have in their providers. It's important that these tools are used correctly," said Joy Pritts, HHS' Office of the National Coordinator for
Health Information Technology (ONC) chief privacy officer. 'Health care providers, administrators and their staffs must create a culture
of privacy and security across their organizations to ensure the privacy and security of their patients' protected health information."

In March 2014 HHS announced the release of a new security risk assessment tool to help health care providers in small to medium

sized offices to conduct risk assessments of their organizations. IFN13] The tool is the result of a collaborative effort by the HHS Office
of the National Coordinator for Health Information Technology and Office for Civil Rights. It is designed to help practices conduct and
document a risk assessment in a thorough, organized fashion at their own pace by allowing them to assess the information security

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risks. A security risk assessment is a key requirement of the HIPAA Security Rule and a core requirement for providers seeking
payment through the Medicare and Medicaid EHR Incentive Program, commonly known as the Meaningful Use Program. These risk
assessments, can uncover potential weaknesses in a health care provider's security policies, processes and systems. The tool can
be downloaded from the HealthIT.gov website which also has a User Guide and Tutorial video to help providers begin using the tool.
Videos on risk analysis and contingency planning are available at the website to provide further context. The tool is available for both
Windows operating systems and iOS iPads.

In addition to increasing the security of data, more and more physicians are also purchasing data breach insurance. A new study from
Experian and the Ponemon Institute found that 32% of healthcare provider organization have already purchased data breach insurance

to mitigate the financial risks of a breach and that 41% of such organizations are considering such insurance. IFN"4] The study also
found that 77% of healthcare organizations believe that cyber risk insurance was important. Such insurance would enable a provider to
cover the high costs of a data breach. Chris Apgar, CEO of Apgar & Associates, a privacy and security-consulting firm, conducted a risk
analysis for a nine-doctor physician practice and found that the cost of notification alone in the event of a breach would be more than
$100,000.

The Government Accounting Office recommended in September 2013 that the Centers for Medicare and Medicaid Services (CMS) take

steps to implement a technical solution for removing Social Security numbers (SSN) from Medicare cards. [FN15] Currently the health
insurance claims number on Medicare beneficiaries' cards includes as one component the beneficiary's (or other eligible person's, such
as a spouse's) SSN. GAO believes this raises the risk that the number could be obtained, and identity theft could be committed. CMS
has already collected information and data as part of its most recent study of SSN removal that could contribute to the identification
and development of an information technology solution. GAO studied CMS's efforts related to the removal of SSNs from Medicare
cards. GAO's objectives in studying CMS's efforts related to the removal of SSNs from Medicare card were to (1) assess actions CMS
has taken to identify and implement IT solutions for removing SSNs from Medicare cards and (2) determine whether CMS's ongoing

IT modernization initiatives could facilitate SSN removal efforts. To do this, GAO reviewed agency documentation and interviewed
officials. GAO believes that some of the efforts CMS has underway to modernize its IT systems could be leveraged to facilitate the
removal of SSNs from Medicare cards. The Department of Health and Human Services agreed with GAO's recommendations, provided
that certain constraints were addressed. However, GAO maintains that its recommendations are warranted as originally stated.

In December 2013 the Department of Health and Human Services' Office of the Inspector General (OIG) released a report showing

that hospitals were not fully implementing all the recommended fraud safeguards in their EHR technology. [FN16] They study was
designed to determined how hospitals that received EHR Medicare incentive payments, administered by CMS, had implemented
recommended fraud safeguards for EHR technology. The OIG conducted an online questionnaire to all the 864 hospitals that had
received Medicare incentive payments as of March 2012. The questionnaire focused on the presence of features and capabilities

in Certified EHR Technology based on the RTI International (a company that the ONC contracted to develop recommendations to
enhance data protection) recommended safeguards regarding audit functions, EHR user authorization and access, and EHR data
transfer. In addition, the OIG conducted structured onsite interviews at eight of the hospitals. The study found that while almost all the
hospitals with EHR technology had RTI-recommended audit functions in place, most of the hospitals were not be using them to their
full extent. The OIG did find that nearly all the hospitals were using RTl-recommended data transfer safeguards and that just less than
50% of the hospitals had begun implementing RTI-recommended tools to include patient involvement in anti-fraud efforts. In addition,
only approximately 25% of the hospitals had policies regarding the use of the copy-paste feature in EHR technology, which, if used
improperly, could pose a fraud vulnerability. In conclusion, the OIG recommended that: (i) audit logs be operational whenever EHR
technology is available for updates or viewing; (ii) ONC and CMS strengthen their collaborative efforts to develop a comprehensive plan
to address fraud vulnerabilities in EHRs; and (iii} CMS develop guidance on the use of the copy-paste feature in EHR technology. CMS
and ONC concurred with all those recommendations.

Then in January 2014 the OIG published its second report concerning the lapses in the oversight of government programs concerning
Electronic Health Records (EHRs). IFN17] The previous report concerned hospitals not adopting fraud safeguards when implementing

their EHR technology. IFN18] The January report examines what the Centers for Medicare & Medicaid Services (CMS) and its
contractors have done to address vulnerabilities in EHRs. According to Danielle Fletcher, a program analyst for the Office of Evaluation

and Inspections, while EHRs can improve care and lower costs, some experts believe they may make it easier to commit fraud. [FN19]

In preparing the report the OIG reviewed policies and guidance documents concerning EHRs and fraud vulnerabilities that CMS and
its contractors have released for healthcare providers as well as documents on EHRs and Medicare claims that CMS gave to its
contractors. In addition, the OIG sent an online questionnaire to CMS administrative and program integrity contractors.

The OIG found that CMS had provided little guidance to its contractors regarding fraud vulnerabilities in EHRs. In addition, it found

that CMS and its contractors have adopted few program integrity practices for EHRs. For example, the OIG found that few contractors
were reviewing EHRs differently from paper medical records. This is a problem because EHR technology can be used to both mask the
authorship of the medical record and to distort information to inflate health care claims. The OIG also found that some of the contractors
could not tell whether some providers had used the 'copy-paste" function to bulk up EHRs to fraudulently bill for services that were

not provided. In addition, the OIG found that few hospitals permitted patients to review their EHRs, which enables patients to discover
errors and fraudulent activity.

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The OIG report contains two specific recommendations: (i) that CMS provide guidance on detecting fraud in EHRs to its contractors and
(ii) that CMS should direct its contractors to use providers' audit logs because audit log data distinguishes paper medical records from
EHRs. CMS agreed with the first recommendation and agreed in part with the second recommendation.

In addition to data breaches, natural disasters also can affect data security. In order to sure their residents' health information is
available after a hurricane or other wide-spread disasters, four Gulf states have partnered with six states in the East and Midwest to

help patients and providers access critical health information when they are unable to visit their regular doctors or hospitals. [FN20]
Working with the Office of the National Coordinator for Health IT (ONC), health information exchange (HIE) programs in Alabama,
Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin, and West Virginia announced their
partnership to allow for the exchange of health information among providers caring for patients who are displaced from their homes.

All the state HIE programs participating in the initiative currently have established at least one operational interstate connection and

are working with other states including Arkansas and Mississippi. This initiative is being made possible through information technology
infrastructure provided through 'Direct," a tool developed by an ONC-led collaboration with broad health IT industry participation that
allows for the secure exchange of health information over the Internet. A guidebook, published by the Agency for Healthcare Research
and Quality, can also help primary care clinicians connect their patients' electronic health records to a local HIE hub and regional health
information organizations.

A 2013 study in the British Medical Journal found that a small percentage of physicians were committing possible patient privacy

violations on Twitter. N2" The study was designed to investigate potential violations of patient confidentiality or other breaches of
medical ethics committed by physicians and medical students using the social networking site Twitter. The researchers looked at 237
accounts of physicians and medical students active on Twitter between July 2007 and March 2012. A total of 13,780 tweets were
examined. Slightly more than 90% of physicians and medical students stated their full name and many used a self-identifying image
on their Twitter accounts even though Twitter demands no personal information from its users. The researchers determined that 276

(1.9%) tweets were as 'unprofessional." These findings correlate with a 2011 Research Letter published in JAMA. IFN22] These tweets
were more common among users writing under a pseudonym and among medical students. For the most part the 'unprofessional
tweets" discussed typically included severe profanity, sexual content, or references to heavy drinking. The researchers found that

26 (0.2%) tweets written by 15 (6.3%) physicians and medical students included information that could violate patient privacy. Such
information did not include personal identification numbers or patients' names, however parts of the patient documentation or otherwise
specific indicatory information on patients were found. The researchers concluded that their findings emphasize the importance of every
physician and medical student considering his or her presence on social networking sites. As of now it is too early to determine if the
introduction of social networking site guidelines for medical professionals will improve awareness.

Emphasizing the importance of physicians maintaining the privacy and confidentiality, a position paper by the American College of
Physicians and the Federation of State Medical Boards and published in Annals of Internal in April 2013 examines the influence
of social media on the patient?physician relationship and provides recommendations for physician communication that preserves

confidentiality while best using these technologies. IFN23] The position papers also stresses the importance for physicians of
demonstrating respect for patients, ensuring trust in physicians, and establishing appropriate boundaries. While the position papers do
not discuss either telehealth or electronic health records, it does offer guidance for practitioners and medical students on such topics
as the use of social networking, blogging, cell phone photography, electronic searching, online forums, texting, and e-mailing. For
example, the position paper recommends that physicians do not interact with patients on such social networking sites as Facebook.
The position papers also stress the physicians' responsibility to ensure to the best of their ability that their professional networks

are secure and that only verified and registered users have access to shared information. It stresses that physicians must follow
appropriate security protocols for storage and transfer of patient information and that they must follow all applicable state and federal
legal requirements, including the HIPAA's privacy rule. Among the recommendations included are:

* physicians should keep their professional and social spheres separate and comport themselves professionally in both;

* e-mail should only be used by physicians in an established patient?physician relationship after receiving patient consent and where
the patient understands the possible risk of privacy;

¢ physicians should include documentation about patient care communications in the patient's medical record;

¢ physicians, trainees, and medical students should be aware that online postings might have future implications for their professional
lives; and

* physicians should periodically 'self-audit" to assess the accuracy of information available about them on physician-ranking Web sites
and other online sources.

In September 2013, the Rhode Island Board of Medical Licensure adopted guidelines for the appropriate use of social media and social

networking in medical practice. [FN24] The guidelines were developed in order to help those physicians who use social media and social
networking to maintain public trust and to protect themselves from any unintended consequences of such behavior. Physicians are
required to:

« protect the privacy and confidentiality of patients;

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* act in a professional manner;

¢ avoid any requests for online medical advice;

* be aware that any information posted online may be available to anyone and can be misconstrued; and
* be forthcoming about credentials and conflicts of interest.

To aid physicians in understanding the importance of such guidelines several narratives are included that demonstrate where
unintended consequences of the use of social media and social networking can undermine a physician-patients relationship.

In 2014 a new twist developed regarding the data security practices of HIPAA-covered entities. In January the Federal Trade

Commission (FTC) ruled that it has authority over HIPAA-covered entities regarding data security issues. IFN25] LabMD, a laboratory
Services Company in the greater Atlanta area, had moved to dismiss a complaint arguing that the FTC had no authority to address
private companies' data security practices as 'unfair ... acts or practices" under of the Federal Trade Commission Act. LabMD had
also argued that by enacting HIPAA, Congress had implicitly stripped the FTC of any authority to enforce the FTC Act in the field

of data security. In dismissing the complaint, the FTC rejected all LabMD's arguments. The FTC stated that accepting LabMD's
arguments 'would greatly restrict the Commission's ability to protect consumers from unwanted privacy intrusions, fraudulent misuse
of their personal information, or even identity theft that may result from businesses' failure to establish and maintain reasonable and
appropriate data security measures."The FTC also stated in its ruling that there is nothing in HIPAA to indicate that Congress intended
to restrict the FTC's authority over data security practices. As of now it is too earlier to determine this decision will affect private
companies.

In September 2014, the Government Accountability Office (GAO) issued a study on the security and privacy of the Healthcare.gov

website. '-N?6l several federal agencies, including the Department of Defense, Department of Homeland Security, Internal Revenue
Service, Office of Personnel Management, Peace Corps, Social Security Administration, and the Department of Veterans Affairs

play key roles in maintaining systems that connect with CMS systems to perform eligibility-checking functions. In addition, several
commercial entities, including CMS contractors, participating issuers of qualified health plans, agents, and others also connect to the
network of systems that support enrollment in Healthcare.gov. The GAO found that weaknesses remain both in the processes used
for managing information security and privacy as well as the technical implementation of IT security controls of the website. GAO
noted that CMS has taken many steps to protect security and privacy, such as developing required security program policies and
procedures, establishing interconnection security agreements with its federal and commercial partners, and instituting required privacy
protections. However, GAO identified weaknesses in the technical controls protecting the confidentiality, integrity, and availability of the
Federally Facilitated Marketplace. For example, GAO found that CMS had not always required or enforced strong password controls,
adequately restricted access to the Internet, consistently implemented software patches, and properly configured an administrative
network. GAO concluded that until such weaknesses are fully addressed, increased and unnecessary risks remain of unauthorized
access, disclosure, or modification of the information collected and maintained by Healthcare.gov and the related systems. GAO made
six recommendations to implement security and privacy management controls to help ensure that the systems and information related
to Healthcare.gov are protected. HHS concurred but disagreed in part with GAO's assessment of the facts for three recommendations.
However, GAO believes its recommendations are valid, as discussed in the report.

The Government Accountability Office (GAO) released a report of cybersecurity and threats to electronic protected health information

(ePHI) on September 26, 2016. IFN27] The report was critical of the Department of Health and Human Services (HHS). The use of
electronic information has allowed provides to more effectively share information and treat their patients. As a result, the information
sharing and storing by electronic means is subject to cyber-based threats. The number of reported hackings affecting health care
records of 500 or more individuals has increased from 0 in 2009 to 56 in 2015. More than 113 million records were breached in 2015
alone. /FN28l

HHS has provided guidance to covered entities on maintaining the privacy and security of protected information. The GAO report found

that this guidance does not go far enough under other federal cybersecurity guidance. [FN28] According to the report, the guidance that
HHS provides to healthcare providers does not adequately address all relevant privacy and security concerns. The GAO report also
found that there are no benchmarks to assess the effectiveness of the HHS's Office for Civil Rights' (OCR) audits and follow-up to
ensure implementation of corrective action.

The GAO report concluded with a list of five recommendations to improve the security of ePHI. First, 'IHHS] should update security
guidance for covered entities and business associates to ensure that the guidance addresses implementation of controls described in
the National Institute of Standards and Technology Cybersecurity Framework." Second, '[HHS] should update technical assistance -
to address technical security concerns." Third, 'IHHS] should revise the current enforcement program to include following up on the
implementation of corrective actions." Fourth, '[HHS] should establish performance measures for the Office of Civil Rights (OCR) audit
program." Finally, '[HHS] should establish and implement policies and procedures for sharing the results of investigations and audits
between OCR and Centers for Medicare & Medicaid Services to help ensure - compliance with the Health Insurance Portability and

Accountability Act of 1996 and the Health Information Technology for Economic and Clinical Health Act." [N30]
Recent Federal Activity

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¢ 2021 CONG US HR 550, referred in Senate, November 30, 2021, would require the Secretary of the Public Health Department to
award grants or cooperative agreements to health departments to assist in simplifying and supporting electronic reporting by any health
care provider, supporting the standardization of immunization information systems to accelerate interoperability with health information
technology, including with health information technology certified under section 3001c95) or with health ifrnoamta8ion networks.

«2019 CONG US HR 7898, enrolled December 18, 2020, would adopt new section in 42 CFR Chapter 156 (Health Information
Technology), Subchapter Ill, (Privacy), Part A (Improved Privacy Provisions and Security Provisions) to require the Secretary of Health
and Human Services to consider certain recognized security practices of covered entities and business associates when making certain
determinations relating to fines, decreasing the length and extent of an audit or remedies otherwise agreed to by the Secretary. Also
provides a definition for 'recognized security practices."

Recent State Activity
Arizona

2021 AZ S.B. 1505 (NS), adopted April 9, 2021, amends AZ ST ? 36-664 (Confidentiality; exceptions) to allow a state, county, or
local health department or officer to disclose communicable disease related information to a nonprofit health information organization
as defined in AZ ST ? 36-3801 (Definitions) that is designated by the Department as this state's official health information exchange
organization. The bill is effective April 9, 2021.

California

¢ 2021 CAA.B. 172 (NS), adopted October 8, 2021, repeals provisions authorizing the Office of Health Information Integrity to establish
and administer demonstration projects to evaluate potential solutions to facilitate health information exchange that promote quality of
care, respect the privacy and security of personal health information, and enhance the trust of the stakeholders. The bill is effective
October 8, 2021.

* 2021 CAA.B. 1131 (NS), amended/substituted March 29, 2021, would adopt CA HLTH & S ? 130260 to require, beginning
January 1, 2023, health plans, hospitals, medical groups, testing laboratories, and nursing facilities, at a minimum, to contribute to,
access, exchange, and make available data through the network of health information exchanges for every person, as a condition of
participating in a state health program, including Medi-Cal, Covered California, and CalPERS.

¢ 2021 CA S.B. 370 (NS), amended/substituted April 28, 2021, would require any federal funds CHHSA receives for health information
technology and exchange to be deposited in the California Health Information Technology and Exchange Fund. The bill would authorize
CHHSA to use the fund to provide grants to health care providers to implement or expand health information technology and to contract
for direct data exchange technical assistance for safety net providers. The bill would require a health information organization to

be connected to the California Trusted Exchange Network and to a qualified national network. The bill would also require a health

care provider, health system, health care service plan, or health insurer that engages in health information exchange to comply with
specified federal standards. This bill would create the position of Deputy Secretary for Health Information Technology within CHHSA to
serve as a single point of contact for health information technology programs that interact with the state government and to coordinate
with specified federal agencies. The bill would require the deputy secretary to establish and appoint specified members to the California
Health Information Technology Advisory Committee, which would provide information and advice to CHHSA on health information
technology issues. On or before July 1, 2022, the bill would require the deputy secretary, in consultation with the advisory committee,

to develop a plan to use federal funding to promote data exchange. The bill would also require the deputy secretary, in consultation
with the advisory committee, to annually submit a report to the Legislature and the Secretary of California Health and Human Services.
This bill would require the department to apply for federal funding made available through the American Rescue Plan Act of 2021 or

the Medicaid Information Technology Architecture program. The bill would authorize specific uses for any funding received, including
creating a unified state health information exchange gateway to improve the bidirectional exchange of data between state sources and
health care providers.

Colorado

2021 CO H.B. 1276 (NS), adopted June 28, 2021, amends CO ST ? 12-280-404 (Program operation--access--rules--definitions--repeal)
allowing the Board to, within existing funds available for operation of the Program, provide a means of sharing prescription information
and electronic health records through a Board-approved vendor and method with the health information organization network in order
to work collaboratively with the statewide health information exchanges designated by the Department of Health Care Policy and
Financing. The bill is effective June 28, 2021.

Connecticut

¢ 2021 CT H.B. 6424 (NS), introduced February 10, 2021, would amend CT ST ? 17b-59e (Electronic health record systems.
Connection to State-wide Health Information Exchange) to clarify and standardize race, ethnicity, and language data collection for
health care providers required to connect to the State-wide Health Information Exchange.

¢ 2021 CT S.B. 1 (NS), adopted June 14, 2021, requires each health care provider with an electronic health record system capable
of connecting to and participating in the State-wide Health Information Exchange as specified in section CT ST ? 17b-59e (Electronic
health record systems. Connection to State-wide Health Information Exchange) of the general statutes shall, collect and include in its

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electronic health record system self-reported patient demographic data including, but not limited to, race, ethnicity, primary language,
insurance status and disability status based upon the implementation plan. The bill is effective June 14, 2021.

¢ 2021 CT S.B. 853 (NS), amended/substituted March 9, 2021, would amend CT ST ? 17b-59g (Program to expedite development
of State-wide Health Information Exchange. Entity to implement the program. Board of directors) to expand the membership of the
State-wide Health Information Exchange (HIE) Board of Directors to include the Department of Social Services Commissioner (or the
Commissioner's designee) as ex-officio, voting member of the Board.

Delaware

2021 DE S.B. 88 (NS), introduced March 18, 2021, would amend DE ST TI 16 ? 10307 (Privacy; protection of information) to enhance
language that requires DHIN to disclose individually-identifiable patient information only with direct patient consent or for purposes
permitted by the federal Health Insurance Portability and Accountability Act of 1996 and associated regulations ('HIPAA'). Provide
additional protections to consumers, by codifying DHIN's general practice of providing Delaware residents with access to their own
health information and requiring DHIN to promulgate regulations giving residents the ability to require DHIN to provide that health
information to third parties under appropriate terms and conditions.

Florida

2022 FL S.B. 998 (NS), filed November 18, 2021, would require rural health networks to use health information exchange systems

for specific purposes, require hospitals to use health information exchange systems to provide certain notification to a patient's
primary care provider, require certain hospitals to require use of an electronic system for patient medical records, define terms, require
health care facilities to use health information exchange systems to exchange electronic health records, provide requirements for the
exchange of electronic health records and minim requirements for such records, prohibit vendors if certified electronic health record
technologies from charging health care facilities and health care practitioners more than a specified amount for building an interface
with a health information exchange system, require the Agency for Health Care Administration to provide health information exchange
systems with access to the electronic prescribing clearinghouse for a specific purpose, and require certain records owners to use a
health information exchange system to provide patient records to health care practitioners and providers.

Illinois

¢ 2021 IL S.B. 2294 (NS), adopted July 6, 2021, adopts IL ST CH 20 ? 3860/997 (Repealer) to repeal the Illinois Health Information
Exchange and Technology Act on January 1, 2027. The bill is effective July 6, 2021.

¢ 2020 IL REG TEXT 513849 (NS), published December 28, 2020, amends 77 |L ADC 450.1010 (Necessary Records) allowing clinical
laboratory test to be reported or transmitted to an electronic health information exchange for the purposes of transmitting, using, or
disclosing clinical laboratory test results in any manner required or permitted by HIPAA. The regulation is effective December 9, 2020.

Kansas

2021 KS S.B. 92 (NS), introduced January 28, 2021, would create the Kansas Equal Access Act to authorize the use of medical
marijuana. The Act would also prohibit health insurance exchange established within Kansas or any health insurance exchange
administered by the federal government or its agencies within Kansas from excluding from coverage an insured individual solely on the
basis that such insured individual purchases, possesses, or consumes medical cannabis.

Kentucky

2021 KY H.B. 74 (NS), introduced January 5, 2021, would adopt a new section of KY ST T. XVII, Ch. 194A (Cabinet for Health and
Family Services) to establish the Kentucky all-payer claims database which must be available to the public, in a form and manner

that ensures the privacy and security of personal health information as required by state and federal law, as a resource to insurers,
consumers, employers, providers, purchasers of health care, and state agencies to allow for continuous review of health care utilization,
expenditures, quality, and safety.

Maryland

* 2021 MD H.B. 78 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 4-302.3 (State Designated Exchange) authorizing the
state designated health exchange to participate in the advisory committee, maintain a data set for the Maryland Commission on Health
Equity and provide data from the data set consistent with the parameters defined by the Advisory Committee. The bill would also adopt
MD HEALTH GEN ? 13-4206 to create an Advisory Committee to establish the parameters of a health equity data set to be maintained
by the state designated health information exchange. The bill is effective October 1, 2021.

* 2021 MD H.B. 1022 (NS) and 2921 MD S.B. 748 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 4-302.3 (State
designated exchange) requiring a nursing home, on request of the Maryland Department of Health, to electronically submit clinical
information to the State designated exchange for a certain purpose; authorizing the State designated exchange to provide certain
information to certain individuals and entities in a certain manner. Requiring an electronic health network to provide certain transactions
to the State designated exchange for certain purposes; prohibiting an electronic health network from charging a certain fee to a health
care provider, health care payor, or the State designated exchange. The bill is effective July 1, 2021.

Missouri

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¢ 2021 MO S.B. 63 (NS), adopted June 8, 2021, adopts MO ST 195.450 establishing a joint oversight task force for prescription

drug monitoring to collect and use patient dispensation information for prescribed Schedule Il, Ill, or IV controlled substances as
submitted by dispensers. Requires the individual's dispensation information to be maintained for a maximum of 3 years, requires the
vendor to treat patient dispensation information and any other individually identifiable patient information submitted under this section
as protected health information, provides that dispensation information and any other individually identifiable patient information is
confidential and not subject to public disclosure, and requires patient dispensation information submitted to be shared with any health
information exchange operating in this state, upon the request of the health information exchange. The bill is effective August 28, 2021.

¢ 2021 MO S.B. 496 (NS), introduced February 10, 2021, would amend MO ST 191.237 (Failure to participate in health information
organization, no fine or penalty may be imposed--no exchange of data, wnen-definitions) to allow a health information exchange

or health information network shall implement policies that meet the requirements of HIPAA governing the privacy and security of
individually identifiable information that is made accessible or delivered through the health information exchange or health information
network. The bill would also add privacy requirements and define 'health information exchange" or 'health information network" and
'health information exchange activities."

¢ 2021 MO S.B. 537 (NS), introduced February 24, 2021, would amend MO ST 191.237 (Failure to participate in health information
organization, no fine or penalty may be imposed--no exchange of data, when--definitions) to modify provisions relating to health
information networks and health information exchanges.

Nebraska

2021 NE L.B. 411 (NS), adopted May 24, 2021, amends NE ST ? 81-6, 125 (Act; purpose; designated health information exchange;
duties) would require, on or before September 30, 2021, each health care facility and health care payor to participate in the designated
health information exchange through sharing of clinical information. The bill is effective May 24, 2021

Nevada

2021 NV A.B. 428 (NS) and 2021 NV A.B. 431 (NS), introduced March 26, 2021, would amend NV ST 439.538 (Electronic transmission
of health information: Exemption from state law concerning privacy or confidentiality of certain health information; ability of person to
opt out of electronic disclosure of certain health information), N\V ST 439.588 (Certification for exchange required; disciplinary action for
failure to comply with law; administrative fine for operating without certification; regulations), N\V ST 439.589 (Adoption of regulations to
prescribe standards relating to electronic health records, health-related information and health information exchanges), NV ST 439.590
(Limitations on use, release or publication of certain information; penalty for unauthorized access to electronic health record or health
information exchange; establishment of complaint system), N\V ST 439.591 (Patient not required to participate in health information
exchange; notification to patient of breach of confidentiality of electronic health records or health information exchange; patient access
to electronic health records), and NV ST 449A.715 (Registration of advance directive: Requirements; duties of Secretary of State)

to provide that a patient is presumed to consent to the retrieval of his or her health care records from a health information exchange
unless the patient opts out. Require the Director of the Department of Health and Human Services to prescribe standards for providing
a patient the opportunity to opt out of allowing access to the patient's health records from a health information exchange.

New York

2021 NY A.B. 749 (NS), introduced January 6, 2021, would amend NY INS ? 1119 (Limited exemption for continuing care retirement
communities) allowing organizations to adopt a written cybersecurity policy that is designed to protect the confidentiality, integrity, and
security of nonpublic information and is in compliance with HITECH, HIPAA, the Gramm-Leach Bliley Act, and all other applicable
cybersecurity and privacy protections governing nursing homes, adult care facilities and assisted living residences to the extent the
protections govern those components of such organization's operations.

North Carolina

¢ 2021 NC H.B. 179 (NS), introduced March 1, 2021, would amend NC ST ? 90-414.4 (Required participation in HIE Network for
some providers) to authorize the imposition of a civil penalty against certain entities and providers that fail to connect to, and submit
mandatory demographic and clinical data information through, the North Carolina Health Information Exchange Network.

* 2021 NC H.B. 395 (NS), adopted May 27, 2021, amends NC ST ? 90-414.4 (Required participation in HIE Network for some
providers) to extend the deadlines for mandatory participation in the statewide Health Information Exchange Network known as
NC HealthConnex for certain providers and entities and to establish a civil penalty as an enforcement mechanism for mandatory
participation. The bill is effective May 27, 2021.

¢ 2021 NC S.B. 226 (NS), introduced March 11, 2021, would amend NC ST ? 90-414.4 (Required participation in HIE Network for
some providers) to extend the deadlines for mandatory participation in the statewide Health Information Exchange Network known
as NC HealthConnex for certain providers and entities and to establish a civil penalty as an enforcement mechanism for mandatory
participation.

Ohio

«2021 OH REG TEXT 589236 (NS), filed July 26, 2021, adopts new OH ADC 3364-15-10 (Confidentiality of patient information)
requiring all University of Toledo workforce members with access to protected health information (PHI) be committed to ensuring

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that PHI is protected and kept confidential. The regulation outlines the appropriate use of PHI consistent with the Health Insurance
Portability and Accountability Act (HIPAA) privacy rule and all updates allowing for the use and disclosure of PHI for treatment,
payment, or health care operations. The regulation is effective August 5, 2021.

¢ 2021 OH REG TEXT 589566 (NS), filed October 4, 2021, amends OH ADC 5123-9-14 (Home and community-based services
waivers ? vocational habilitation under the individual options, level one, and self-empowered life funding waivers) requiring vocational
habilitation services provided through virtual support to comply with applicable laws governing an individual's right to privacy and the
individual's protected health information and OH ADC 5123-9-17 (Home and community-based services waivers ? adult day support
under the individual options, level one, and self-empowered life funding waivers) requiring adult day support services provided through
virtual support to comply with applicable laws governing an individual's right to privacy and the individual's protected health information.
The regulations are effective October 15, 2021.

Oklahoma

¢ 2021 OK S.B. 574 (NS), adopted May 24, 2021, adopts new section to designate purposes of Oklahoma State Health information
Network and Exchange (OKSHINE), provide certain protections for participation in OKSHINE, and provide for and limit disclosure of
certain health information. The bill is effective May 24, 2021.

¢ 2021 OK REG TEXT 592571 (NS), approved July 19, 2021, adopts OK ADC 317:30-3-35 (Oklahoma State Health Information
Network and Exchange (OKSHINE)) for the establishment and operation of statewide health information exchange, known as
OKSHINE. OKSHINE is the state-designated organization that facilitates the exchange of health information to and from authorized
individuals and health care organizations in the state for the purpose of improving health outcomes. The regulation was adopted via
emergency and is effective July 19, 2021 through September 14, 2022, unless superseded by another rule or disapproved by the
Legislature.

Oregon

2021 OR H.B. 3039 (NS), engrossed April 13, 2021, would require the Oregon Health Authority, in coordination with Department
of Human Services, to convene one or more groups of stakeholders and experts to study and make recommendations regarding
electronic referral system for social services and statewide health information exchange.

Vermont

2021 VT S.B. 117 (NS), adopted March 29, 2021, amends 18 VT ST ? 1129 (Immunization Registry) to permit the Department of
Health to provide immunization registry information to the Vermont Health Information Exchange. The bill is effective March 29, 2021.

Washington

2021 WA H.B. 1127 (NS), enrolled April 21, 2021, would protect the privacy and security of COVID-19 health data collected by entities
other than public health agencies, health care providers, and health care facilities. The bill would also amend WA ST 42.56.360 (Health
care) to exempt COVID-19 health data from disclosure.

Ill. Healthcare IT Systems and Electronic Health Records

Despite an initial slow pace of adoption of health IT there are encouraging signs of that it is becoming more widely used. At the end
of 2014, five years since the passage of the HITECH Act, $25.4 billion had been spent IFN31] on incentive payments to more than

410,000 health care providers. ""*2] Also at the end of 2014, 80% of eligible professionals and 98% of eligible hospitals had qualified
for payments by adopting electronic health records. This is an improvement from May of 2013 when the Department of Health and
Human Services announced that more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive

payments for adopting or meaningfully using electronic health records (EHRs). [FN33] According to a 2012 survey by the Centers for
Disease Control and Prevention, only 17% of physicians and only 9% of hospitals were using EHRs in 2008.

Realizing that many patients are eager to take care of new technology, Healthgrades, an online resource for information on physicians
and hospitals, has announced that it is partnering with athenahealth to enable almost one million persons a day to look for a physician

and book an appointment online with athenahealth's network of more than 55,000 health care providers. [FNS4] This partnership is
expected to help front offices save time and improve accuracy. The offering is fully automated and permits patients to view appointment
availability and to book appointments from Healthgrades. The information is then added to the physicians' schedules on athenahealth's
network. This new partnership will enable hospitals use both athenahealth and Healthgrade's Patient Direct Connect solution to further
their physician alignment strategies and make it easier to book appointments at no additional cost.

In addition to Healthgrades, many hospitals and physicians are using online services, such as InQuicker and ZocDoc, which allow

patients to make such appointments. [FN35] Wigst of the online services let the patient enter a zip code and describe the care they need
so find the care they need. In addition, one a patient books an appointment for ER care and the ER becomes backed up, the service
will text the patient with a new appointment at a later time. While such services are usually free for patients, the healthcare provider
may be charged between $200 and $300 a month for using them. ZocDoc currently has over 6,000,000 patients a month making
appointments using their service.

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Online health communities can be very effective in providing patient-centered care to persons suffering from chronic conditions.

[FN36] Online health communities are Internet-based platforms that bring together a group of patients, a group of professionals, or

a mixture of both. Such communities may be either open or closed based on the accessibility of the community content. Members
of the community interact using modern communication technologies such as blogs, chats, and forums. The study found that such
communities could be used to share experiences, exchange knowledge, and increase disease-specific expertise. The researchers
also found that such communities can bridge geographical distances and enable interdisciplinary collaboration across institutions.
In addition, the researchers found that such communities can be used to actively engage and empower patients in their health care
process and to tailor care to their individual needs.

One reason for the adoption of tablets is new applications being offered for health care providers. Allscripts has released Allscripts
Wand?, an iPad application that extends the most commonly used functions of Allscripts Professional? and Enterprise? solutions.

[FNS7] Allscripts believes the application has great potential as a recent study in Archives of Internal Medicine found that iPad use in
hospitals could reduce delays and improve continuity of patient care. In addition, a poll of more than 5,000 physicians conducted by the
Physicians Consulting Network revealed that 27% of primary care and specialty physicians own an iPad or similar device, a rate that is
five times higher than the general population.

The new WAND application will enable healthcare providers to:

¢ review appointment lists and current patient status;

¢ retrieve patient data quickly, with drill-down access to details;

¢ input real-time information like vitals and medications from the examination room

* access EHR information anytime of the day;

¢ view a timeline of key patient information such as lab results, medications, vital signs, and more; and
¢ e-prescribe with electronic transmission to pharmacies.

A study by the Health Research and Educational Trust on the attitudes of Americans concerning health information technology showed

that almost 80% of the American public favor the use of EHRs and believe EHRs could improve care. IFN38] Almost 60% of those
surveyed believe EHRs will reduce costs. In addition, 64% feel that the benefits EHRs provide outweigh the privacy risks. Those
respondents with higher incomes and greater familiarity in using electronic technologies had the most positive views towards EHRs. Of
the respondents, 64% had heard of e-prescribing and 44% were aware of their physician using such technology.

Accenture, a global management consulting, technology services and outsourcing company, found that 41% of U.S. consumers would

switch physicians in order to gain online access to the EHRs. [N39] Their survey, which included more than 9,000 people in nine
countries, showed that only 36% of U.S. consumers currently have full access to their EHRs, but more than 57% have taken ownership
of their records by self-tracking their personal health information, including their health history (37%), physical activity (34%), and health
indicators such as blood pressure and weight (33%). More than 80% of the consumers believed they should have full access to the
EHRs while 65% of U.S. physicians believe patients should only have limited access. Currently, according to the survey, 63% of U.S.
patients have limited access to their EHRs.

One concern some have about electronic health records is their security. A 2013 study published in the American Journal of Managed
Care looks at physician capability to electronically exchange laboratory, pharmacy, and clinical information at a national and state

level. FN4°l The researchers used the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement as

their data source. That survey covered 4,326 nonfederal office-based physicians who provide direct patient care. The survey asked

the physicians about their ability to exchange such information as pharmacy data, laboratory data, and patient clinical summaries. To
assess the ability of the physicians to exchange patient clinical summaries, the researchers looked at the percentage of respondents
who indicated that they 'exchange patient clinical summaries electronically with any other providers."The researchers found that the
ability to exchange clinical information varied widely from state to state. They believe that a state's investment in Health IT and its
statutes and regulation regarding Health IT, as well as the presence of regional Health IT organizations in the state may account for this
variation. The researchers also found that the fact that not all electronic health records systems offer the same exchange capabilities

is a major challenge facing the exchange of clinical information. The study concluded that most physicians currently have the capability
of electronically exchanging laboratory and pharmacy information and that one-third can exchange clinical summaries with patients or
other providers.

In May 2013 the Office of the National Coordinator for Health Information Technology (ONC) released 'Governance Framework for

Trusted Electronic Health Information Exchange." IFN41] This document is intended to serve as the ONC's guiding principles on Health
Information Exchange (HIE) governance and to provide a common conceptual foundation applicable to all types of governance models.
The document does not prescribe specific solutions. It does, however, describe milestones and outcomes that ONC expects of and
from HIE governance entities as they enable electronic HIE. The intended audience for this framework includes state governments,
public-private partnerships, and HIE organizations. In addition, ONC believes third party assessors, such as those organizations dealing

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with certification and accreditation, will find the framework useful as they develop ways to assess the competency, credibility, and
trustworthiness of HIE governance entities. The framework includes four categories of principles:

¢ Organization Principles: Five principles intended to instill confidence among governed organizations, their users, and other exchange
partners regarding the way in which the electronic exchange is conducted;

¢ Trust Principles: Six principles to ensure patients have trust in the electronic HIE;

¢ Business Principles: Four principles regarding responsible financial and operational HIE policy that is necessary to improve care
coordination, improve the efficiency of health care delivery, and mitigate behaviors that could result in proprietary networks and
resistance to exchanging information; and

* Technical Principles: Six principles concerning the expectations of technical conformance and the use of standards an entity that sets
HIE policy should promote.

In May 2014, the ONC approved the American National Standards Institute for a second three-year term as the ONC-Approved

Accreditor (ONC-AA) for the ONC Health Information Technology Certification Program. [FN42] The ONC certifies electronic health
record technology products to ensure they meet the standards to improve health care quality, safety, and efficiency through the
promotion of health information technology and electronic health information exchange. The ONC-AA accredits the certification bodies
that seek to serve as ONC-Authorized Certification Bodies under this program and to ensure that they continue to meet requirements
necessary to maintain accreditation. The American National Standards Institute was approved as the ONC-AA after a competitive
process that included an evaluation against a specific set of requirements, including conformance to ISO/IEC 17011, and experience
evaluating conformance of certification bodies to ISO Guide 65.

Predictably, another cited obstacle, for both physicians and hospitals, to adopting electronic systems is the cost involved. Potential
costs to implementing health IT systems ranged from about $20 million for small hospitals to $200 million for major research institutions.

[FN43] Among hospitals with no EHR systems in place, nearly three-quarters cited inadequate capital as a barrier, while 44 percent cited
maintenance costs, 36 percent cited physician resistance and 32 percent felt the return on investment was unclear. The authors of the
hospital study concluded that the survey results 'suggest that policymakers face substantial obstacles to the achievement of healthcare

performance goals that depend on health information technology. " [FN44] Dr. David Blumenthal, the current National Coordinator for
Health Information Technology was one of the authors of the study.

To address the issue of the cost of adopting EHR systems, the federal goverment in 2011 began disbursing incentive payments to
hospitals and physicians. IFN45] Then in 2012 HHS Secretary, Kathleen Sebelius announced the next steps for health care providers

who are using electronic health record (EHR) technology and receiving incentive payments from Medicare and Medicaid. [FN46]
Secretary Sebelius stated, 'We have seen great success and momentum as we've taken the first steps toward adoption of this critical
technology. As we move into the next stage, we are encouraging even more providers to participate and support more coordinated,
patient-centered care." These proposed rules, from the Centers for Medicaid & Medicaid Services (CMS) and the Office of the National
Coordinator for Health Information Technology (ONC), will govern stage 2 of the Medicare and Medicaid Electronic Health Record
Incentive Programs. What is considered 'meaningful use" is evolving in three stages. Under Stage 1, which began in 2011 and remains
the starting point for all providers, the term 'meaningful use" consists of transferring data to EHRs and being able to share information,
including electronic copies and visit summaries for patients. Under Stage 2, to be implemented in 2014 under the proposed rule,
'meaningful use" includes new standards such as online access for patients to their health information, and electronic health information
exchange between providers. Under Stage 3, scheduled to be implemented in 2016, 'meaningful use" will include demonstrating that
the quality of health care has been improved.

CMS' proposed rule specified the Stage 2 criteria that eligible providers must meet to qualify for Medicare and/or Medicaid EHR

incentive payments. [FN47] The proposed rule also specified the Medicare payment adjustments that, beginning in 2015, providers will
face if they fail to demonstrate meaningful use of certified EHR technology and fail to meet other program participation requirements.
Under the proposed rule, Stage 1 was extended an additional year, allowing providers to attest to Stage 2 in 2014. The proposed rule
also identified standards and criteria for the certification of EHR technology, so eligible professionals and hospitals can be sure that the
systems they adopt can perform the required functions to demonstrate either stage of meaningful use that would be in effect starting in
2014.

In May 2015, the American Hospital Association (AHA) urged CMS to focus on developing the mature standards and infrastructure
needed for efficient and effective health information exchange, and to refrain from finalizing Stage3 EHRrequirements for meaningful

use until CMS has more experience with Stage 2. IFN48] AHA's Executive Vice President Rick Pollack in an open letter to CMS stated
that while the current Stage 3 proposals offer promising ideas that could further health information exchange and support greater
patient engagement, the transition to new technology that supports Stage 2 EHR requirementshas been very challenging for providers
due to the lack of 'vendor readiness, mandates to use untested standards, insufficient infrastructure to meet requirements to share
information and compressed timelines.'In addition, Pollack emphasized the Stage 2 EHR requirements have been very expensive. AHA
estimates that between 2010 and 2013 $47 billion was spent annually by hospitals on information technology.

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On Oct. 6, 2015 CMS and Office of the National Coordinator for Health Information Technology (ONC) released final rules that simplify

requirements and add new flexibilities for providers to make electronic health information more readily available. [FN49] The final rule for
2015 Edition Health IT Certification Criteria (2015 Edition) and final rule with comment period for the Medicare and Medicaid Electronic
Health Records (EHRs) Incentive Programs are intended to continue to move the health care industry away from a paper-based
system, where a doctor's handwriting needed to be interpreted and patient files could be misplaced.

As part of the regulations, CMS announced a 60-day public comment period to gather additional feedback about the EHR Incentive
Programs going forward, with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-
based Incentive Payment System and consolidates certain aspects of several quality measurement and federal incentive programs into
one more efficient framework. CMS will use this feedback to inform future policy developments for the EHR Incentive Programs, as well
as consider it during rulemaking to implement MACRA, which we expect to release in the spring of 2016. The EHR Incentive Programs

in 2015 through 2017, major provisions include: IFN50]
* 10 objectives for eligible professionals including one public health reporting objective, down from 18 total objectives in prior stages;

¢ 9 objectives for eligible hospitals and critical access hospitals (CAHs) including one public health reporting objective, down from 20
total objectives in prior stages; and

* Clinical Quality Measures (CQM) reporting for both eligible professionals (EPs) and eligible hospitals/CAHs remains as previously
finalized.

For Stage 3 of the EHR Incentive Programs in 2017 and subsequent years, major provisions include:

* 8 objectives for eligible professionals, eligible hospitals, and CAHs: In Stage 3, more than 60 percent of the proposed measures
require interoperability, up from 33 percent in Stage 2;

¢ public health reporting with flexible options for measure selection;
« CQM reporting aligned with the CMS quality reporting programs; and

* finalize the use of application program interfaces (APIs) that enable the development of new functionalities to build bridges
across systems and provide increased data access. This will help patients have unprecedented access to their own health records,
empowering individuals to make key health decisions.

The Stage 3 requirements are optional in 2017.

In addition to the final rule for the EHR Incentive Programs, ONC also announced the final rule for the 2015 Edition Health IT
Certification Criteria. This rule focuses on increasing interoperability ? a secure but seamless flow of electronic health information ? and
improving transparency and competition in the health IT marketplace.

CMS's incentive program is showing definite signs of success. By the end of May 2012 more than 100,000 health care providers
were using electronic health records that meet federal standards and had benefitted from the Medicare and Medicaid EHR Incentive

Programs. [FN51] Three months earlier, CMS Acting Administrator Marilyn Tavenner and National Coordinator for Health Information
Technology Farzad Mostashari, M.D., Sc.M., declared an ambitious goal of getting 100,000 health care providers to adopt or
meaningfully use EHRs by the end of 2012,'Meeting this goal so early in the year is a testament to the commitment of everyone who
has worked hard to meet the challenges of integrating EHRs and health information technology into clinical practice," said Acting
Administrator Tavenner. In December 2014, the ONC announced that over 400,000 eligible hospitals and professionals participate in

the Medicare and Medicaid Electronic Health Record Incentive Programs. [FN52]

However, small hospitals are still facing economic challenges in adapting to EHRs. Starting October 2014, hospitals that do not meet

Medicare's EHR standards will begin to see financial penalties. [FNS3) Many of the country's 2,000 rural and small-town hospitals
expressed concerned that they would not be able meet that deadline. Among the financial challenges facing such hospitals is that

the average rural hospital is running an annual financial loss of 8%. Also, it is difficult for hospitals to find people with information
technology skills outside of large, urban areas. As a result, some small hospitals are turning to bigger hospitals for help. For example,
a rural hospital in Red Lodge, Montana decided to become part of the larger Billings Clinic health care system, in part to get IT help.
While aligning with a larger system means giving up some if not all control of a hospital's operations, affiliating with a big network often
has benefits and can improve the care in small towns. One of the advantages the doctors at the Red Lodge hospital have found is that
now they can share patient records instantly and securely with the large hospital in Billings and get expert advice on an almost daily
basis.

The Office of Inspector General has found that the Oklahoma Health Care Authority did not always pay Medicaid electronic health

record incentive payments to professionals in accordance with Federal and State requirements. IFN54] The State agency incorrectly paid
$888,000 to 47 hospital-based professionals and claimed $127,000 more than it paid on its CMS-64 reports. Additionally, the National
Level Repository data did not include a $21,000 incentive payment.

To aid hospitals in the adoption of EHRs CMS issued a memorandum to State Survey Agency Directors concerning Electronic Health
Record Navigators. [FN59] in the memorandum CMS advised hospitals and Critical Access Hospitals (CAHs) that State Survey Agency

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surveyors may be requesting that experienced hospital/CAH electronic health record users with appropriate system permissions be
assigned as 'navigators' to assist the surveyors with medical record information retrieval for survey tasks requiring detailed medical
record review. CMS believes that providing such assistance is analogous to the traditional expectation for paper-based records that
such providers retrieve closed paper medical records requested by surveyors. CMS started that hospitals/CAHs are expected to
provide the necessary assistance to enable surveyors to review EHRs. The navigator would pull up records, or appropriate portions of
the records, when requested to do so by the surveyor for the surveyor to review via the computer. It is neither expected nor advisable
to ask that all requested records be printed out for the survey or to review. Surveyors are expected to request printouts or screen shots
selectively, based on their preliminary survey findings.

Another obstacle to the adoption of electronic systems is the workforce shortage ofqualified trained individuals. IFN56] To address this
shortage the HITECH Act authorized the creation of a program to assist in the establishment and/or expansion of programs to train a
skilled workforce to facilitate the adoption of EHRs. The Community College Consortia to Educate Health Information Professionals
is designed to train individuals to meet the needs of physicians and hospitals. The goal of the Consortia, which consists of over 70-

member community colleges, is to train 10,500 individuals a year. [FNS7]

Several studies have shown that the use of IT technology has definite advantages. A 2013 study published in JAMA shows that e-visits

for urinary tract infections (UTIs) and sinus infections may be less expensive and just as effective as in-person office visits. [FNS8) Ay
e-visit generally requires the patient to complete an online form after which a doctor or a nurse contacts the patient within a matter of
hours with advice concerning treatment. Dr. James Rohrer of the Mayo Clinic said that e-visits are happening across the country and
that many insurance companies believe they will cut costs. The study compared all e-visits and office visits for sinus infections and
UTIs over a 17-month period at four primary care practices in Pittsburgh, Pennsylvania. The e-visits and the office visits both resulted
with seven percent or less of the patients having a follow-up visit for the same conditions. The researchers estimated the average cost
for UTIs were $93 for an office visit as opposed to $74 for an e-visit. According to the study the main difference between e-visits and
traditional office visits is that e-visit patients tended to be prescribed more antibiotics. The researchers stated that while this may be of
concern it was difficult to interpret this fact on its own.

To address interoperability concerns, in early 2015 HHS released a draft of a shared nationwide interoperability roadmap. IFNSS] The
roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic
health information. The roadmap is built on a vision papers that HHS released in June 2014. HHS focused on three key areas in the
roadmap: (i) improving the way providers are paid, (ii) improving and innovating in care delivery, and (ii) sharing information more
broadly to providers, consumers, and others to support better decisions while maintaining privacy. The draft Roadmap identifies critical
actions to achieve success in sharing information and interoperability and outlines a timeframe for implementation. Along with the
announcement, the National Coordinator for Health Information Technology released its Draft 2015 Interoperability Advisory, which sets
forth the best available standards and implementation specifications for interoperability of clinical health information. The roadmap is
based on a core set of building blocks that HHS believes is necessary to achieve interoperability:

* core technical standards and functions;

* certification to support adoption and optimization of health IT products and services;
¢ privacy and security protections for health information;

* a supportive business, clinical, and regulatory environment; and

* rules of engagement and governance.

HHS and the Office of the National Coordinator for Health Information Technology (ONC) announced the release of the Final Federal

Health IT Strategic Plan 2015-2020. '*N®°l yyhile the aim of the Plan is to improve interoperability and the infrastructure of health IT, the
goal is to enhance health and wellness. This Final Plan follows a prior Plan released in 2011. In a letter accompanying the Final Plan,
the National Coordinator notes:

Implementation of the prior Plan created a strong foundation for achieving this Plan's goals and objectives. Over 450,000 eligible
professionals and 4,800 eligible hospitals received an incentive payment for participation in the Medicare and Medicaid Electronic
Health Record (EHR) Incentive Programs. This incredible achievement was not easy. Hospitals and health care providers have
invested capital, time, and hard work to convert their patient medical records from paper systems to EHRs, and to adapt workflow and
culture to deliver care in this electronic environment. This has created a strong demand for the seamless sharing of information across

technology systems, information platforms, location, provider, or other boundaries. [FN61]
The Plan identifies the following federal health IT principles:

* focus on value;

* be person-centered;

* respect individual preferences;

* build a culture of electronic health information access and use;

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¢ create an environment of continuous learning and improvement;
* encourage innovation and competition; and

* be a responsible steward of the country's money and trust.
From these principles, four goals emerge:

advance person-centered and self-managed health;

transform health care delivery and community health;

foster research, scientific knowledge, and innovation; and

enhance nation's health IT infrastructure. 'FN&21

The push to adopt EHRs has been driven by the belief that they offer definite benefits to both providers and patients. A 2011 study
reported in the Journal of American Medicine, which was done by researchers at the Department of Veterans Affairs, found that the

use of computers to scan doctors' notes could reduce dangerous complications following surgery. IFN63] The study employed 'natural
language processing" to detect clues for possible post-surgery complications. By looking at the records of approximately 3,000 VA
patients between the years of 1999 and 2006, the technology dramatically increased the detection of such complications as acute renal
failure, deep vein thrombosis, and pneumonia.

There is some evidence, however, that suggests that EHRs do little to help patients outside of hospitals. Researchers from Stanford
University who analyzed federal data on more than 255,000 patients, about a third of whom had electronic health records (EHRs),
released in study in January 2011 which found that often there is no benefit to have an EHR. Using 20 different measures of quality, the

researchers compared the care of those patients to the care of patients without EHRs. [FN64] Sich measures included whether smokers
were counseled on ways to quit and whether proper medication was prescribed for patients with simple infections. On 19 of the 20
measures, they found no benefit from having an EHR. The one exception was dietary advice. The researchers found that patients at
high-risk for illness were slightly more likely to receive counseling on a proper diet. Dr. Randall Stafford, a professor at the Stanford
Prevention Research Center and co-author of the study said, "Our initial hope was that we would see a correlation between electronic
health records and quality, and when we looked at the subset of patients whose doctors got help from the clinical decision support
systems, we'd see an even stronger relationship. Perhaps we need to re-examine the naive assumption that just putting in place an
EHR system will make a huge difference.'

Also, there is a 2013 study published in Health Affairs that examined the Rand Corporation's 2005 projection that health information

technology could save the United States more than $81 billion annually. IFN65] The authors found that seven years later the empirical
data on the technology's impact on health care efficiency and safety are mixed. The authors believe several factors have caused the
mixed results. These factors include: (i) the slow adoption of health IT systems, coupled with the choice of systems that are neither
interoperable nor easy to use; and (ii) the failure of health care providers and facilities to reengineer care processes to take advantage
of the full benefits of health IT. Today, 72% of office-based physicians use some sort of electronic system in their practice, however

only 40% of practices meet the definition of a 'basic" system. [FN66] According to Dr. Art Kellermann, one of the authors, the ability for
doctors to easily share information is the exception in America, not the rule. The authors believe that the original goals for health IT are
achievable provided the systems are redesigned by creating more-standardized systems that are easier to use, are truly interoperable,
and afford patients more access to and control over their health data. Dr. Kellermann stated, 'As we shift American health care and start
paying for the best quality care and the best outcomes, rather than who does the most stuff, who orders the most tests or who does the
most operations, then | think you'll see IT becoming a tool for efficiency and high performance.

Many experts, however, do see a real advantage to EHRs in addition to their ability to prevent medical errors. For example, the
Veterans Administration (VA), which has been utilizing electronic health records for over 20 years, is in the process of creating the

world's largest medical database for research purposes. [FN67] Dart of this project involves obtaining blood samples from 1 million U.S.
veterans. Those samples will then be paired with the VA's current mega-database which contains records of laboratory results, vital
signs, pharmaceuticals, assessments of depression, post-traumatic stress disorder, suicide screening, alcohol and substances use, and
traumatic brain injury. The patient's names will be removed from the database to ensure that the data is anonymous. The VA intends
for the database to be used by researchers for such purposes as to better understand why some people are more responsive to certain
drugs and why some are more vulnerable to certain diseases. Despite scrubbing the names from the data, VA clinics are reporting

that the number one concern of possible participants is privacy and the fear that the information could end up with future employers or
insurers.

The military is also seeing the advantages of Health IT in caring for its service members. Recently TRICARE Management Activity,
a component of the U.S. Military Health System, has awarded LongView International Technology Solutions, Inc. (LongView) a five-
year, multi-award contract to develop new information technology systems for the Military Health System's Pacific Joint Information

Technology Center (JITC) on Maui. [FN68] The contract's ceiling value is $300 million. The Pacific JITC is center for proof of concept and
prototyping of Information Management/Information Technology products and services to support the Department of Defense's medical
readiness requirements and the Department's Information Technology modernization needs across the medical continuum of care. The

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Pacific JITC's mission is to rapidly research, test, and develop warfighter medical solutions and products, through pilots or prototypes
that provide mission critical value and actionable information to the Department. Ben Long, President and CEO of LongView, said 'As a
national security and federal healthcare-focused Service-Disabled Veteran-Owned Small Business, LongView keenly understands the
importance the Pacific JITC program plays in advancing the medical IM/IT solutions that support the warfighter, including the prototype
development of the Electronic Health Record.'LongView is based in the Washington D.C. area.

Hospitals that have adopted the use of EHRs have been very pleased with the results. In 2012, The Ohio State University Wexner

Medical received the Stage 7 Award for its four hospitals. [FN69] Stage 7 is the highest level of implementation on the Electronic Medical
Records Adoption Model, which tracks EMR progress at hospitals and health systems. 'Our electronic system will allow us to provide
more efficient, effective and better coordinated care to our patients. Patient records are in a central, secure location where health
providers can access their patients' current health information," said Steven G. Gabbe, MD, Wexner Medical Center's CEO. HIMSS
Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of EMR systems for
hospitals. The Model has eight stages (0-7) that measure a hospital's implementation and utilization of IT applications.

More and more hospitals are receiving the Stage 7 Award. Currently only 1.16 percent of the more than 19,085 U.S. ambulatory clinics
in the HIMSS Analytics? Database, have received the Stage 7 Ambulatory Award. In November 2013, HIMSS Analytics recognized

Atrius Health and also separately its affiliate, Reliant Medical Group, in Worcester, Mass., [FN70] 59 of Truman Medical Centers (TMC)

ambulatory clinics, [FN71] St. Vincent Hospital in Green Bay, Wis., St. Mary's Hospital Medical Center in Green Bay, Wis., and St.
Nicholas Hospital in Sheboygan, Wis., part of Hospital Sisters Health System, and 44 of University of Missouri's (MU Health Care)'s

ambulatory clinics with its State 7 Ambulatory Award. [FN72]

HIMSS announced in October 2013 the opening of the HIMSS Innovation Center as part of the Global Center for Health Innovation, in

downtown Cleveland, Ohio. [FN73] The Innovation Center, which covers a 30,000-square-foot space, includes a Health IT Simulation
Center testing health IT interoperability and a Healthcare Technology Showcase demonstrating the value of IT and information
exchange to patient care, clinician and patient satisfaction, population health, and the bottom line. The Innovation Center is a fully
operational, multi-care environment populated with simulated patient demographic, clinical and financial data. It allows members of
the health and healthcare communities to interact in real-time to both test and demonsirate scenarios that elicit a specific product's
interoperability and other capabilities to improve quality and patient outcomes, cost-effective care coordination, secure data exchange,
and better business performance.

The pursuit of a comprehensive national health IT system has emerged because of demonstrations showing that digitalizing medical
information could outweigh any potential drawbacks in the long run. The Department of Veterans Affairs (VA) has demonstrated
benefits to quality of healthcare and significant cost savings from the use of health IT, according to a study published in Health Affairs.

[FN74] Researchers from the Center for Information Technology Leadership believe the finding could provide a framework for measuring
benefits of federal health IT funding programs. They compared health IT in the VA with private sector systems over a ten-year period
from 1997 to 2007 and examined how well providers met clinical guidelines using EHRs and computerized alerts. The study focused on
chronic illnesses like diabetes, which affect a quarter of VA patients.

The study's authors found that the VA spent more on health IT compared to the private sector and achieved higher levels of health

IT adoption and quality of healthcare. Diabetic VA patients showed better compliance with glucose testing, had better controlled
cholesterol levels, and underwent timelier retinal exams compared to Medicare counterparts. The elimination of redundant tests and
reduction of medical errors resulted in more than 86 percent of the savings of healthcare costs. Reduced workload and operating
expenses also led to savings. 'VA has seen its investment in health information technology pay off for veterans and taxpayers for many
years, and this study provides positive evidence for this correlation," said VA Secretary Eric K. Shinseki. 'The benefits have exceeded

costs, proving that the implementation of secure, efficient systems of electronic records is a good idea for all our citizens. " [FN75]

State governments are using contests as ways to encourage ideas concerning the use of health information technology. For example,
in March 2012, the Maryland Department of Health and Mental Hygiene (DHMH) has partnered with the Chesapeake Regional
Information System for Our Patients (CRISP) and the Abell Foundation to launch a contest for practical ideas concerning the innovative

use of data to address public health challenges facing Maryland. IFN76] Applicants are encouraged to propose solutions using data

from more than 16 existing health-related databases in combination with various other publicly available state and Federal databases.
Applicants are encouraged to propose ideas that leverage Maryland's health information exchange infrastructure and lead to significant
health gains, while respecting privacy. A total of $5,000 in prize money, provided by the Abell Foundation, will be awarded for the best
ideas.

To aid providers in effectively engaging patients in choosing how they want their electronic patient health information shared, in
September 2013, HHS launched its Meaningful Consent site, an online resource to help health care providers effectively engage

patients in choosing how they want their electronic patient health information shared. [FN77] The website includes the laws, policies and
issues related to the electronic exchange of health information. In addition, the site is a source of strategies and tools that can be used
to engage and educate patients. It is designed

for providers, certain health information organizations and other implementers of health information technology.

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Because of all the interest in Health IT, the industry itself is thriving. Mercom Capital Group, LLC, a global consulting firm, released a
report on funding and mergers & acquisitions in the Health IT Sector showing that globally the second quarter of 2014 was the sector's

first billion-dollar quarter. [FN78] Venture Capital funding raised $1.8 billion in 161 deals, which was a 104% increase over $861 million
raised in 2014's first quarter. The $2.6 billion raised so far this year is greater than the $2.2 raised in all of 2013. U.S. companies raised
$1.6 billion of the $1.8 billion raised globally with a total of 161 deals. Forty-seven of those deals came out of California, 12 were New
York, eight in Massachusetts and seven deals each in Texas and Tennessee.

The success in the industry is contributing to a positive feeling among the workforce. Healthcare IT Leaders just released the results of

a survey of healthcare IT professionals completed during May 2014. [FN79] OF the 446 valid, completed surveys, 198 were by individuals
who self-identified as permanent IT employees for a healthcare industry employer and 248 self-identified as IT consultants with
healthcare clients. The survey found that 43% of the consultants were 'very satisfied" in their jobs and only 2% were 'very dissatisfied"
while only 19% of the full-time employees said they were very satisfied and 12% reported being very dissatisfied. The survey also found
that 40% of the consultants were very satisfied with their pay while only 18% of the full-time employees said they were. Both groups
had 54% of the respondents saying that they found their jobs either extremely challenging or very challenging. Both groups also had
high numbers of respondents saying their work was either extremely meaningful or very meaningful (72% of full-time employees and
82% of consultants). Only a small minority of both groups said they would not consider a new job, which infers that most would consider
changing positions if the job was right. Health IT Leaders recommends that Healthcare IT hiring companies should focus on retention of
their IT employees by keeping the team engaged and well-compensated.

To assist in growing the workforce to meet future demands, the U.S. Department of Labor, Education and Training Administration and
Bellevue College have teamed with HIMSS to offer a Veterans Career Initiative. [FN80] The initiative's goal is to 'to welcome transitioning

military veterans into the health IT field - a growing and promising area for technologically-adept veterans." IFN81] The Bureau of Labor
Statistics projects that health IT jobs will grow by 21% through 2020. This workforce solution is funded by an $11.7 million grant
awarded by the U.S. Department of Labor's Employment and Training Administration. The initiative offers a veteran mentoring program
in which military veterans working as health IT professionals assist veterans transitioning to the workforce, a webinar series and a
health IT certification program.

On Nov. 4, 2014, HHS Secretary Sylvia M. Burwell today named a new member to the Health Information Technology Policy

Committee (HITPC) and renewed appointments for three members of the Health IT Standards Committee (HITSC). IFN82] The
committees are charged with recommending policies and technologies needed to implement a nationwide health information technology
infrastructure and strategic plan. The HHS Secretary, appoints three members of the HITPC with input from the HHS National
Coordinator for Health IT, four members are appointed by Congress, the Comptroller General of the United States appoints 13
members and the President appoints the other members. The new member named is Anjum Khurshid, a senior advisor - health
systems division, Louisiana Public Health Institute. The continuing members are Floyd Eisenberg, M.D., M.P.H., Leslie Kelly Hall, and
Arien Malec.

In May 2015, the ONC has announced the availability of online tools and resources designed to help states participating in the State

Innovation Models initiative improve health care quality and lower costs. IFN83] The State Innovation Models initiative supports states
in planning or implementing a customized, fully developed proposal creating statewide health transformation to improve health care,
focusing on Medicare, Medicaid, and Children's Health Insurance Program beneficiaries. Thirty-four states, three territories, and the
District of Columbia, representing nearly two-thirds of the U.S. population, are participating in the initiative. Under the initiative ONC
has developed tools and resources to help leverage existing health IT infrastructure. These include resources that can help states
and health care providers use health IT tools to manage an individual's care for both their primary care and behavioral health needs,
ensuring the individual is getting the right care when they need it.

Recently CMS announced on its blog that it will update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

beginning in 2015. [FNE4] The purpose of these changes is to reduce the reporting burden on providers, while at the same time
supporting the long-term goals of the program. As of January 2014, over 400,000 eligible providers have joined the numbers of
hospitals and professionals that have adopted or are meaningfully using EHRs. CMS intends to propose the new rule this spring. CMS
plans for it to be responsive to provider concerns about software implementation and information exchange readiness. In addition, the
new role will be reflective of developments in the industry and progress toward program goals achieved since the program began in
2011. Among the proposals CMS is considering are:

* to realign hospital EHR reporting periods to the calendar year. This proposal will allow hospitals to incorporate 2014 Edition software
into their workflows and to better align with other CMS quality programs.

* to modify other parts of the program so that they better align with long-term goals, reduce complexity, and lessen providers' reporting
burdens.

¢ to shorten the EHR reporting period to 90 days.

In July 2015, the Department of Health and Human Services announced that as part of the effort to create an interoperable learning
health system the Office of the National Coordinator for Health Information Technology (ONC) would award twenty entities for three

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health information technology grant programs totaling about $38 million. IFN85] The grants build on programs funded from the Health
Information Technology and Clinical Health Act (HITECH). These grants will further the Department's efforts to improve the way
providers are paid, improve and innovate in care delivery, and share information more broadly to providers, consumers, and others to
support better health care decisions while maintaining privacy. The three cooperative agreement programs are:

¢ Advance Interoperable Health Information Technology Services to Support Health Information Exchange. This is a two-year
cooperative agreement program that was awarded $29.6 million to support the efforts of 12 states or state designated entities to
expand the adoption of health information exchange technology, tools, and services; facilitate and enable the send, receive, find, and
use capabilities of health information across organizational, vendor, and geographic boundaries; and increase the integration of health
information in interoperable health IT to support care processes and decision making. The organizations selected to participate in

this program include:Arkansas Office of Health Information Technology, California Emergency Medical Services Authority, Colorado
Department of Health Care Policy and Financing, Delaware Health Information Network, Illinois Health Information Exchange Authority,
Nebraska Department of Administrative Services, New Hampshire Health Information Organization Corporation, New Jersey Innovation
Institute, Oregon Health Authority, Rhode Island Quality Institute, South Carolina Health Information Partners, Inc., and Utah Health
Information Network.

* The Community Health Peer Learning Program. This is a two-year cooperative agreement grant award was made to AcademyHealth
to work with 15 communities around population health strategies. Communities working with AcademyHealth under this program will be
required to identify data solutions, accelerate local progress, disseminate best practices and learning guides, and help inform national
strategy around population health challenges. The grant for this program totals $2.2 million.

¢ The Workforce Training Program. This is a two-year cooperative agreement program has awarded seven grantees $6.7 million to
update training materials from the original Workforce Curriculum Development program funded under HITECH. In addition to updating
training materials, the goal of this program is to train incumbent health care workers to use new health information technologies in a
variety of settings, including: team-based care environments, long-term care facilities, patient-centered medical homes, accountable
care organizations, hospitals, and clinics. This workforce program will focus on the four key topic areas of: population health, care
coordination, new care delivery and payments models, and value based and patient centered care. The organizations selected to
participate in this program include:University of Alabama at Birmingham, Bellevue College, Bellevue, Washington, Columbia University,
New York City, New York, Johns Hopkins University, Baltimore, Maryland, Normandale Community College, Bloomington, Minnesota,
Oregon Health & Science University, Portland, Oregon, and The University of Texas Health Science (Houston).

In January 2016, the Centers for Medicare and Medicaid Services requested feedback from the health information technology industry
to improve the certification and testing of electronic health records used for reporting quality measures. CMS wants feedback on the
following: 'how often to require recertification, the number of clinical quality measures a certified health IT module should be required to
certify and testing of certified HIT modules "in order to reduce the burden and further streamline the process for providers and health IT
developers while ensuring such products are certified and tested appropriately for effectiveness. Following the comment period, CMS
will determine whether it should update the rules regarding quality reporting programs.

The Department of Health and Humans Services' Office of Civil Rights (OCR) issued guidelines on October 7 for HIPPA-covered

entities that utilize cloud computing solutions. [FNS6] The guidance provides guidance to covered entities and business associates,
including cloud service providers (CSPs), with understanding their obligations under HIPAA privacy and security rules when
implementing cloud computing solutions. The guidelines clarify that CSPs that lack an encryption key to encrypted date are not
exempt CSPs from the obligations of HIPAA because encryption alone does not safeguard ePHI. Thus, CSPs must execute Business
Associate Agreements with its covered entity and business associate customers. As a result, the CSP is both contractually liable for
meeting the terms of the Business Associate Agreement and directly liable for compliance with the applicable requirements of HIPAA.

CSPs cannot argue that they are a conduit and therefore not a business associate. CSPs providing cloud services that involve creating,
receiving or maintaining ePHI meet the definition of a business associate, even if the CSP is providing no-view services. CSPs must
document security incidents just like any other business associate and must satisfy any breach notification requirements that applies
to unencrypted data. Health care providers, other covered entities, and business associates may use mobile devices to access ePHI
in the cloud if appropriate physical, administrative, and technical safeguards are in place to protect the confidentiality, integrity, and
availability of the ePHI on the mobile device and in the cloud. As is normally the case under HIPAA, CSPs are not required to maintain
ePHI for a period beyond when it has finished providing services to a covered entity or business associate. Covered entities and
business associates can use CSPs that store ePHI on servers outside the U.S. but should consider the increased risks of hacking or
malware that may be present in other countries. Of course, cross-border transfers of ePHI may raise other regulatory issues. HIPAA
does not require CSPs to provide documentation or allow auditing of their security practices by their customers. CSPs that receive and
maintain only information that has been de-identified in accordance with the HIPAA Privacy Rule will not be considered a business
associate.

Nearly 87% of physicians in the United States were using electronic health records in 2015 which has nearly doubled since 2007. The
increase in use has been spurned by federal incentives and a desire to improve accessibility. However, physicians and patients are still
having trouble accessing and sharing the electronic health records. Right now, it appears that there are too many players in creating

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the technology for electronic health records that is leading to varied standards, disorganization, and complexity. As a result, 'President
Obama signed new legislation that included provisions designed to help improve interoperability of health records systems." [FN87]
Hospital ICUs Lean on Telemedicine Amid U.S. COVID-19 Crisis

(Reuters) - As the coronavirus pandemic spreads deeper into America's small towns and rural outposts, Dr. Tallulah Holmstrom has
seen familiar faces fill her intensive-care unit in Camden, South Carolina. [FN88]

A native of this hamlet of 7,000 people, Holmstrom saw its ICU threatened with closure in recent years as specialists departed for
bigger cities. Now faraway doctors are helping treat the community's COVID-19 patients, thanks to technology.

KershawHealth, the local hospital, installed cameras and other equipment for 24-hour monitoring by a company that employs doctors
and nurses remotely. Sitting in cubicles in St. Louis, Houston and Honolulu, as well as other countries including Israel and India,
these medical workers watch patients' vital signs on computer screens and talk to local staff on two-way video about medications and
treatments. KershawHealth employees can summon emergency help from these teleworkers by hitting a button on the wall.

Holmstrom said those changes, begun four years ago, have helped her hospital better handle the current crisis. While Camden and
surrounding Kershaw County have seen more than 1,600 confirmed infections and 34 deaths, the technology has enabled many of the
area's COVID-19 patients to be hospitalized close to home.

'Now a patient can look up from their ICU bed here and they are seeing a friend's daughter or son taking care of them or someone they
go to church with,' said Holmstrom, chief medical officer at KershawHealth.

Camden is among a growing number of communities relying on this elaborate form of telemedicine to cope with an unrelenting
COVID-19 case load and to manage unpredictable surges.

Well before the current crisis, vast stretches of rural America lacked easy access to advanced medical care. More than 130 rural
hospitals have closed in the United States since 2010, including 18 last year, according to University of North Carolina researchers.

Rural areas tend to have higher rates of underlying health conditions such as diabetes and hypertension. Their populations often are
older and poorer ? making them more vulnerable to COVID-19.

Even if beds were available, qualified staff are hard to find. It's estimated that 43 states, including South Carolina, face a shortage of
highly trained ICU doctors, known as intensivists, according to researchers at George Washington University. These shortages may
worsen with hospitalizations in many states predicted to peak this fall, when the coronavirus mixes with flu season, according to Patricia
Pittman, director of the university's Mullan Institute for Health Workforce Equity.

'No one is suggesting telemedicine is ideal, but it's probably one of the least bad options,' she said. 'It is definitely better than having no
one and helicoptering people out.'

SCALING EXPERTISE

About a third of U.S. hospitals surveyed in 2017 said they had access to a formal program of telemedicine for critically ill patients.
Studies have shown telemedicine can benefit ICU patients by promoting the best practices supported by medical evidence and by
reducing complications. During the pandemic, doctors say, it has helped conserve personal protective equipment and reduce workers'
exposure to the virus.

There can be drawbacks, too, if physicians try to monitor too many people at once, which can lead to poor decisions or even medical
errors. Tele-ICU generally requires physicians working remotely to hold a license in each state where people are hospitalized.

The Trump administration has eased rules on telehealth during the pandemic and expanded reimbursement by Medicare. Shares of
telemedicine companies such as Teladoc Health Inc have soared as patients embraced online visits.

Sutter Health, a large hospital system in California, said it manages more than 300 ICU beds across 18 hospitals from offices in
Sacramento and San Francisco.

Earlier this month at its Sacramento hub, Dr. Vanessa Walker checked in remotely on a patient who was taken off a ventilator earlier in
the day at Sutter's Roseville hospital about 25 miles away. Using a headset and camera, she clicked the patient's name on her screen,
which rang a doorbell to notify the patient that she was entering the room via video.

'Save your breath. You're doing well otherwise,' she told the patient.

Walker, the medical director of Sutter's electronic ICU for its hospitals in California's Central Valley, had a wide array of information
across six monitors at her desk. She could review medical records and see multiple scans of the patient's lungs before and after
treatment.

CAUTIONARY TALE

As use of this technology grows, patient-safety advocates warn hospitals not to cut corners. They say cameras and computers are no
substitute for trained professionals at the bedside who can respond rapidly to life-threatening complications.

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The Leapfrog Group, a nonprofit that monitors patient safety, recommends that a physician certified in critical care medicine perform an
in-person review of each ICU patient daily before handing off monitoring to colleagues remotely. The group says remote doctors should
lower their patient loads if they can't respond within five minutes to requests from on-site staff and evaluate the patient.

Steve Burrows, a Los Angeles filmmaker, remains a skeptic.

He said his mother had complications during a hip operation in 2009 and suffered permanent brain damage in surgery and the ICU at a
Wisconsin hospital.

In litigation, Burrows said, he learned that a doctor was remotely monitoring more than 150 ICU patients, and there was no physician
in the ICU who could respond to his mother's low blood pressure. He released an HBO documentary, 'Bleed Out,' in 2018 about his
mother's case.

'Telemedicine is fantastic if it's used properly,' he said in an interview. 'But I think replacing doctors at the bedside with technology is
insane.'

At trial, a jury found there was no negligence by the hospital. Advocate Aurora Health, the current hospital owner after a merger, said
its electronic ICU 'does not replace bedside caregivers. Instead, it serves as an additional set of eyes that provides an extra layer of
safety.'

'CONSTANT ATTENTION'

Advanced ICU Care, the St. Louis company serving Camden, works with more than 90 hospitals in 26 states. Overall, it has treated
more than 1,300 COVID-19 patients.

'These patients need constant attention and continuous adjustments. That is a lot of what we do,' said Dr. Ram Srinivasan, the
company's chief medical officer.

South Carolina remains a hot spot for coronavirus infections with more than 126,000 cases and 2,877 confirmed deaths as of
September 11.

The state's first two cases of COVID-19 were announced the same day in early March and one was in Camden, a place so rural that
signs remind people not to ride horses on the sidewalk.

Holmstrom, the chief medical officer at KershawHealth, got a call with the news while driving home that Friday, March 6. Within a matter
of days, there were six people infected and four were hospitalized.

The Camden ICU was nearly full for weeks as the medical staff juggled COVID-19 patients alongside the normal flow of critically ill
people. Hospitalizations eased around Memorial Day, Holmstrom said, only to surge again in July and much of August.

'When you're a town this small and 32 people get sick in one day that's a lot,' said Vic Carpenter, Kershaw County administrator.

Holmstrom, who was born in the hospital where she now works, has experienced highs and lows. A close friend who spent six weeks in
the hospital is now back to full strength. Holmstrom arranged final video calls for others to say goodbye to their families.

KershawHealth is bracing for another surge this fall, when it once again will turn to remote doctors to back up busy hospital staff.
'It's like someone constantly in the background overlooking everything with your care,' Holmstrom said.
Regulatory Relief and Insurers' Adoption of Telehealth Key to Keeping Momentum in U.S.

(Regulatory Intelligence) - The U.S. healthcare sector appears to have reached a point of no return from telehealth usage, due to the
COVID-19 pandemic, and is pushing to maintain the growth momentum. More regulatory accommodation and a stronger endorsement

by health insurers of virtual care are key to achieving that goal. [FN89]

Health insurers have largely supported reimbursing for telehealth services since the start of the pandemic. However, they have
expressed concerns on issues like overutilization, the application to value-based payments models, and state jurisdictional questions.
They are urging lawmakers to include provisions for insurers to better incorporate telehealth services in their plans.

The administration of President Donald Trump eliminated several roadblocks to help providers and insurers embrace telehealth
during the public health emergency. The Centers for Medicare and Medicaid Services is also working on making some of the changes
permanent.

Congressional action, however, is needed to allow patients to receive healthcare services in their homes and other sites of care.
Healthcare and policy experts say the magnitude of the opportunity offered by virtual healthcare must be recognized and lawmakers
need to act soon to allow providers and insurers to unlock all the benefits offered by telehealth.

'The increased uptake of telehealth is certainly understandable... from the standpoint of patient care, from the standpoint of institutional
viability and from the standpoint of the fiscal viability of the U.S. federal government,' said Philip Auerswald, associate professor at
George Mason University. 'Telehealth presents a larger opportunity to move the entire health service delivery system away from the
institutional setting and toward home healthcare, wherever practical,' he said.

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'The regulatory structure we have currently strongly favors care delivered in an institutional setting. Where the different elements
of healthcare to the home have been reimbursed, [they] have strongly tended to be under highly constrained requirements and
disfavorable financial structures,' he added.

Prior to the COVID-19 public health emergency, patients had to travel to 'originating sites' such as hospitals, health clinics, or
physician's offices to be eligible for reimbursement. The Centers for Medicare and Medicaid Services has made some exceptions in
very few cases, such as for end-stage renal disorder patients.

More data on the efficacy of telehealth and more customer satisfaction from receiving virtual care could change the regulatory bias
towards care provided in an institutional setting, Auerswald added.

'Telehealth can bring healthcare into the 21st century,' Kyle Zebley, Director of public policy at the American Telehealth Association
(ATA) said. 'Preventative care, value-based care, home-based care, aging in place - these are all things we cannot get to without fuller
utilization or interoperability of telehealth and medical devices in remote monitoring.'

The ATA is calling on Congress to remove the arbitrary originating-site restriction and allow patients to receive services in the home
and other sites of care. Congress should also allow CMS to determine practitioners appropriate to practice telehealth, according to the
ATA.

CMS has currently allowed all providers to be eligible to bill Medicare for telehealth services during the course of the COVID-19
emergency.

Health insurers have called for policy revision that would enable healthcare delivery across state lines. The ATA proposes that states
could set up licensure compacts or groups in which physicians with a license in one state will be automatically eligible to practice in
other member states.

Insurers have also sought regulatory provisions to use technology to manage any overutilization of telehealth services. Proponents of
telehealth, however, call that concern unfounded, saying a timely telehealth consultation may put off a potentially more cost-intensive
treatment.

While the pandemic led to patients shifting almost completely to virtual care, most agree that a healthy mix of in-person and virtual care
needs to be determined in order to sustain telehealth integration into routine healthcare.

Insurers and healthcare providers also must find a way to integrate telehealth services into the value-based care payment model,
in which insurers reimburse providers based on the overall health outcome of the patient rather than the number of health services
rendered to them. Telehealth is currently reimbursed on a fee-for-service basis, a payment model that insurers have been trying to
move away from.

'The private sector will likely drive the innovation and solutions while regulators have to create a path for patients to access this new
healthcare environment,' Zebley said. 'The ATA is working to ensure regulatory roadblocks are not put back up once the public health
emergency comes to an end,' he said.

'Telehealth is healthcare and the care received from a telehealth visit when clinically appropriate is just as good and high quality, if not
better than the care you would receive in person,' Zebley said.

Recent Federal Activity

85 FR 84472-01, issued December 28, 2020, amends 42 ? 414.1305 (Definitions) revising the definition of 'certified electronic health
record technology (CEHRT)." The regulations are effective January 1, 2021.

Recent Federal Activity
Arkansas

2021 AR H.B. 1886 (NS), engrossed April 19, 2021, would amend AR ST ? 16-46-106 (Access to medical records for legal
proceeding ? Definitions) to update the requirements for accessing medical records for legal proceedings and adding fees for
duplication of electronically stored medical records. The bill is effective July 30, 2021.

California

2021 CA A.B. 858 (NS), amended/substituted July 15, 2021, would adopt a new section to would authorize each worker who provides
direct patient care at a general acute care hospital to override health information technology and clinical practice guidelines if, in their
professional judgment, and in accordance with their scope of practice, which includes receiving the approval of the patient's physician,
it is in the best interest of the patient to do so. Require each employer to notify all workers who provide direct patient care, and if subject
to a collective bargaining agreement, their representatives, before implementing new information technology that materially affects the
jobs of the workers or their patients. Prohibit an employer from retaliating or otherwise discriminating against a worker providing direct
patient care who requests to override health information technology and clinical practice guidelines or discusses these issues with other
employees or supervisors.

Colorado

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2021 CO H.B. 1276 (NS), adopted June 28, 2021, amends CO ST ? 12-280-404 (Program operation--access--rules--definitions--repeal)
allowing the Board to, within existing funds available for operation of the Program, provide a means of sharing prescription information
and electronic health records through a Board-approved vendor and method with the health information organization network in order
to work collaboratively with the statewide health information exchanges designated by the Department of Health Care Policy and
Financing. The bill is effective June 28, 2021.

Connecticut

* 2021 CT H.B. 6398 (NS), adopted June 24, 2021, amends CT ST ? 17a-565 (Advisory board) to allow the Department of Mental
Health and Addiction Services to establish and use a single electronic health record (EHR) system for authorized personnel to access
patient health records from any of DMHAS's divisions and facilities for purposes of diagnosing and treating patients and improving
operations. The bill is effective October 1, 2021.

* 2021 CT H.B. 6424 (NS), introduced February 1, 2021, would amend CT ST ? 17b-59e (Electronic health record systems. Connection
to State-wide Health Information Exchange) to clarify and standardize race, ethnicity, and language data collection for health care
providers required to connect to the State-wide Health Information Exchange.

¢ 2021 CT S.B. 1 (NS), adopted June 14, 2021, requires each health care provider with an electronic health record system capable
of connecting to and participating in the State-wide Health Information Exchange as specified in section CT ST ? 17b-59e (Electronic
health record systems. Connection to State-wide Health Information Exchange) of the general statutes shall, collect and include in its
electronic health record system self-reported patient demographic data including, but not limited to, race, ethnicity, primary language,
insurance status and disability status based upon the implementation plan. The bill is effective June 14, 2021.

District of Columbia

«2021 DC REG TEXT 558898 (NS), published January 29, 2021, amends 22-A DC ADC ? 8024 (Behavioral Health Stabilization
Programs: General Requirements) to require each provider to provide the Department with regular access to the provider's medical
and billing records, including electronic medical records, within 24 hours of a Departmental request, or, immediately in the case of
emergency.

* 2021 DC REG TEXT 574188 (NS), adopted December 23, 2020, adopts 29 DC ADC ? 9006 (Records and Confidentiality of
Information) establishing the confidentiality requirements for Home and Community-Based Services Waiver for Individual and Family
Support. Adds electronic record system requirements. The rulemaking was adopted via emergency and is effective December 23,
2020.

Georgia
2021 GA H.B. 697 (NS), introduced March 1, 2021, would amend GA ST ? 31-7-280 (Annual report) and adopt GA ST ? 31-7-286 to

define 'certified electronic health records technology," 'information blocking" and 'interoperability' and to require the report to include,
for hospitals or the hospital's electronic health records vendor or other such agent of the hospital, the current status of implementation
or use of the meaningful electronic health records user standards, interoperability standards, and certified electronic health records

technology standards.
Maine

¢ 2021 ME H.P. 773 (NS), introduced March 11, 2021, would adopt ME ST T. 24-A ? 7510 (Maine Health Care Board) to require that
all electronic health records used by providers be fully interoperable with the open-source electronic health records system used by the
United States Department of Veterans Affairs.

¢ 2021 ME S.P. 207 (NS), adopted May 25, 2021, amends ME ST T. 24-A ? 4304 (Utilization review) providing that unless a waiver is
granted by the superintendent, a carrier or entity under contract toa carrier must make available to a provider in real time at the point
of prescribing one or more electronic benefit tools that are capable of integrating with at least one electronic prescribing system or
electronic medical record system to provide complete, accurate, timely, clinically appropriate formulary and benefit information specific
to an enrollee. The bill is effective January 1, 2022.

Maryland

2021 MD S.B. 262 (NS), adopted May 18, 2021, requires the Department of Information Technology to conduct a certain review
of certain information technology platforms used by certain health occupations boards and make certain recommendations on the
feasibility and cost of developing a certain common information technology platform. The bill is effective June 1, 2021.

Massachusetts

¢ 2021 MA H.D. 1893 (NS), draft/request February 12, 2021, and 2021 MA S.B. 1088 (NS), draft/request February 11, 2021, would
require the Executive Office of Health and Human Services to coordinate with the Executive Office of Public Safety and Security to
develop regulations that would allow healthcare providers to be able to access reports on individuals maintained by agencies within
each executive office as well as other public safety and law enforcement officials through a secure electronic medical record, health
information exchange, or other similar software or information systems connected to healthcare providers for the purposes of: (i)
improving ease of access and utilization of such data for treatment and diagnosis; (ii) supporting integration of such data within the

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electronic health records of a healthcare provider for purposes of treatment of diagnosis; or (iii) allowing healthcare providers and
their vendors to maintain such data for the purposes of compiling and visualizing such data within the electronic health records of a
healthcare provider that supports treatment or diagnosis.

¢ 2021 MA S.D. 1141 (NS), draft/request February 17, 2021, would adopt new MA ST 40J ? 6F and MA ST 40J ? 6G to clarify and
enhance privacy protections for electronic health records.

¢ 2021 MA S.D. 2285 (NS), draft/request February 19, 2021, would amend MA ST 6D ? 16 (Office of patient protection; powers and
duties; external review system) and MA ST 1181 ? 7 (Fully interoperable electronic health records systems connecting to statewide
health information exchange) to protect life-saving electronic health records from reckless corporate greed and corruption.

Minnesota

2021 MN H.F. 1075 (NS), introduced February 11, 2021, would amend MN ST ? 62J.495 (Electronic health record technology) to
establish the criteria hospitals and health care providers must meet when implementing an interoperable electronic health records
system within their hospital system or clinical practice setting.

Nevada

2021 NV REG TEXT 580114 (NS), adopted December 1, 2021, adopts RO08-21 s 2 providing that a practitioner whose electronic
health records are integrated with the records of patients in the database of the computerized program must maintain the electronic
health records in conformance with all applicable federal and state laws, maintain a record access to the database of the computerized
program and the retrieval of patient utilization reports from that database, and retain the records as s health care record in accordance
in a manner that is easily retrievable upon the request of the Board of a representative. Defines 'electronic health record." The
regulation is effective

New York

2021 NY A.B. 6656 (NS), introduced March 23, 2021, would adopt NY GEN BUS Ch. 20, Art. 42 (Electronic Health Products and
Services) to regulate the privacy of electronic health products and services.

North Carolina

2021 NC H.B. 178 (NS), amended/substituted May 11, 2021, would adopt NC ST ? 58-56B-15 (Real time requirements) to require
real-time exchange of patient-specific eligibility information, including any information related to a health benefit plan's coverage,
benefits, formulary, and cost-sharing requirements, to be facilitated using health care industry standards developed by an organization
accredited by the American National Standards Institute. Require electronic health records to display, through real-time integration, the
most up-to-date patient-specific eligibility information, including information on a health benefit plan's coverage, benefits, formulary,
cost-sharing requirements, therapeutically equivalent alternatives, and prior authorization requirements. Require electronic health
record vendors, payors, providers, pharmacies, and other organizations involved in the process of prescribing, dispensing, paying

for, and exchanging information relating to prescription drugs to partner with intermediaries to ensure the delivery of accurate patient-
specific prescription price transparency information.

North Dakota

2021 ND H.B. 1033 (NS), adopted April 19, 2021, amends ND ST 19-02.1-14.3 (Biosimilar biological products) to require a pharmacist
who dispenses a biosimilar product to communicate to the prescriber the name and manufacturer of the drug within 2 business days
following the dispensing of the biosimilar product. The communication shall occur via an entry in an interoperable electronic medical
records system, an electronic prescribing technology, a pharmacy benefit management system or a pharmacy record that can be
accessed electronically by the prescriber. The bill is effective August 1, 2021.

Oklahoma

* 2021 OK REG TEXT 575189 (NS), approved June 11, 2021, revokes OK ADC 450:27-9-23 (Electronic health records and data
sharing). The regulation is effective September 15, 2021.

¢ 2021 OK REG TEXT 575191 (NS), approved June 11, 2021, revokes OK ADC 450:55-25-22 (Electronic health records and data
sharing). The regulation is effective September 15, 2021.

Oregon

2021 OR H.B. 3159 (NS), adopted July 19, 2021, adopts new sections to authorize the authority to provide incentives to health care
providers and health insurers to assist in deferring the costs of making changes to electronic health records systems or similar to
facilitate the collection of data on race, ethnicity, preferred spoken and written languages, disability status, sexual orientation and
gender identity from the health care provider's or health insurer's patients, clients and members. The bill is effective September 25,
2021.

Texas

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2021 TX S.B. 640 (NS), adopted June 14, 2021, establishes a study on the interoperability needs and technology readiness of
behavioral health service providers in Texas. The bill requires the Commission to determine which of the providers use an electronic
health record management system.

Utah

2021 UT S.B. 173 (NS), adopted March 17, 2021, amends UT ST ? 78B-5-618 (Patient access to medical records--Third party access
to medical records) to enact new requirements relating to requests for medical records in an electronic form and require a health care
provider to waive certain fees for a request for medical records for an indigent individual. The bill is effective May 5, 2021.

Vermont

2021 VT H.B. 51 (NS), introduced January 8, 2021, would adopt the Ownership of Medical Data in Electronic Health Records; Report to
direct the Agency of Human Services to develop recommendations regarding the ownership of medical data in electronic health records
and to report those recommendations to the General Assembly.

Washington

¢ 2021 WAH.B. 1272 (NS), adopted May 3, 2021, amends WA ST 43.70.052 (Hospital financial and patient discharge data--Financial
reports--Data retrieval--American Indian health data--Patient discharge data--Confidentiality and protection) to allow hospitals to apply
for a grant to support updating their electronic health records system. The bill is effective July 25, 2021.

* 2021 WA S.B. 5437 (NS), introduced February 8, 2021, would require the Department of Corrections to implement a comprehensive
electronic health records system at the Department and to require the comprehensive electronic health records system to be able to
communicate with information and data systems used by managed care organizations for purposes of care coordination activities.

¢ 2021 WA REG TEXT 546056 (NS), filed September 7, 2021, adopts VWWA ADC 246-470-037 (Waiver for integrating electronic health
record system with the prescription monitoring program) establishing a waiver process for the integration requirements for electronic
health record system with the prescription monitoring program due to economic hardship, technological limitations that are not
reasonably in the control of the facility, entity, office, or provider group, or other exceptional circumstance demonstrated by the facility,
entity, office, or provider group. The regulation is effective October 8, 2021.

IV. Telehealth/Telemedicine

Related to, and utilizing, health IT, telehealth and telemedicine offer ways for providing healthcare over long distances and have the
potential to benefit individuals living in remote and medically underserved areas. IMS Research is predicting that the use of telehealth

will increase dramatically over the next five years. [FN&0] According to their analysis over 1.3 million patients will be receiving telehealth
services in 2017. The researchers believe that telehealth will reduce the rate of patient readmissions and in-home care visits. IMS
estimates that the revenue from telehealth will increase from $174.5 million in 2012 to $707.9 million in 2017.

Seeing the potential for telehealth to help those in areas where there is a shortage of physicians, the Federal government is actively
pursuing telehealth. Recently, teams at the Veterans Administration's National Center for Post-Traumatic Stress Disorder (PTSD)
and the Department of Defense's National Center for Telehealth and Technology have collaborated to create a mobile app to educate
about PTSD, information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help

with managing the stresses of daily life with PTSD. IFN91] Then, in November 2012, the Veterans Administration (VA) announced that

following a two-year pilot program with the University of Kansas it is expanding the program to cover the entire state of Kansas. [FN92]
VA officials believe this program will make it easier for veterans to receive mental health services and could be a model for future
programs across the country. During the pilot program, the University of Kansas and the VA partnered at a Garden City clinic equipped
with a telemedicine site that allowed veterans from western Kansas who have mental health problems to connect with VA doctors in
Wichita. The program will now expand to the 80 telemedicine sites the University of Kansas has around the state. Each site is equipped
with high-definition televisions and other equipment that allow patients and their medical providers in relatively remote hospitals to
interact with doctors and other specialists at the University Medical Center. The VA intends to use that system to connect veterans with
VA providers in Wichita and elsewhere. However, officials said the expansion could be slowed while privacy protocols and other details
still are negotiated with officials at each of the telemedicine locations. Each of the telemedicine sites has already agreed to be equipped
for following the protocols aimed at protecting patient information. The system will use a secure Internet connection to link the sites with
providers elsewhere. Using the Internet will enable VA patient information to be displayed to medical staff in remote locations without
permitting them access to the VA's secure patient database.

Telehealth enables these doctors to gain access to specialized care experts. IFN®3] Telehealth is proving particularly helpful in the
treatment of young patients as rural ER doctors typically see very few young patients during a year. The researchers looked at records
for 320 patients, including 58 who had telemedicine consultations, 63 who had phone consultations and 199 who had no consultation.
The average quality of care rating on a scale of 1 to 7 was 5.76 for patients who received telemedicine consults, 5.38 for patients who
received phone consultations, and 5.26 for those who received no consultation.

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One example of the successful use of telemedicine can be seen in a program using it to improve asthma care for students. Since 2006
the University of Rochester Medical Center has been working with the Rochester City School District to try to improve asthma care for

the upper New York state's district's students. IFN®4] Also for almost dozen years, University of Rochester Medical Center has been
using telemedicine to allow offsite doctors to make quick diagnoses of sick students in city schools. A recent $3.6 Million grant from

the National Institutes of Health is allowing the Medical Center to bring those two programs together. In doing so, researchers hope to
reduce both student absences and preventable visits to doctor's offices and emergency rooms. The researchers also intend to create a
telemedicine-centric asthma treatment program that will be able to be replicated in other locations. As part of the program, with the start
of this school year, students with asthma began receiving evaluations in school nurses' offices. After these evaluations the students will
be given help in taking their daily asthma medications while in school and be given regular reminders to take their medications at home.
After the first six weeks in the program, the students will receive a follow-up visit from a telehealth assistant. This assistant will check
their breathing again and send their readings to offsite doctors, who will determine if the medications are working. The researchers are
hoping that the five-year program will lower student absences. According to the Centers for Disease Control, for students, especially
those from lower-income areas, asthma is a leading cause of school absences.

Another successful of use of telemedicine in California's 'Virtual Dental Home Demonstration Project."This project is a $2.5 million

experiment to provide both dental care and education about dental care to underserved populations. [FN@5] Currently it exists in 50
locations across the state and has 15 specially trained hygienists and dental assistants who work via teledentistry with dentists. These
hygienists and dental assistants have all completed a special educational program. They travel to the different locations and, with
special permission from the state and perform basic procedures by working online with dentists. It is estimated that for every dollar

spent on preventative services, the teledentistry program will save $50 on more expensive procedures. A bill [FN96] pending in the
Senate, after passing the Assembly, would expand the Virtual Dental Home approach statewide. The bill would authorize a registered
dental assistant who has completed the specified educational program to determine which radiographs to place protective restorations
as specified. The bill would also eliminate the requirement for face-to-face contact between a health care provider and a patient under
the Medi-Cal program for teledentistry by store and forward.

In July 2014 the American Medical Association released its Guiding Principles for Telemedicine and many telemedicine providers are

expressing support for them. IFN97] The providers are pleased that the AMA believes that telemedicine can strengthen the physician-
patient relationship and that it improves access to health care services. The one guideline that providers tend to disagree with is AMA's
belief that a physician should be licensed in each state in which he or she provides services via telemedicine. There are currently

two proposals being raised to address that concern. One is reciprocity, where a state recognizes the license of another state for
telemedicine purposes, and the other, which originated with the Federation of State Medical Boards, involves the creation of a simplified
path to get an out-of-state license to practice via telemedicine. The guiding principles the AMA adopted provide that telemedicine
services should be covered and paid where:

¢ a valid patient-physician relationship is established prior to the telemedicine services being provided;
* physicians abide by the state licensure and scope of practice laws of the state where the patients are located;
* the standards and scope of the services provided are consistent with those for in person patient services;

¢ the services are delivered in a manner that is consistent with the laws regarding patient privacy and the security of their records
and in a transparent manner (including advance knowledge of cost sharing responsibilities and any limitations on drugs that can be
prescribed);

¢ the patient history is collected, each visit is documented, and a summary of the visit is provided to the patient; and

* the telemedicine services include coordination with the patient's medical home and/or any treating physicians. [FNS8]

The private sector is active in improving the tools that are used in providing telehealth. TeleHealth Services, a leading provider

of hospital televisions and interactive patient engagement solutions, in October 2012 announced the launch of the new line of UL
approved and ENERGY STAR? 5.3 certified Samsung LED healthcare televisions. IFN®8] The new hospital televisions provide a full-
array LED backlight, a more compact cabinet, industry leading energy savings, and enhanced multi-set management capabilities.
The new healthcare LED televisions combine the traditional hospital-specific features with new enhancements that promote patient
satisfaction, optimize operational efficiency, and improve sustainability. 'The patient experience is a growing opportunity for hospitals
and patients that are expecting more from healthcare facilities and increasingly want access to modern conveniences in the inpatient
setting. We are excited to evolve our partnership with Samsung to deliver LED hospital televisions to enhance patient satisfaction
efforts,' said George Fleming, president and CEO of TeleHealth Services. Among the hospital specific features, the healthcare
televisions include are:

¢ Pro:ldiom decoding, allowing hospitals to provide patients with a wide variety of high-definition channels;

¢ UL Listing to meet the more requirements for the use in a hospital environment;

* universal pillow speaker interface for cross compatibility between multiple pillow speaker brands and pin sets;
¢ autosensing side inputs to allow patients access to external content sources; and

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¢ four energy saving modes that can reduce power consumption by up to 70 percent.

On September 1, 2013, HHS Secretary Sebelius announced that HHS was awarding nearly $5.3 million grants that will help to expand

the rural HIT workforce and the use of telehealth to improve mental health services for veterans in rural areas. [FN100] Close to $4.4
million will go to rural organizations in 15 states to recruit and train current health care staff, local unemployed workers, rural veterans,
and other potential students to meet the technology needs of rural hospitals and clinics. The grants will enable community colleges to
work with local rural health care providers to develop rural-focused HIT training programs. Students selected for these programs will
gain EHR technology certification, apprenticeship training and the opportunity for employment in rural hospitals and clinics. In addition,
Maine, Montana, and Alaska will each receive $300,000 to enhance crisis intervention services through telehealth technologies.

Accenture estimates that funding for on-demand healthcare companies will reach $1 billion in 2017. On-demand healthcare companies
include providing location-based services with near real-time and 24/7 options. On-demand healthcare make physicians exceedingly

accessible to patients while reducing costs. Investments are increasing because 29 states have created telehealth parity laws. [FN101]

Doctor on Demand received accreditation from the American Telemedicine Association for online patient consultations. Doctor on
Demand offers 24/7 direct to consumer healthcare services through its internet-based patient portal. Doctors on Demand offers
consumers primary care, psychology, and lactation consulting. American Telemedicine Association Accreditation Program for Online
Patient Consultations establishes standard criteria regarding the security of patient information, transparency in pricing and operations,

qualifications and licensing of providers and clinical practices and guidelines. [FN102]

Analogic Corporation launched an ultrasound-based telehealth initiative. Analogic Corporation acquired Oncura Partners Diagnostics,
LLC, a provider of remote, real-time ultrasound imaging and teleconsulting services in the veterinary market. Analogic is using the

Oncura technology to expand ultrasound telehealth into the human healthcare market. IFN103]

Third Eye Health, a Chicago startup, is working with nursing homes to keep patients out of hospitals by using Google Glass, texts,

and live video chats. Third Eye Health builds secure mobile platform for sharing information. The hope is that patients will be able to
remotely interact with a nurse instead of making unnecessary trips to the hospital. Third Eye Health partners with the nursing homes to
provide the technology but the facilities are responsible for billing Medicare and other insures for reimbursement for services provided

through their technology. [FN104]

According to a study published in JAMA Internal Medicine, patients who set up virtual visits with physicians are having varied
experiences in terms of quality of care. The study found that the diagnosis was correct in 76.5% of cases, the diagnosis was wrong
in 14.9% of cases, and no diagnosis was given in 8.7% of cases. The cases also varied in terms of whether the physicians asked all
the recommended history questions and carried out all relevant aspects of physical examination. The study also found that there was

greater variation in consultations for viral pharyngitis and acute rhinosinusitis than other conditions. [FN105]

Four states, New York, Hawaii, Oregon, and Washington, will attempt to make abortion more accessible by allowing women to obtain
abortion-inducing drugs through the mail. Women in their first 9 weeks of pregnancy can receive the pills by mail if they live in the same
state as the clinic and undergo an ultrasounds and blood test to confirm the pregnancy and rule out risks. A physician will then use

video conferencing to counsel the women on how to take the pills. [FN106]
Cigna expanded access and choice to affordable telehealth services for millions of individuals enrolled in Cigna administered medical

and behavioral health plans for 2017.Cigna added AMWELL to its telehealth coverage. AMWELL, along with MDLIVE, operate a
national network of board-certified physicians that can treat minor medical conditions. Cigna is also planning to add telehealth video

consultations for behavioral health professionals. [FN107]

On March 17, 2020, the Office for Civil Rights(OCR) at the U.S. Department of Health and Human Services (HHS) announced that,
effective immediately, it 'will exercise its enforcement discretion and will not impose penalties for noncompliance with regulatory
requirements under HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth

during COVID-19 nationwide public health emergency." IFN108] The notice also allows a covered health care provider to assess and
treat other conditions unrelated to COVID-19. A covered health care provider is expected to exercise professional judgment when
making a request to examine the patient via telehealth. A covered health care provider may examine a patient exhibiting COVID-19
symptoms via widely available communications apps, including FaceTime, Facebook Messenger video chat, Google Hangouts video,
or Skype. However, covered health care providers are not permitted to use applications like Facebook Live, Twitch, TikTok, or other
video communications that are similarly public facing.

The New York Department of Financial Services adopted an amendment to 11 NY ADC 52.16 (Prohibited provisions and coverages)

via emergency rulemaking. IFN109] The rule requires New York State insurance companies to waive cost-sharing, including deductibles,
copayments (copays), or coinsurance for in-network telehealth visits. The rule will encourage New Yorkers to seek medical attention
from their homes rather than visit a hospital or doctor's office for health care services that may be unrelated to COVID-19.

Legislation Pending to Increase Children's Access to Telehealth

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Congresswoman Lisa Blunt Rochester (D-Del.}) and Congressman Michael C. Burgess, M.D. (R-Texas), introduced a bill that would
provide guidance and strategies to states to increase access to telehealth for both the Medicaid program and Children's Health
Insurance Program (CHIP).

The Telehealth Improvement for Kids' Essential Services (TIKES) Act of 2020 would also review the impact of telehealth on patient
health and encourage improved collaboration.

'The COVID-19 pandemic has allowed for us to make rapid progress on expanding access to telehealth so children and families across
the country, especially those in rural and underserved communities, face fewer barriers to accessing medical care," said Rep. Blunt
Rochester. 'With the introduction of the TIKES Act, we can continue that progress by bringing better alignment and clarity to Medicaid
telehealth policies, as well as provide guidance to state Medicaid programs on the opportunities telehealth services can have for
children. I'd like to thank my colleague, Congressman Burgess, for joining me in this critical effort."

'Amidst the pain and suffering that our nation has endured throughout the COVID-19 pandemic, a major takeaway has been the
advantage of telehealth. There is a convenience factor to not having to take time to physically transport yourself to the doctor's office
and have your child sit in a waiting room with other potentially sick patients," said Rep. Burgess. 'This bipartisan legislation will improve
utilization of telehealth by requiring the Centers for Medicare and Medicaid Services (CMS) to provide guidance to states on how to
make the most of telehealth options in their Medicaid and CHIP programs. Additionally, it directs studies to gather data that can help
inform future telehealth policy. | urge my fellow members to support this legislation that will help build upon the telehealth foundation
that we have built this year."

The TIKES Act of 2020 is focused on:

¢ Providing states with guidance and strategies to increase telehealth access for Medicaid and Children's Health Insurance Program
(CHIP) populations

¢ Requiring a Medicaid and CHIP Payment and Access Commission (MACPAC) study examining data and information on the impact of
telehealth on the Medicaid population

* Requiring a Government Accountability Office (GAO) study reviewing coordination among federal agency telehealth policies and
examine opportunities for better collaboration, as well as opportunities for telehealth expansion into early care and education settings

'| commend the leadership of Congresswoman Blunt Rochester and Congressman Burgess in responding to issues raised by health
systems like Nemours by introducing this important legislation. Telehealth has facilitated the delivery of high-quality, efficient care

to millions of American children. The public health challenge of COVID-19 highlighted its effectiveness and proved its value as a
permanent part of the US healthcare system," said R. Lawrence Moss, MD, FACS, FAAP, president and CEO of Nemours Children's

Health System. [FN110]
CMS Announces Expanded Telehealth Services in Medicaid and Medicare

The Centers for Medicare and Medicaid Services (CMS) announced it had expanded the list of telehealth services that Medicare fee-
for-service will pay for during the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on October 14. CMS is also
providing additional support to state Medicaid and Children's Health Insurance Program (CHIP) agencies in their efforts to expand
access to telehealth.

The actions reinforce President Trump's Executive Order on Improving Rural Health and Telehealth Access to improve the health of all
Americans by increasing access to better care.

'Responding to President Trump's Executive Order, CMS is taking action to increase telehealth adoption across the country," said CMS
Administrator Seema Verma. 'Medicaid patients should not be forgotten, and today's announcement promotes telehealth for them as
well. This revolutionary method of improving access to care is transforming healthcare delivery in America. President Trump will not let
the genie go back into the bottle."

 

Expanding Medicare Telehealth Services

For the first time using a new expedited process, CMS is adding 11 new services to the Medicare telehealth services list since

the publication of the May 1, 2020, COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible
practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE. These new
telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation
services. The list of these newly added services is available at: https:/Awww.cms.gov/Medicare/Medicare-General-Information/
Telehealth/Telehealth-Codes.

In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to
allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare
telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries' access to telehealth services
during the COVID-19 PHE.

Since the beginning of the PHE, CMS has added over 135 services to the Medicare telehealth services list ? such as emergency
department visits, initial inpatient and nursing facility visits, and discharge day management services. With today's action, Medicare will

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pay for 144 services performed via telehealth. Between mid-March and mid-August 2020, over 12.1 million Medicare beneficiaries ?
over 36 percent ? of people with Medicare Fee-For-Service have received a telemedicine service.

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS is releasing, for the first time, a
preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE. This snapshot shows, among other things,

that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and
June of this year, representing an increase of more than 2,600% when compared to the same period from the prior year. The data also
shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both
age groups and states.

To further drive telehealth, CMS is releasing a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations
for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned
from states that have implemented telehealth changes. The updated supplemental information is intended to help states strategically
think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps
states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may
use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the
PHE expires.

The toolkit includes approaches and tools states can use to communicate with providers on utilizing telehealth for patient care. It
updates and consolidates in one place the Frequently Asked Questions (FAQs) and resources for states to consider as they begin
planning beyond the temporary flexibilities provided in response to the pandemic.

To view the Medicaid and CHIP data snapshot on telehealth utilization during the PHE, please visit: https:/Awww.medicaid.gov/
resources-for-states/downloads/medicaid-chip-beneficiaries-COVID-19-snapshot-data-through-20200630.pdf.

Telemedicine Offsets Some Drop in U.S. Outpatient Visits During COVID-19

(Reuters Health) - An increase in telemedicine visits in the U.S. during the COVID-19 pandemic has offset some of the decline in

outpatient care, although use of telehealth varies by state, a study of commercially insured patients suggests. [FN111]

Researchers examined insurance claims from the OptumLabs Data Warehouse on all outpatient visits from January 1 to June 16, 2020
for 16,740,365 individuals with commercial insurance.

From the weeks of January 1 to June 10, total outpatient visits for both telemedicine and in-person care declined from a weekly rate
of 103.5 per 1,000 enrollees to 94.1 per 1,000. Over this same period, telemedicine weekly visit rates increased from 0.8 per 1,000
enrollees to 17.8 visits per 1,000 and in-person visits decreased from 102.7 per 1,000 enrollees to 76.3 visits per 1,000.

'| think the major take-away is that telemedicine is a new normal for health care delivery, but that, as a country, we will have a huge
amount of health care to catch up on given the large drop in doctor visits that we saw,' said senior study author Dr. Michael Barnett, an
assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health in Boston.

'It will be hard to catch up, but our health system has to develop new ways to make up for this lost time, like expanding telephone and
community-based outreach,' Dr. Barnett said by email.

Telemedicine visits peaked during the week of April 15, then declined by the week of June 10, the study team reports in JAMA Internal
Medicine.

While telemedicine visits increased during the study period by 2013%, total visits (in-person plus telemedicine) were down overall by
9.1%, the authors note.

Over the last four weeks of the study, the proportion of total outpatient visits done via telemedicine also varied widely across the U.S.,
from as low as 8.4% in South Dakota to as high as 47.6% in Massachusetts.

One limitation of the study is that results from a commercial insurance population might not be generalizable to other groups, such as
the uninsured or individuals covered by Medicare or Medicaid, the study team notes.

Still, the increased uptake of telemedicine during the initial peak of the COVID-19 pandemic earlier in the year, followed by a decline
near the start of summer, suggests that this is a reasonable alternative to in-person visits for routine care, said Dr. Michael Albosta of
Central Michigan University College of Medicine in Saginaw.

'Telemedicine is convenient, in that it reduces travel time to and from appointmenits.,' Dr. Albosta, who wasn't involved in the study, said
by email. 'Further, telemedicine may allow for providers to expand access to care for populations with limited access to primary care
providers, such as certain parts of rural America.'

At the same time, the fact that telemedicine didn't entirely offset the decline of in-person visits during the pandemic suggests that there
may be short-term and long-term consequences from delays of necessary care, said Dr. Sonu Bhaskar of Liverpool Hospital and NSW
Brain Clot Bank in Sydney, Australia.

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'The decrease in outpatient volume or deferred care during the pandemic should raise red flags among clinicians,' Dr. Bhaskar, who
wasn't involved in the study, said by email. 'Clinicians need to be more engaged with patients who are unable or unwilling to seek
outpatient care.'

Washington State Extends Coverage Requirement in Telehealth, COVID-19 Tests

Washington Insurance Commissioner Mike Kreidler ordered health insurers to cover telehealth and testing as the COVID-19 pandemic

continues. /FN"21

Under an emergency order, extended until Dec. 11, insurers are required to cover telehealth visits conducted under additional methods,
including phone and video tools such as Apple Inc.'s FaceTime and video chat features in Facebook Inc.'s Messenger, Alphabet Inc.'s
Google Hangouts, GoToMeeting and Skype.

Since the start of the pandemic, there were a total of 127,702 COVID-19 cases in Washington as of Nov. 13, an increase of about 33.8
percent from a month earlier, according to the Department of Health.

'This continues to be a critical time for all Washingtonians and we need to provide safe and flexible access to care,' Kreidler said in a
statement. 'During this unprecedented time, people should not have to worry about their insurance coverage.'

Kreidler originally issued the order on March 24 and issued this extension, the seventh one, on Nov. 13.

Under state law, orders by the insurance commissioner may stay in effect for a maximum of 60 days unless the commissioner extends
them, which can only be done for 30 days and if the commissioner determines the situation warrants an extension.

Carriers also must cover all medically necessary diagnostic testing for certain illnesses during provider visits for COVID-19 without co-
pays, co-insurance or deductibles. Those illnesses include the flu and certain other viral respiratory illnesses. In addition, insurers are
required to treat visits to drive-up COVID-19 testing sites as provider visits without co-pays, co-insurance or deductibles.

Kreidler directed health insurers to waive or expedite requirements related to prior authorization for home health care or long-term care
facility services, to help free up hospital beds by speeding up discharges of patients who are ready to leave.

Grace periods for premium payments expired after May 23 and were never extended.
HHS Amends PREP Act Declaration, Including to Expand Access to COVID-19 Countermeasures Via Telehealth

On December 4, Among other things, the amendment authorizes healthcare personnel using telehealth to order or administer Covered
Countermeasures, such as a diagnostic test that has received an Emergency Use Authorization (EUA) from the Food and Drug
Administration (FDA), for patients in a state other than the state where the healthcare personnel are already permitted to practice. While
many states have decided to permit healthcare personnel in other states to provide telehealth services to patients within their borders,
not all states have done so.

Recent Federal Activity

* 2019 CONG US HR 3417, reported in House December 24, 2020, would amend 42 USCA ? 1395m (Special payment rules for
particular items and services) updating the requirements for the treatment of mental health telehealth services.

¢ 2019 CONG US HR 5201, reported in House December 24, 2020, would amend 42 USCA ? 1395m (Special payment rules for
particular items and services) to expand the use of telehealth for certain mental health services.

¢ 2021 CONG US HR 1205, engrossed in House May 12, 2021, would adopt Sec. 520J-1 (Securing Appropriate Follow-On Care

for Acute Mental Health Illness After an Emergency Department Encounter) to allow grants to be used for alternative approaches

to providing psychiatric care in the emergency department setting, including tele-psychiatric support and other remote psychiatric
consultation, implementation of peak period crisis clinics, or creation of psychiatric emergency service units and for proactive follow up
such as telephone check-ins, telemedicine, or other technology-based outreach to individuals during the period of transition.

* 2021 CONG US HR 1324, engrossed in House May 12, 2021, would adopt Sec. 399V-7 (Program to Improve the Care Provided to
Patients in the Emergency Department Who Are At Risk) to allow a grant awarded to be used to increase the availability of, and access
to, evidence-based treatment for individuals who are at risk of suicide, including through telehealth services and strategies to reduce
the boarding of these patients in emergency departments.

* 2021 CONG US HR 1620, engrossed March 17, 2021, would adopt the Violence Against Women Act Reauthorization Act of 2021
and require guidance from the Attorney General and Secretary of the Department of Health and Human Services to include technical
assistance and best practices with respect to the use of telehealth for both training examiners and conducting the exams, including the
Project ECHO model and other models.

¢ 2021 CONG US HR 3755, placed on calendar Senate September 29, 2021, would adopt the Women's Health Protection Act of 2021
and allow a health care provider to provide abortion services without a limitation on a health care provider's ability to provide abortion
services via telemedicine, other than a limitation generally applicable to the provision of medical services via telemedicine.

¢ 2021 CONG US HR 4350, placed on Senate calendar October 18, 2021, would amend coverage of telehealth services under
TRICARE program during certain health emergencies.

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¢ 2021 CONG US HR 5248, introduced in House September 14, 2021, would require the Secretary to maintain a program, to be known
as the Provider Bridge Program to streamline the process for mobilizing health care professionals during the COVID-19 pandemic

and future public health emergencies, including by utilizing communications pathways and new technology and to connect health

care professionals with State agencies and health care entities in order to quickly increase access to care for patients by means of
telehealth. The Provider Bridge Program must be designed to ease the burden on health care professionals and support license
portability by offering a dedicated customer service hub to help clinicians navigate State licensure requirements, including those specific
to telehealth, during states of emergency and make it easier for State agencies and health care entities to connect with registered
health care professionals to expand workforce needs by providing access to a database of information for verified, volunteer clinicians
willing to provide telehealth services during emergencies.

«2021 CONG US HR 5506, introduced in House October 8, 2021, would establish a Rural Telehealth Access Task Force to determine
how to address barriers to the adoption of telehealth technology and access to broadband internet access service in rural areas.

* 2021 CONG US HR 5541, introduced in House October 8, 2021, would amend the Internal Revenue Code of 1986 to extend the
exemption for telehealth services from certain high deductible health plan rules.

* 2021 CONG US HR 5981 (NS), introduced in House, November 15, 2021, would amend 26 USCA ? 223 (Health savings accounts) to
permanently extend the exemption for telehealth services from certain high deductible health plan rules.

* 85 FR 84472-01, issued December 28, 2020, amends 42 CFR ? 410.78 (Telehealth services) updating the definition for 'interactive
telecommunications system" and updating the process for making changes to the list of Medicare telehealth services. Amends 42 ?
414.1305 (Definitions) revising the definition of 'certified electronic health record technology (CEHRT)." The regulations are effective
January 1, 2021.

¢ 86 FR 26786-01, filed May 17, 2021, adopts 35 CFR ? 35.6 (Eligible uses) allowing a recipient to use funds to respond to the public
health emergency or its negative ecumenic impacts, including expenditures for the mitigation and prevention of COVID-19, including
expenses for establishing and operating public telemedicine capabilities for COVID-19-related treatment. The interim final rules is
effective May 17m 2021.

¢ 86 FR 56144-01, published October 7, 2021, amends 42 CFR ? 59.5 (What requirements must be met by a family planning project?)
requiring each project to provide for medical services related to family planning (including consultation by a clinical services provider,
examination, prescription and continuing supervision, laboratory examination, contraceptive supplies), in person or via telehealth, and
necessary referral to other medical facilities when medically indicated, and provide for the effective usage of contraceptive devices and
practices. The regulation is effective November 8, 2021.

¢ 86 FR 61555-01, published November 5, 2021, amends 42 CFR ? 416.51 (Conditions for coverage-Infection Control), 42 CFR ?
418.60 (Condition of participation: Infection control), 42 CFR ? 441.151 (General requirements), 42 CFR ? 460.74 (Infection control),
42 CFR ? 482.42 (Condition of participation: Infection prevention and control and antibiotic stewardship programs), 42 CFR ? 483.430
(Condition of participation: Facility staffing), 42 CFR ? 484.70 (Condition of participation: Infection prevention and control), 42 CFR ?
485.70 (Personnel qualifications), 42 CFR ? 485.640 (Condition of participation: Infection prevention and control and antibiotic
stewardship programs), 42 CFR ? 485.725 (Condition of participation: Infection control), 42 CFR ? 485.904 (Condition of participation:
Personnel qualifications), 42 CFR ? 486.525 (Required services), 42 CFR ? 491.8 (Staffing and staff responsibilities), and 42 CFR ?
494.30 (Condition: Infection control) exempting staff who exclusively provide telehealth or telemedicine services outside of the facility
setting and who do not have any direct contact with patients and other staff from the COVID-19 staff vaccination requirements. The
regulations are effective November 5, 2021.

¢ 86 FR 61874-01, published November 8, 2021, amends 42 CFR ? 512.397 (ETC Model Medicare program waivers and additional
flexibilities) providing that beginning upon the expiration of the Public Health Emergency for the COVID-19 pandemic, CMS waives

the geographic and site of service originating site requirements for purposes of kidney disease patient education services furnished by
qualified staff via telehealth, regardless of the location of the beneficiary or qualified staff and CMS also waives the requirement that
CMS pay a facility fee to the originating site with respect to telehealth services furnished to a beneficiary at an originating site that is not
one of the locations. The regulation is effective January 1, 2022.

¢ 86 FR 64996-01 (NS), filed November 19, 2021, adopts 42 CFR ? 410.72 (Registered dietitians' and nutrition professionals' services)
allowing MNT and DSMT services to be provided as telehealth services when registered dietitians or nutrition professionals act as
distant site practitioners. Amends 42 CFR ? 410.78 (Telehealth services) updating the requirements for telehealth services. Amends 42
CFR ? 423.160 (Standards for electronic prescribing) to revise the requirements for electronic prescribing of Schedule II, Ill, IV, and V
controlled substances that are Part D drugs. The regulations are effective January 1, 2022.

Recent State Activity
Alabama

¢ 2021 AL S.B. 102 (NS), adopted March 18, 2021, establishes the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The Compact
will come into effect on the date on which the Compact is enacted into law in the 7th Compact state.

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¢ 2021 AL S.B. 130 (NS), adopted March 18, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact will come into effect on the date on which the Compact is enacted into law in the
10th Compact state.

Alaska
* 2021 AK H.C.R. 301 (NS), introduced September 12, 2021, would make temporary changes relating to telemedicine and telehealth.

* 2021 AK H.B. 76 (NS), adopted April 30, 2021, adopts new section to allow, during the COVID-19 public health disaster emergency,
to provide treatment, render a diagnosis, or prescribe, dispense, or administer a prescription, excluding a controlled substance, through
telehealth, without first conducting an in-person physical examination under specified circumstances. The new section is effective
retroactive to February 14, 2021.

¢ 2021 AK H.B. 3009 (NS), introduced September 11, 2021, and 2021 AK S.B. 3006 (NS), amended/substituted September 12, 2021,
would adopt new uncodified section (Telemedicine and Telehealth) to exempt a health care provider who is providing treatment,
rendering a diagnosis, or prescribing, dispensing, or administering a prescription, excluding a controlled substance, through
telehealth,from the requirement to first conduct an in person physical examination.

¢ 2021 AK S.B. 56 (NS), amended/substituted February 12, 2021, would add a new section Telemedicine and Telehealth to establish
the requirements for a provider who is providing treatment, rendering a diagnosis, or prescribing, dispensing, or administering a
prescription, excluding a controlled substance through telehealth without first conducting an in-person physical examination when
certain conditions are met.

«2021 AK S.B. 78 (NS), amended/substituted April 21, 2021, would adopt AK ST ? 08.64.64 (telehealth) and AK ST ? 08.68.163
(Telehealth) to establish the requirements for a health care provider or nurse to provide treatment, render a diagnosis, or prescribe,
dispense, or administer a prescription, excluding a controlled substance, through telehealth, without first conducting an in-person
physical examination.

* 2021 AK REG TEXT 583537 (NS), filed May 11, 2021, amends 12 AK ADC 44.925 (Standards of practice for telehealth) defining
'urgent situation" and updating the standards of practice for telehealth by APRNs during an urgent situation. The regulation is effective
May 11, 2021.

¢ 2021 AK REG TEXT 583537 (NS), filed August 26, 2021, amends 12 AK ADC 44.925 (Standards of practice for telehealth) updating
the requirements to allow APRNs who are licensed in Alaska to have flexibilities to prescribe, dispense, and administer buprenorphine
via telehealth without an in-person visit during an urgent situation or during a disaster emergency declared by the governor. Adds a
definition for 'urgent situation'. The regulation is effective May 11, 2021.

¢ 2021 AK REG TEXT 583537 (NS), filed September 10, 2021, amends 12 AK ADC 44.925 (Standards of practice for telehealth)
allowing an advanced practice registered nurse (APRN) to use telehealth to examine, diagnose, and treat a patient for an opioid use
disorder without a health care provider present with the patient. This rulemaking adopts a previous emergency rule as final.

* 2021 AK REG TEXT 585748 (NS), filed June 14, 2021, amends 12 AK ADC 40.943 (Standard of practice for telemedicine) allowing
a physician or physician assistant to use telemedicine to prescribe, dispense, or administer buprenorphine to initiate or continue
treatment for opioid use disorder during a public health emergency declared by the Governor or Commissioner of Health and Social
Services or an emergency. Requires the physician or physician assistant to document the reason why another health care provider
cannot be present with the patient. Defines 'emergency.' The regulation was amended via emergency andis effective June 10, 2021.

* 2021 AK REG TEXT 585748 (NS), filed October 6, 2021, amends 12 AK ADC 40.943 (Standard of practice for telemedicine) allowing
a physician or physician assistant to use telemedicine to prescribe, dispense, or administer buprenorphine to initiate or continue
treatment for opioid use disorder during a public health emergency declared by the Governor or Commissioner of Health and Social
Services or an emergency. Requires the physician or physician assistant to document the reason why another health care provider
cannot be present with the patient. Defines 'emergency.' The rulemaking adopts a previous emergency rule as final.

Arizona

¢ 2021 AZ H.B. 2454 (NS), adopted May 5, 2021, would amend AZ ST ? 20-841.09 (Telehealth: coverage of health care services:
definition), AZ ST ? 20-1057.13 (Telehealth: coverage of health care services: definition), AZ ST ? 20-1376.05 (Telehealth: coverage
of health care services: definition), AZ ST ? 20-1406.05 (Telehealth: coverage of health care services: definition), AZ ST ? 23-1026
(Period medical examination of employee: effect of refusal or obstruction of examination or treatment), AZ ST ? 32-1401 (Definitions),
AZ ST ? 32-1854 (Definition of unprofessional conduct), AZ ST ? 32-1901.01 (Definition of unethical and unprofessional conduct:
permittees: licensees), AZ ST ? 32-2061 (Definitions), AZ ST ? 32-3248.01(Schedule II controlled substances: dosage limit: exceptions:
morphine: opioid antagonist), AZ ST ? 32-3254 (Definitions), AZ ST ? 36-2272 (Consent of parent required for mental health screening
or treatment of minors: exception: violation: classification: definition), AZ ST ? 36-3601 (Definitions), AZ ST ? 36-3602 (Delivery of
health care through telehealth: requirements: exceptions), AZ ST ? 36-3603 (State jurisdiction: scope), AZ ST ? 36-3604 (Use of
telehealth for abortion prohibited: penalty: definition), AZ ST ? 38-672 (Traumatic event counseling for public safety employees: report:
exceptions: definitions), AZ ST ? 38-673 (Traumatic event counseling for peace officers and firefighters: report: exceptions: definitions)

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to update terminology to use 'telehealth" instead of 'telemedicine,' update definitions, and update requirements for the provision of
telehealth services. The bill would adopt AZ ST ? 20-243 (Telehealth health care services; network adequacy; incentives; notice;
definitions) to prohibit an insurer from using contracted telehealth providers to meet network adequacy standards. The bill would

also adopt AZ ST ? 36-3605 (Health care providers: determination of telehealth medium), AZ ST ? 36-3606 (Interstate telehealth
services: requirements: venue), and AZ ST ? 36-3607 (Telehealth advisory committee on telehealth best practices: membership: report:
committee termination) to provide definitions and establish requirements for interstate telehealth services. The bill is effective May 5,
2021.

¢ 2021 AZ H.B. 2820 (NS), engrossed May 3, 2021, would adopt AZ ST ? 36-4001 to provide the definition for 'practice of dietetics and
nutrition" and 'telehealth."

* 2021 AZ H.B. 2870 (NS), introduced February 11, 2021, would amend AZ ST ? 36-449.03 (Abortion clinics; rules; civil penalties),
AZ ST ? 36-2156 (Informed consent; ultrasound required; violation; civil relief; statute of limitations), AZ ST ? 36-2301.02 (Review of
ultrasound results) to update the requirements for a telemedicine encounter for a medication abortion. The bill would also repeal AZ
ST ? 36-3604 (Use of telemedicine for abortion prohibited; penalty; definition).

¢ 2021 AZ S.B. 1145 (NS), engrossed January 28, 2021, would amend AZ ST ? 32-1401 (Definitions) and AZ ST ? 32-1854 (Definition
of unprofessional conduct) to clarify that the physical or mental health status examination may be performed through telemedicine with
a Clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for
the purpose of obtaining a written certification from the physician.

¢ 2021 AZ S.B. 1271 (NS), adopted May 10, 2021, allows supervising qualified physicians to delegate to a permittee the performance
of health care tasks that are of a nature typically delegated in an accredited internship or residency program, including the ability to
provide delegated telehealth services that are of a similar nature, if all other specified conditions are met. The bill is effective May 10,
2021.

¢ 2021 AZ S.B. 1682 (NS), engrossed February 23, 2021, would amend AZ ST ? 32-1401 (Definitions) and AZ ST ? 32-1854 (Definition
of unprofessional conduct) to clarify that the physician or mental health status examination may be conducted through telemedicine as
defined in AZ ST ? 36-3601 (Definitions) with a clinical evaluation that is appropriate for the patient and the condition which the patient
presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of AZ ST T.
36, Ch. 28.1 (Arizona Medical Marijuana Act).

* 2021 AZ REG TEXT 589317 (NS), published July 23, 2021, amends AZ ADC R4-24-107 (Fees) requiring the Board to establish and
collect a $100 regulation fee from an out-of-state health care provider of telehealth services. The regulation is effective June 29, 2021.

* 2021 AZ REG TEXT 591452 (NS), published August 20, 2021, amends AZ ADC R4-26-108 (Fees and Charges) and Az ADC
R4-26-402 (Fees and Charges) requiring the Board to collect a $600 fee to register as an out-of-state health care provider of telehealth
services. Amends Az ADC R4-26-417 (Licensing Time Frames) establishing the licensing time frame for initial registration as an out-of-
state health care provider of telehealth services. The regulation is effective September 1, 2021.

¢ 2021 AZ REG TEXT 596522 (NS), published October 15, 2021, amends AZ ADC T. 20, Ch. 5, Art. 1, App. A (Physicians' and
Pharmaceutical Fee Schedule 2021/2022) establishing the Physicians' and Pharmaceutical Fee Schedule for 2021/2022 and providing
that reimbursement values for telehealth services are governed by the Fee Schedule and providing that performance of telehealth
services are governed by AZ ST T. 36, Ch. 36 (Telehealth). The regulation is effective October 1, 2021.

Arkansas

¢ 2021 AR H.B. 1063 (NS), adopted April 21, 2021,amends AR ST ? 17-80-402 (Definitions) to update the definition of 'professional
relationship" to include a healthcare professional, who is licensed in Arkansas and has access to a patient's personal health record
that is maintained by a physician, is allowed to use technology deemed appropriate by the healthcare professional, including without
limitation using a telephone to conduct an audio-only consultation, to diagnose, treat, and, if clinically appropriate, prescribe a
noncontrolled drug to a patient located in Arkansas. Amends AR ST ? 23-79-1602 (Coverage for telemedicine) to prohibit a health
benefit plan from imposing on coverage for healthcare services provided through telemedicine a requirement for a covered person to
choose any commercial telemedicine service provider or a restricted network of telemedicine-only providers rather than the covered
person's regular doctor or provider of choice or a copayment, coinsurance, or deductible that is not equally imposed upon commercial
telemedicine providers as those imposed on network providers. Amends AR ST ? 23-79-1601 (Definitions) to update the definition for
'telemedicine." The bill is effective July 30, 2021.

* 2021 AR H.B. 1068 (NS), adopted April 18, 2021, amends AR ST ? 17-80-402 (Definitions) and AR ST ? 23-79-1601 (Definitions) to
provide that the 'originating site" includes the home of a patient and amends AR ST ? 17-80-404 (Appropriate use of telemedicine) to
allow a healthcare professional to use telemedicine to perform group meetings for healthcare services, including group therapy. The bill
is effective July 30, 2021.

¢ 2021 AR H.B. 1176 (NS), adopted April 8, 2021, adopts AR ST ? 20-77-112 (Provision of behavioral and mental health services
via telemedicine -- Medicaid reimbursement) to authorize reimbursement for behavioral and mental health services provided via
telemedicine. The bill is effective April 8, 2021.

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¢ 2021 AR H.B. 1760 (NS), adopted April 25, 2021, established the Psychological Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 AR S.B. 410 (NS), adopted April 5, 2021, adopts AR ST ? 23-61-1010 (Community bridge organizations) to allow a hospital to
use funding available through the Department of Human Services to improve the hospital's ability to deliver care through coordination
with other healthcare professionals and with the local emergency response system that may include training of personnel and
improvements in equipment to support the delivery of medical services through telemedicine. Amends AR ST ? 23-79-1601
(Definitions) to update the definition for 'health benefit plan" regarding coverage provided through telemedicine. The bill is effective
January 1, 2022.

¢ 2021 AR S.B. 617 (NS), adopted April 30, 2021, would adopt AR ST ? 17-92-118 (New prescription requests and new refill requests
from prescriber) to allow the pharmacy to establish a professional relationship between a pharmacist and the patient by telephone or
telemedicine consult.

* 2021 AR S.B. 703 (NS), adopted May 3, 2021, amends AR ST ? 17-80-402 (Definitions) to update the definition for 'telemedicine" and
provide the definition for 'telehealth certification."The bill is effective July 30, 2021.

«2021 AR REG TEXT 581684 (NS), approved March 22, 2021, adopts AR ADC 016.00.1-241.000 (First Connections Developmental
Therapy Telemedicine), AR ADC 016.00.1-244.000 (Telemedicine for Occupational, Physical, and Speech Therapists and Assistants),
AR ADC 016.00.1-245.000 (Telemedicine for Applied Behavioral Analysis (ABA) for BCBA), AR ADC 016.00.1-246.000 (Telemedicine
Autism Waiver), AR ADC 016.00.1-260.102 (Telemedicine Originating Site Requirements for Advanced Practice Registered Nurses),
AR ADC 016.00.1-260.103 (Telemedicine Originating Site Requirements to Allow Services to a Beneficiary in his or her Home
Through Date of Service December 31, 2021), AR ADC 016.00.1-265.100 (Behavioral Health Telemedicine) establishing telemedicine
requirements in response to COVID-19. The rulemaking was adopted via emergency and are effective March 24, 2021.

California

* 2021 CAA.B. 32 (NS), amended/substituted May 24, 2021, would amend CA BUS & PROF ? 2290.5 (Telehealth; definitions; consent;
in-person health care delivery services; violations; scope of practice; confidentiality; exceptions; privileges and credentials of telehealth
service providers), CA HLTH & S ? 1374.14 (Telehealth services; requirements for health care service plan contracts), CA INS ?
10123.855 (Telehealth services; requirements for health insurance contracts), and CA WEL & INST ? 14087.95 (Exemption from
certain provisions of the Health and Safety Code) and adopt CA WEL & INST ? 14092.4, CA WEL & INST ? 14132.721, and CA WEL
& INST ? 14132.722 to authorize a provider to enroll or recertify an individual in specified Medi-Cal programs through telehealth and
other forms of virtual communication, and would authorize a county eligibility worker to determine eligibility for, or recertify eligibility for,
the Medi-Cal Minor Consent program remotely through virtual communication, as specified, require health care services furnished by
an enrolled clinic through telehealth to be reimbursed by Medi-Cal on the same basis, to the same extent, and at the same payment
rate as those services are reimbursed if furnished in person. The bill would prohibit the State Department of Health Care Services from
restricting the ability of an enrolled clinic to provide and be reimbursed for services furnished through telehealth, require the department
to indefinitely continue the telehealth flexibilities in place during the COVID-19 pandemic state of emergency, require the department,
by January 2022, to convene an advisory group with specified membership to provide input to the department on the development of

a revised Medi-Cal telehealth policy that promotes specified principles, and require the department, by December 2024, to complete

an evaluation to assess the benefits of telehealth in Medi-Cal, including an analysis of improved access for patients, changes in health
quality outcomes and utilization, and best practices for the right mix of in-person visits and telehealth.

* 2021 CAA.B. 130 (NS), adopted July 9, 2021, adopts CA EDUC ? 49419 to require the Office to assist in the development of the
telehealth guidelines. The bill is effective July 9, 2021.

¢ 2021 CAA.B. 133 (NS), adopted July 27, 2021, requires the Department to seek any federal approvals it deems necessary to

extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery
and reimbursement of services via telehealth modalities in the Medi-Cal program, and subject to approval by the Department of
Finance, would require the Department to implement those extended waivers or flexibilities for which federal approval is obtained for

a specified period of time ending December 31, 2022. The bill also requires the Department to convene an advisory group to provide
recommendations to inform the Department in establishing and adopting billing and utilization management protocols for telehealth
modalities to increase access and equity and reduce disparities in the Medi-Cal program. The bill authorizes the State Department of
State Hospitals to conduct a reevaluation, as defined, in person or by video telehealth, of a defendant in county custody if the defendant
has been committed to and awaiting admission to the department for 60 days or more, as specified. The bill requires the department to
provide funding at a rate set by the department for reimbursement of information technology support and a portion of staff time used to
facilitate telehealth interviews and evaluations of felony defendants. The bill is effective July 27, 2021.

¢ 2021 CAA.B. 167 (NS), adopted September 23, 2021, amends CA EDUC ? 49429 (Telehealth technology in schools; mental and
behavior health; guideline development) requiring the State Department of Education, in consultation with the State Department of
Health Care Services and appropriate stakeholders, to, on or before December 31, 2022, develop guidelines, as provided, for the
use of telehealth technology in public schools, including charter schools, to provide mental health and behavioral health services to
pupils on school campuses, and to post those guidelines on its internet website on or before December 31, 2022. The bill is effective
September 23, 2021.

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¢ 2021 CA A.B. 457 (NS), adopted October 1, 2021 removes the date restriction, thereby extending the telehealth reimbursement parity
requirement for all contracts between a health care service plan or a health insurer and a health care provider. The bill also enacts the
Protection of Patient Choice in Telehealth Provider Act, and would require a health care service plan and a health insurer to comply
with specified notice and consent requirements if the plan or insurer offers a service via telehealth to an enrollee or an insured through
a third-party corporate telehealth provider, as defined. For an enrollee or insured that receives specialty telehealth services for a mental
or behavioral health condition, the bill would require that the enrollee or insured be given the option of continuing to receive that service
with the contracting individual health professional, a contracting clinic, or a contracting health facility. The bill is effective January 1,
2022.

¢ 2021 CAA.B. 523 (NS), enrolled September 13, 2021, would adopt CA WEL & INST ? 14593.3 to allow services in the California
Program of All-Inclusive Care for the Elderly program to be provided via telehealth.

* 2021 CAA.B. 935 (NS), amended/substituted April 19, 2021, would adopt the Mothers and Children Mental Health Support Act of
2020 to require health care services plans and health insurers, by July 1, 2022, to provide access to a telehealth consultation program
that meets specified criteria and provide providers who treat children and pregnant and certain postpartum persons with access to a
mental health consultation program. The bill would require the consultation by a mental health clinician with expertise appropriate for
pregnant, postpartum, and pediatric patients to be conducted by telephone or telehealth video, and to include guidance on the range
of evidence-based treatment options, screening tools, and referrals. The bill would require health care service plans and insurers to
communicate information relating to the telehealth program at least twice a year in writing.

* 2021 CAA.B. 1162 (NS), amended/substituted April 26, 2021, would amend CA INS ? 10123.13 (Group or individual health insurance
policies; notice of contested or denied claim; time for reimbursement of claims; reasonably contested claims; waiver) and CA INS ?
10123.147 (Time for reimbursement of complete claim; notice to contest or deny claim) to clarify that every insurer issuing group or
individual policies of health insurance that covers hospital, medical, or surgical expenses, including those telehealth services covered
by the insurer must reimburse claims or any portion of any claim, whether in state or out of state, for those expenses as soon as
practical, but no later than 20 working days after receipt of the claim by the insurer unless the claim or portion thereof is contested or
denied by the insurer, in which case the provider to be notified, in writing, that the claim is contested or denied, as soon as possible, but
no later than 20 working days after receipt of the claim by the insurer.

¢ 2021 CAA.B. 1278 (NS), amended/substituted July 13, 2021, would adopt new section to require a physician and surgeon to provide
to each patient at the initial office visit, and at an office or telehealth visit annually thereafter, a written notice of the Open Payments
database and if a patient does not seek treatment within a 12-month period, the notice must be made at the next office or telehealth
visit. Requiring a physician and surgeon to provide to each patient at the initial office visit, and at an office or telehealth visit annually
thereafter, a written disclosure of the names of all drug and device companies the physician and surgeon received payment or transfers
of value from as reported on the Open Payments database for the three most recent years available and if a patient does not seek
treatment within a 12-month period, the disclosure must be made at the next office or telehealth visit.

¢ 2021 CAA.B. 1494 (NS), amended/substituted April 29, 2021, would amend CA HLTH & S ? 1607 (Skin puncture and venipuncture;
predonation screening; personnel; supervision; displacement) to authorize the registered nurse placed in charge to physically present
or available via telehealth and exempt a blood bank from the requirement to obtain verbal or written consent from a patient for the use
of telehealth.

¢ 2021 CA S.B. 133 (NS), enrolled July 15, 2021, would require the Department to seek any federal approvals it deems necessary to
extend the approved waiver or flexibility implemented pursuant to those provisions as of July 1, 2021, that are related to the delivery
and reimbursement of services via telehealth modalities in the Medi-Cal program, and subject to approval by the Department of
Finance, would require the Department to implement those extended waivers or flexibilities for which federal approval is obtained

for a specified period of time ending December 31, 2022. The bill would also require the Department to convene an advisory group

to provide recommendations to inform the Department in establishing and adopting billing and utilization management protocols for
telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The bill would authorize the State
Department of State Hospitals to conduct a reevaluation, as defined, in person or by video telehealth, of a defendant in county custody
if the defendant has been committed to and awaiting admission to the department for 60 days or more, as specified. The bill would
require the department to provide funding at a rate set by the department for reimbursement of information technology support and a
portion of staff time used to facilitate telehealth interviews and evaluations of felony defendants.

* 2021 CA S.B. 306 (NS), adopted October 4, 2021, amends CA WEL & INST ? 14105.181 (Definitions; reimbursement for office visits;
administration and regulations) to provide that office visits, including in person and visits through telehealth, must be reimbursed at the
same rate as those office visitsbilled as comprehensive clinical family planning services by Family PACT providers. The bill is effective
January 1, 2022.

¢ 2021 CA S.B. 365 (NS), enrolled September 3, 2021, would new section and amend CA WEL & INST ? 14132.72 (Telehealth;
medical services without in-person contact; barriers to in-person visits; type of setting where services are provided; use of telehealth
not to be required if inappropriate; all-county letters, provider bulletins, and instructions) to make electronic consultation services
reimbursable under the Medi-Cal program for enrolled providers, including FQHCs or RHCs, and require the Department to develop a
reimbursement policy for those services that, at a minimum, and with respect to primary care providers, is consistent with the Medicare
program coverage policy. The bill would also define 'electronic consultation service" or 'e-consult service."

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¢ 2021 CA S.B. 508 (NS), amended/substituted April 14, 2021, would amend CA WEL & INST ? 14132.06 (Covered Medi-Cal benefits;
health services provided by certain local educational agencies; enrollment; public accounting; federal financial participation) to provide
that telehealth is an approved modality for service delivery, except for services, such as specialized mental transportation services,
that preclude a telehealth modality, to allow LEAs to use any appropriate non-public facing remote communication products that

meet privacy and security requirements in their delivery of billable telehealth services, and to require the Department to reimburse for
covered services provided via telehealth in the same manner and at the same rate as for face-to-face services.

¢ 2021 CA REG TEXT 562712 (NS), field August 10, 2021, adopts 16 CA ADC ? 1396.8 (Standards of Practice for Telehealth Services)
establishing the standards of practice for telehealth services. The regulation is effective August 10, 2021.

Colorado

* 2021 CO H.B. 1021 (NS), adopted June 18, 2021, adopts CO ST ? 27-60-108 (Peer support professionals ? cash fund ? fees ?
requirements ? rules ? legislative declaration ? definitions) to allow a peer support professional to provide services for a recovery
support services organization in various clinical and nonclinical settings, including but not limited to services delivered via telemedicine.
The bill is effective September 7, 2021.

¢ 2021 CO H.B. 1190 (NS), adopted May 18, 2021, amends CO ST ? 24-240-104 (Definitions) to provide the definition for 'distant site,"
'originating site," and 'store-and-forward transfer" and update the definition for 'telemedicine." Amends CO ST ? 12-240-107 (Practice
of medicine defined--exemptions from licensing requirements--unauthorized practice by physician assistants and anesthesiologist
assistants--penalties--definitions--rules--repeal) to update the definition of 'practice of medicine" to include telehealth. The bill is
effective May 18, 2021.

¢ 2021 CO H.B. 1256 (NS), adopted May 27, 2021, amends CO ST ? 25.5-5-320 (Telemedicine--reimbursement--disclosure statement--
definition--repeal) to require the State Department to promulgate rules specifically relating to entities that deliver health-care or mental
health-care services exclusively or predominately through telemedicine. The bill is effective May 27, 2021.

* 2021 CO H.B. 1258 (NS), adopted June 18, 2021, adopts CO ST ? 27-60-108 (Temporary youth mental health services program -
established - rules - report - definitions - repeal) to require the Office to reimburse each mental health session with a youth client at the
same rate regardless of whether the appointment is a telehealth or in-person appointment. The bill is effective September 7, 2021.

* 2021 CO H.B. 1275 (NS), engrossed June 4, 2021, would adopt CO ST ? 25.5-5-511 (Reimbursement for pharmacists' services -
legislative declaration) would require that a pharmacist receive reimbursement under the medical assistance program for providing
services authorized in statute, which reimbursement must be equivalent to the reimbursement provided to a physician or advanced
practice nurse for the same services rendered, including services delivered by a pharmacist through telemedicine.

¢ 2021 CO H.B. 1279 (NS), adopted June 24, 2021, adoptsthe Occupational Therapy Licensure Interstate Compact. One of the stated
purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services. The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 CO S.B. 3 (NS), adopted January 12, 2021, adopts the Occupational Therapy Practice Acts. One of the stated purposes for
the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The bill is
effective January 12, 2021.

«2021 CO S.B. 21 (NS), adopted May 28, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact will come into effect on the date on which the Compact is enacted into law in the 7th
Compact state.

* 2021 CO S.B. 102 (NS), adopted April 15, 2021, amends CO ST ? 12-220-104 (Definitions-rules) would remove the definition

for 'telehealth by store and forward transfer." Amends CO ST ? 12-220-505 (Interim therapeutic restorations by dental hygienists--
permitting process--rules--subject to review-repeal) to update the requirements for a dental hygienist who utilizes telehealth and
works under supervision by telehealth. Amends CO ST ? 25.5-5-321.5 (Telehealth--interim therapeutic restorations--reimbursement
-definitions) and CO ST ? 25.5-8-109.5 (Telehealth--interim therapeutic restorations-- reimbursement-definitions) to update the
definition for 'store-and-forward transfer." The bill is effective September 1, 2021.

¢ 2021 CO S.B. 139 (NS), adopted May 7, 2021, would amend CO ST ? 10-16-123 (Telehealth ? definitions) to require each dental
plan issued, amended, or renewed in this ate to cover services offered to a covered person through telehealth. Amend CO ST ?
25.5-5-320 (Telemedicine--reimbursement-disclosure statement--definition-repeal) to update the definition for 'health-care or mental-
care services."

¢ 2021 CO S.B. 292 (NS), adopted June 22, 2021, adopts CO ST ? 18-3-407.9 (Forensic nurse examiners ? telehealth program ?
creation ? appropriation) creating the forensic nurse examiners telehealth program. The bill is effective June 22, 2021.

* 2020 CO REG TEXT 572523 (NS), filed December 15, 2020, adopts an Emergency Regulation 20-E-11 (Concerning Coverage and
Reimbursement for Telehealth Services During the COVID-19 Disaster Emergency) under 3 CO ADC 702-4 (Life, Accident and Health).
The regulation ensures that carriers offering health benefit plans reimburse providers for provision of telehealth services using non-
public facing audio or video communication products during the COVID-19 nationwide public health emergency. Provides for authority,

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scope and purpose, applicability, definitions, reimbursements for telehealth services, severability, incorporated materials, enforcement,
effective date, and history. This Emergency Regulation is effective December 15, 2020 and replaces Emergency Regulation 20-E-11
effective August 14, 2020.

¢ 2021 CO REG TEXT 564785 (NS), adopted December 15, 2020, adopts 3 CO ADC 702-4:20-E-16 (Concerning Coverage and
Reimbursement for Telehealth Services During the COVID-19 Disaster Emergency) to require insurers offering health benefit plans
to reimburse providers for provision of telehealth services using non-public facing audio or video communication products during the
COVID-19 nationwide public health emergency. The regulation was adopted via emergency and is effective December 15, 2020.

«2021 CO REG TEXT 572207 (NS), published February 10, 2021, adopts 10 CO ADC 2505-10:8.520.8 (Home Health Telehealth
Services) to require prior authorization for home health telehealth services. The rule is effective March 15, 2021.

Connecticut

¢ 2021 CT H.B. 5045 (NS), introduced January 11, 2021, would amend CT ST ? 17b-245e (Telehealth services provided under the
Medicaid program. Report) to expand telehealth services under the Medicaid program to ensure adequate access to medical specialists
in southeastern Connecticut.

¢ 2021 CT H.B. 5118 (NS), introduced January 12, 2021, would extend the sunset date for certain provisions of public act 20-2 of the
July special session to May 30, 2022, provide that a health insurer may pay a reduced reimbursement to a health care provider who
provides a covered benefit to an insured through telehealth, provided the amount of such reduced reimbursement shall be equal to at
least fifty per cent of the reimbursement that the health insurer would have paid to the health care provider if the health care provider
had provided the covered benefit to the insured in person and prohibit a health care provider from seeking reimbursement for an in-
person covered benefit if the provider previously sought reimbursement for the same covered benefit provided to the same insured
through telehealth.

¢ 2021 CT H.B. 5142 (NS), introduced January 12, 2021, would amend CT ST ? 19a-906 (Telehealth services) to allow for the provision
of mental health treatment services through telehealth using audio-only telephone.

¢ 2021 CT H.B. 5395 (NS), introduced January 22, 2021, would allow veterinarians to provide telehealth services and establish certain
standards with regard to a veterinarian-client relationship in the context of the provision of such services.

¢ 2021 CT H.B. 5546 (NS), introduced January 26, 2021, would amend CT ST ? 38a-499a (Coverage for telehealth services) and CT
ST ? 38a-526a (Coverage for telehealth services) to expand required health insurance coverage for telehealth services and variety
of telehealth providers and platforms that are eligible for reimbursement, provide that no telehealth provider who provides a covered
benefit to an insured through telehealth and receives a reimbursement for such benefit must seek any payment from the insured for
such benefit except for any coinsurance, copayment, deductible or other out-of-pocket expense due and owing for such benefit under
the insured's health insurance policy, and prohibit health carriers from reducing the amount of any reimbursement paid to a telehealth
provider for a covered benefit solely because the telehealth provider provided such covered benefit to an insured through telehealth.

¢ 2021 CT H.B. 5549 (NS), introduced January 26, 2021, would expand required health insurance coverage for telehealth and require
reimbursement parity for telehealth services.

* 2021 CT H.B. 5573 (NS), introduced January 26, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day
to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 CT H.B. 5596 (NS), adopted May 10, 2021, requires a study concerning the expansion of the provision of telehealth services in
Connecticut. The bill is effective May 10, 2021.

¢ 2021 CT H.B. 6006 (NS), introduced January 28, 2021, would amend the general statutes to codify the Governor's executive orders
regarding telehealth.

¢ 2021 CT H.B. 6249 (NS), introduced January 29, 2021, and 2021 CT S.B. 509 (NS), introduced January 27, 2021, would expand
the list of providers who may provide, and permitted scope of, telehealth services, and expand required health insurance coverage for
telehealth services.

¢ 2021 CT H.B. 6470 (NS), adopted July 7, 2021, specifies conditions under which audio-only telehealth services can be provided under
Medicaid and HUSKY B and requires Medicaid reimbursement for telehealth services to be the same as if the service was provided

in person, to the extent allowed under federal law. Requiring the Department of Social Services (DSS) Commissioner, to the extent
permissible under federal law, to provide Medicaid reimbursement for telehealth services to the same extent as services provided in
person. Allowing telehealth providers to provide services from any location. The bill is effective July 1, 2021.

¢ 2021 CT H.B. 6472 (NS), introduced February 18, 2021, would adopt new section to require the Commissioner to provide coverage
and reimbursement under the Medicaid program for telehealth services for a period of two years and study whether the benefits of
expanding such services should be made permanent.

¢ 2021 CT H.B. 6637 (NS), amended/substituted May 21, 2021, would adopt new sections to require the state-wide mental health
services program to include regional service centers or options that provide for culturally and linguistically affirmative mental health

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services and accessible mental health services to deaf, deaf-blind, and hard of hearing persons, including the provision of sign
language interpreting, video relay telecommunications, captioning, telehealth, and telemedicine services.

¢ 2021 CT S.B. 205 (NS), introduced January 22, 2021, would expand provisions covering the provision of telehealth services by health
care providers and expand health insurance coverage for such services to include coverage for services rendered by chiropractors,
physical therapists, naturopaths, and optometrists.

¢ 2021 CT S.B. 395 (NS), introduced January 26, 2021, would amend CT ST ? 38a-499a (Coverage for telehealth services) and CT
ST ? 38a-526a (Coverage for telehealth services) to provide that individual and group health insurance policies delivered, issued for
delivery, renewed, amended or continued in this state must provide coverage for mental health intakes and visits, provided through
telehealth, and that such coverage must be provided at the same level of benefits and cost sharing as mental health intakes and visits
provide in person.

* 2021 CT S.B. 401 (NS), introduced January 26, 2021, would expand telehealth for physical and mental health services.

¢ 2021 CT S.B. 503 (NS), introduced January 27, 2021, would amend CT ST ? 38a-499a (Coverage for telehealth services) and CT
ST ? 38a-526a (Coverage for telehealth services) to expand required health insurance coverage for mental health and substance use
disorder services provided through telehealth.

¢ 2021 CT S.B. 979 (NS), introduced March 3, 2021, would amend CT ST ? 17b-245e (Telehealth services provided under the Medicaid
program. Report) to require the Commissioner of Social Services to expand access to medical specialists in southeastern Connecticut
by expanding telehealth services.

Delaware

¢ 2021 DE H.B. 160 (NS), adopted June 23, 2021, amends DE ST TI 18 ? 3370 (Telehealth and Telemedicine) and DE ST TI 18 ?
3571R (Telehealth and Telemedicine) to update the definition for 'distant site," 'originating site," 'telehealth," and 'telemedicine." The bill
adopts DE ST TI 24 ? 6001 et seq. (Provisions Applicable to Telehealth and Telemedicine) authorizing health-care providers to practice
by telehealth and telemedicine. The bill is effective July 1, 2021.

«2021 DE REG TEXT 578328 (NS), issued June 1, 2021, amends 24 DE ADC 3500-18.0 (Telepsychology) removing provision
exempting, in the context of a face-to-face relationship, electronic communication used specific to appointment scheduling, billing, and/
or the establishment of benefits and eligibility for services and telephone or other electronic communications made for the purpose of
ensuring client welfare in accord with reasonable professional judgment from the requirements of this rule. Makes technical changes.
The regulation is effective June 11, 2021.

¢ 2021 DE REG TEXT 589818 (NS), signed September 10, 2021, adopts uncodified section (Alternative Benefit Plan) to require the
alternative benefit plan to provide coverage for telemedicine but provides that the service must be covered by Medicaid in a face-to-face
setting to be available for coverage under telemedicine. The regulation is effective October 11, 2021.

¢ 2021 DE REG TEXT 592461 (NS), published September 1, 2021, amends 18 DE ADC 1409-2.2 (Definitions) updating the definition
for 'originating site," 'store and forward transfer," 'telehealth, and 'telemedicine."Amends 18 DE ADC 1409-4.0 (Telehealth) clarifying
that coverage for health care services provided through telehealth are practiced within the scope of State law, including but not limited
to 24 Del.C. Ch. 60. The regulation is effective September 11, 2021.

District of Columbia

¢ 2021 CA A.B. 457 (NS), adopted October 1, 2021 removes the date restriction, thereby extending the telehealth reimbursement parity
requirement for all contracts between a health care service plan or a health insurer and a health care provider. The bill also enacts the
Protection of Patient Choice in Telehealth Provider Act, and would require a health care service plan and a health insurer to comply
with specified notice and consent requirements if the plan or insurer offers a service via telehealth to an enrollee or an insured through
a third-party corporate telehealth provider, as defined. For an enrollee or insured that receives specialty telehealth services for a mental
or behavioral health condition, the bill would require that the enrollee or insured be given the option of continuing to receive that service
with the contracting individual health professional, a contracting clinic, or a contracting health facility. The bill is effective January 1,
2022.

¢ 2019 DC L.B. 145 (NS), adopted December 22, 2020, adopts the Psychology Interjurisdictional Compact to regulate the date to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The Compact
comes into effect on the date on which the Compact is enacted into law in the 7th Compact State.

* 2021 DC L.B. 399 (NS), enrolled October 8, 2021, and 2021 DC L.B. 400 (NS), enrolled November 29, 2021, would amend DC
CODE ? 3-1205.02 (Exemptions) to allow an individual to engage in the practice of providing healthcare to District residents for a
particular health occupation without a District license, registration, or certification until August 10, 2022, if the individual provides
healthcare services at a licensed or certified healthcare entity, which may include telehealth services or to an established patient who
has returned to the District, and the individual is providing continuity of care to the patient by telehealth in accordance with applicable
laws and regulations.

* 2021 DC REG TEXT 591854 (NS), adopted August 18, 2021, amends 29 DC ADC ? 910 (Medicaid-Reimbursable Telemedicine
Services) adding audio-only communication as an allowable method of telemedicine. Adds verbal consent as an allowable method for

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a beneficiary to consent to telemedicine services. Clarifies that providers must maintain appropriate documentation to demonstrate that
a beneficiary has consented to telemedicine services. Clarifies the telemedicine services technology requirements applicable to audio-
only communication and video-audio communication methods. The regulation was amended via emergency and is effective August 18,
2021 through December 16, 2021.

¢ 2021 DC REG TEXT 591854 (NS), adopted October 28, 2021, amends 29 DC ADC ? 910 (Medicaid-Reimbursable Telemedicine
Services) adding audio-only communication as an allowable method of telemedicine. Adds verbal consent as an allowable method for
a beneficiary to consent to telemedicine services. Clarifies that providers must maintain appropriate documentation to demonstrate that
a beneficiary has consented to telemedicine services. Clarifies the telemedicine services technology requirements applicable to audio-
only communication and video-audio communication methods. These amendments were originally adopted by emergency rulemaking
(2021 DC REG TEXT 591854 (NS)) and have been adopted as final with one technical change. The regulation is effective November 5,
2021.

* 2021 DC REG TEXT 594939 (NS), adopted September 22, 2021, adopts 17 DC ADC ? 4020 (Temporary Waiver of Licensure
Requirements for Certain Healthcare Providers) allowing an individual to engage in the unlicensed practice of providing healthcare to
District residents for a particular health occupation if the individual provides healthcare services at a licensed or certified healthcare
entity, which may include the provision of healthcare services by telehealth, or to an established patient who has returned to the
District of Columbia, and the individual is providing continuity of care to the patient by telehealth in accordance with appliable laws and
regulations. The regulation was adopted via emergency rulemaking and is effective September 22, 2021 and expires January 19, 2022.

Florida

¢ 2021 FL H.B. 119 (NS), filed December 23, 2020, would adopt FL ST ? 916.135 (Misdemeanor Mental Health Diversion Pilot
Program) to allow a telehealth provider to evaluate the defendant using a standardized, validated mental health screening instrument to
determine if there is an indication that the defendant has a mental health disorder and allows for continued treatment via telehealth..

¢ 2021 FL H.B. 247 (NS), amended/substituted April 14 , 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services)
clarifying that telehealth provider may not use telehealth to prescribe a controlled substance listed in Schedule I| unless certain
conditions are me.

¢ 2021 FL H.B. 831 (NS), filed February 8, 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services) to update the
definition for 'telehealth" and update the practice standards for a telehealth provider. The bill would also amend FL ST ? 627.42396
(Reimbursement for telehealth services) to prohibit certain health insurance policies from denying coverage for covered services
provided through telehealth under certain circumstances, prohibit health insurers from excluding covered services provided through
telehealth from coverage, provide reimbursement requirements relating to telehealth services, provide that health insurers are not
required to reimburse providers for originating fees or costs for telehealth services, provide cost-sharing limitations for health insurers
relating to telehealth services, authorize health insurers to conduct utilization reviews under certain circumstances, and authorize health
insurers to limit telehealth services to certain providers. The bill would also adopt FL ST ? 641.31093 (Requirements for reimbursement
by health maintenance organization for telehealth services) to prohibit certain health insurance policies from denying coverage for
covered services provided through telehealth under certain circumstances, prohibit health insurers from excluding covered services
provided through telehealth from coverage, provide reimbursement requirements relating to telehealth services, provide that health
insurers are not required to reimburse providers for originating fees or costs for telehealth services, provide cost-sharing limitations for
health insurers relating to telehealth services, authorize health insurers to conduct utilization reviews under certain circumstances, and
authorize health insurers to limit telehealth services to certain providers.

¢ 2021 FL H.B. 1381 (NS), adopted June 29, 2021, adopts FL ST ? 383.2163 (Telehealth minority maternity care pilot programs) to
require the Department to establish telehealth minority maternity care pilot programs which uses telehealth to expand the capacity for
positive maternal health outcomes in racial and ethnic minority populations. The bill is effective July 1, 2021.

¢ 2021 FL H.B. 1477 (NS), filed February 26, 2021, would amend FL ST ? 409.908 (Reimbursement of Medicaid providers) to require
the Agency to reimburse the use of telehealth to include services provided in real time, services provided using store-and-forward
technologies, and remote patient monitoring services to the extent that these technologies are available. Amend FL ST ? 456.47

(Use of telehealth to provide services) to revise the definition for 'telehealth" and authorize telehealth providers to prescribe specified
controlled substances through telehealth under certain circumstances. Amend FL ST ? 458.347 (Physician assistants) and FL ST ?
459.022 (Physician assistants) to clarify that the term 'easy availability' includes the ability to communicate by way of telehealth. Amend
FL ST ? 465.003 (Definitions) to define 'remote-site pharmacy" or 'remote site" and to allow an off-site pharmacist, acting in the capacity
of a prescription department manager, from remotely supervising a registered pharmacy technician at a remote-site pharmacy. Amend
FL ST ? 465.014 (Pharmacy technician) and FL ST ? 465.015 (Violations and penalties) to allow a registered pharmacy technician
operating under remote supervision of an off-site pharmacist to compound and dispense medicinal drugs under such supervision. Adopt
FL ST ? 465.0198 (Remote-site pharmacy permits) to establish the requirements for a remote-site pharmacy. Amends FL ST ? 893.05
(Practitioners and persons administering controlled substances in their absence) to prohibit a telehealth provider from prescribing
through telehealth a controlled substance listed in Schedule | or Schedule II.

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¢ 2021 FL H.B. 1565 (NS), filed March 1, 2021, would amend FL ST ? 491.005 (Licensure by examination) to require a licensed mental
health professional to be accessible by telephone or electronic means when a registered intern is providing clinical services through
telehealth.

¢ 2021 FL H.B. 6079 (NS), filed February 16, 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services) to update the
definition for 'telehealth" and revise exemption for certain health care professionals to provide health care services using telehealth in
this state under certain conditions.

¢ 2021 FL S.B. 590 (NS), adopted June 29, 2021, amends FL ST ? 1011.62 (Funds for operation of schools) to allow telehealth to be
used to contract the local mobile crisis response service for a student crisis situation. The bill is effective July 1, 2021.

¢ 2021 FL S.B. 660 (NS), introduced March 2, 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services) to update the
definition for 'telehealth" and remove a prohibition on prescribing controlled substances through telehealth.

¢ 2021 FL S.B. 700 (NS), introduced March 2, 2021, would amend FL ST ? 409.908 (Reimbursement of Medicaid providers), FL ST ?
456.47 (Use of telehealth to provide services), and FL ST ? 465.003 (Definitions) to require the Agency for Health Care Administration
to reimburse the use of telehealth services under certain circumstances and subject to certain limitations, authorize telehealth providers
to prescribe specified controlled substances through telehealth under certain circumstances, authorize out-of-state physician telehealth
providers to engage in formal supervisory relationships with certain nonphysician care practitioners in this state, and update definitions.

¢ 2021 FL S.B. 818 (NS), amended/substituted March 30, 2021, would amend FL ST ? 491.005 (Licensure by examination) to require
that when a registered intern is providing clinical services through telehealth, a licensed mental health professional must be accessible
by telephone or other electronic means.

¢ 2021 FL S.B. 864 (NS), amended/substituted March 17, 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services) to
update the definition for 'telenealth" and revise an exemption from telehealth registration requirements.

¢ 2021 FL S.B. 1188 (NS), introduced March 2, 2020, would adopt FL ST ? 916.135 (Misdemeanor Mental Health Diversion Pilot
Program) to allow a telehealth provider to evaluate the defendant using a standardized, validated mental health screening instrument to
determine if there is an indication that the defendant has a mental health disorder and allows for continued treatment via telehealth.

¢ 2021 FL S.B. 1250 (NS), introduced March 2, 2021, would amend FL ST ? 409.967 (Managed care plan accountability) to prohibit
Medicaid managed care plans from using providers who exclusively provider services through telehealth to achieve network adequacy,
FL ST ? 627.42396 (Reimbursement for telehealth services) to prohibit certain health insurance policies from denying coverage for
covered services provided through telehealth under certain circumstances, prohibit health insurers from excluding covered services
provided through telehealth from coverage, provide reimbursement requirements and cost-sharing limitations for health insurers relating
to telehealth services, prohibit health insurers from requiring an insured to receive services through telehealth services, authorize
health insurers to conduct utilization reviews under certain circumstances, authorize health insurers to limit telehealth services to
certain providers, delete certain requirements for certain health insurers and telehealth providers, FL ST ? 627.6699 (Employee Health
Care Access Act) to require certain small employer benefit plans to comply with certain requirements for reimbursement of telehealth
services, and FL ST ? 641.31 (Health maintenance contracts) to prohibit a health maintenance organization from requiring a subscriber
to receive certain services through telehealth, delete requirements for contracts between certain health insurers and telehealth
providers. The bill would also adopt FL ST ? 641.31093 (Requirements for reimbursement by health maintenance organization for
telehealth services) to prohibit certain health maintenance organizations from denying coverage for covered services provided through
telehealth under certain circumstances, prohibit health maintenance organizations from excluding covered services provided through
telehealth from coverage, provide reimbursement requirements and cost-sharing limitations for health maintenance organizations
relating to telehealth services, prohibit a health maintenance organization from requiring a subscriber to receive services through
telehealth, and authorize health maintenance organization to limit telehealth services to certain providers.

¢ 2021 FL S.B. 1370 (NS), amended/substituted March 11, 2021, would amend FL ST ? 474.202 (Definitions) to define 'veterinary
telemedicine" and adopt FL ST ? 474.2021 (Veterinary telemedicine) to authorize veterinarians to practice veterinary telemedicine and
provide licensure requirements to practice veterinary telemedicine.

¢ 2021 FL H.B. 1381 (NS), amended/substituted March 11, 2021, would adopt FL ST ? 383.2163 (Telehealth minority maternity care
pilot programs) to require the Department to establish telehealth minority maternity care pilot programs which uses telehealth to expand
the capacity for positive maternal health outcomes in racial and ethnic minority populations.

¢ 2021 FL S.B. 1540 (NS), amended/substituted March 31, 2021, would adopt FL ST ? 383.2163 (Telehealth minority maternity care
pilot programs) to require the Department to establish a telehealth minority maternity care pilot program in Duval County and Orange
County which uses telehealth to expand the capacity for positive maternal health outcomes in racial and ethnic minority populations.

¢ 2021 FL S.B. 1568 (NS), engrossed April 22, 2021, would amend FL ST ? 491.005 (Licensure by examination) to provide that when a
registered intern is providing clinical services through telehealth, a licensed mental health professional must be accessible by telephone
or other electronic means.

¢ 2021 FL S.B. 1820 (NS), introduced March 10, 2021, would amend FL ST ? 456.47 (Use of telehealth to provide services) authorizing
telehealth providers to prescribe controlled substances to qualified patients through telehealth under certain circumstances.

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¢ 2022 FL H.B. 333 (NS), filed October 18, 2021, would amend FL ST ? 381.986 (Medical use of marijuana) to authorize qualified
physicians to perform patient examinations and evaluations through telehealth for renewals of physician certifications for the medical
use of marijuana.

¢ 2022 FL H.B. 679 (NS), filed November 22, 2021, would amend FL ST ? 381.986 (Medical use of marijuana) to allow an examination,
for a certification renewal, to be conducted through telehealth if such examination is conducted by the same qualified physician who
conducted the examination for initial certification and provide that if a patient changes his or her qualified physician, the new qualified
physician must conduct an initial physical examination of the patient while physically present in the same room before conducting any
examination through telehealth. Amend FL ST ? 456.47 (Use of telehealth to provide services) to allow a telehealth provider to use
telehealth to prescribe a controlled substance for the treatment and evaluation of an existing qualified patient for the medical use of
marijuana in accordance with FL ST ? 381.986 (Medical use of marijuana).

¢ 2022 FL H.B. 693 (NS), filed November 22, 2021, would amend FL ST ? 491.005 (Licensure by examination) to require a licensed
mental health professional to be accessible by telephone or electronic means when a registered intern provides clinical services
through telehealth.

¢ 2022 FL S.B. 164 (NS), filed September 14, 2021, would amend FL ST ? 381.986 (Medical use of marijuana) to authorize qualified
physicians to perform patient examinations and evaluations through telehealth for renewals of physician certifications for the medical
use of marijuana.

¢ 2022 FL S.B. 358 (NS), amended/substituted November 3, 2021, would adopt the Licensed Professional Counselor Interstate
Compact. One of the stated purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access
to Professional Counseling services.

¢ 2022 FL S.B. 630 (NS), filed October 25, 2021, would adopt FL ST ? 925.13 (Sentence deferral for pregnant women) to require an
appropriate assessment by a licensed health care practitioner or a telehealth provider to be offered to an incarcerated pregnant women
or postpartum woman.

¢ 2022 FL S.B. 726 (NS), filed November 2, 2021, would amend FL ST ? 409.967 (Managed care plan accountability) to prohibit
Medicaid managed care plans from using providers who exclusively provide services through telehealth to achieve network adequacy.
Amend FL ST ? 627.42396 (Requirements for reimbursement by health insurers for telehealth services) to prohibit certain health
insurance policies from denying coverage for covered services provided through telehealth under certain circumstances, prohibit
health insurers from excluding covered services provided through telehealth from coverage, provide reimbursement requirements and
cost-sharing limitations for health insurers relating to telehealth services, prohibit health insurers from requiring an insured person to
receive services through telehealth, authorize health insurers to limit telehealth services to certain providers, and delete requirements
for contracts between certain health insurers and telehealth provide. Amend FL ST ? 627.6699 (Employee Health Care Access Act)
to require certain small employer benefit plans to comply with certain requirements for reimbursement of telehealth services. Amend
FL ST ? 641.31 (Health maintenance contracts) to prohibit a health maintenance organization from requiring a subscriber to receive
certain services through telehealth; deleting requirements for contracts between certain health insurers and telehealth providers.
Adopt FL ST ? 641.31093 (Requirements for reimbursement by health maintenance organizations for telehealth services) to prohibit
certain health maintenance organizations from denying coverage for covered services provided through telehealth under certain
circumstances, prohibit health maintenance organizations from excluding covered services provided through telehealth from coverage,
provide reimbursement requirements and cost-sharing limitations for health maintenance organizations relating to telehealth services,
prohibit a health maintenance organization from requiring a subscriber to receive services through telehealth, and authorize health
maintenance organizations to limit telehealth services to certain providers.

¢ 2022 FL S.B. 768 (NS), filed November 2, 2021, would amend FL ST ? 491.005 (Licensure by examination) requiring a licensed
mental health professional to be accessible by telephone or electronic means when a registered intern provides clinical services
through telehealth.

¢ 2021 FL REG TEXT 558948 (NS), published June 8, 2021, amends 64 FL ADC 64816-30.001 (Disciplinary Guidelines; Range of
Penalties; Aggravating and Mitigating Circumstances) updating the disciplinary guidelines to clarify language due to statutory changes,
including telehealth registrants. The regulation is effective June 24, 2021.

¢ 2021 FL REG TEXT 558948 (NS), published September 28, 2021, amends 64 FL ADC 64B33-5.001 (Disciplinary Guidelines)
updating the disciplinary guidelines to clarify language due to statutory changes, including telehealth registrants. The regulation is
effective September 28, 2021.

¢ 2021 FL REG TEXT 562296 (NS), published January 26, 2021, adopts 64 FL ADC 64B12-8.024 (Out-of-State Telehealth Discipline)
establishing disciplinary guidelines for out of state telehealth registrants. The regulation is effective February 8, 2021.

* 2021 FL REG TEXT 565365 (NS), published February 23, 2021, adopts FL ADC 64B4-5.0015 (Out-of-State Telehealth Discipline)
establishing disciplinary guidelines for out-of-state telehealth registrants. The regulation is effective March 11, 2021.

¢ 2021 FL REG TEXT 573002 (NS), published May 11, 2021, adopts FL ADC 65C-28.021 (Qualified Residential Treatment Programs)
allowing a QE to utilize telehealth for contact with the child and requiring the QE to abide by the Agency for Health Care administration
(AHCA) telehealth guidelines when using a Medicaid service. The rulemaking is effective May 23, 2021.

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¢ 2021 FL REG TEXT 573004 (NS), published May 11, 2021, adopts FL ADC 65C-14.121 (Standards for Qualified Residential
Treatment Program Credential) requiring the QRTP to provide a minimum of 2 contacts per month and providing that while face to face
contact is the preferred method for contact with the youth and family/caregiver, the QRTP may utilize telehealth. The rulemaking is
effective May 26, 2021.

¢ 2021 FL REG TEXT 573311 (NS), published May 11, 2021, amends FL ADC 64B19-17.002 (Disciplinary Guidelines) establishing the
disciplinary guidelines for a telehealth registrant. The rulemaking is effective May 25, 2021.

* 2021 FL REG TEXT 578877 (NS), published October 26, 2021, amends 64 FL ADC 64B3-12.001 (Disciplinary Guidelines) updating
the disciplinary guidelines to clarify language due to statutory changes, including telehealth registrants. The regulation is effective
November 7, 2021.

¢ 2021 FL REG TEXT 584870 (NS), published September 8, 2021, amends 64 FL ADC 6481-9.001 (Disciplinary Guidelines) adding
disciplinary actions for statutory violations for telehealth registrants. The regulations are effective September 22, 2021.

¢ 2021 FL REG TEXT 585991 (NS), published November 2, 2021, amends 64 FL ADC 64817-7.002 (Guidelines for Disposition of
Disciplinary Cases) updating the disciplinary guidelines to clarify language due to statutory changes, including telehealth registrants.
The regulation is effective November 17, 2021.

¢ 2021 FL REG TEXT 590945 (NS), published October 5, 2021, amends 64 FL ADC 64B19-13.004 (Board Approval of Continuing
Psychological Education Providers) requiring providers of psychological medical errors courses to include content on the potential for
medical errors while providing services through telehealth. The regulation is effective October 20, 2021.

¢ 2021 FL REG TEXT 593158 (NS), published November 2, 2021, amends 64 FL ADC 64817-7.001 (Disciplinary Guidelines) updating
the disciplinary guidelines to clarify language due to statutory changes, including telehealth registrants. The regulation is effective
November 17, 2021.

* 2021 FL REG TEXT 599928 (NS), filed November 25, 2021, adopts FL ADC 65DER21-2 to amend 65 FL ADC 65D-30.0142

(Clinical and Operational Standards for Medication-Assisted Treatment for Opioid Use Disorders) updating the requirements related to
conducting assessment services through telehealth. Requires the initial assessment for methadone medication-assisted treatment to be
conducted face-to-face. The regulation was amended adopted via emergency rulemaking and is effective November 25, 2021.

Georgia

¢ 2021 GAH.B. 9 (NS), introduced January 26, 2021, would amend GA ST ? 20-2-779.1 (Suicide awareness and prevention training) to
develop guidelines for the use of telehealth services in public school to provide mental health and behavioral health services to students
at school or during any school related function and to define the term 'telehealth."

* 2021 GAH.B. 34 (NS), adopted May 10, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact will come into effect on the date on which the Compact is enacted into law in the
10th Compact state.

¢ 2021 GAH.B. 215 (NS), introduced February 2, 2021, would amend GA ST ? 49-4-142 (Department of Community Health) to require
the Department to take all reasonable and necessary steps to obtain permanent federal approval and to permanently implement the
state's authorization through an Appendix K submission for a temporary waiver modification due to the COVID-19 pandemic emergency
to utilize telehealth options in accordance with federal Health Insurance Portability and Accountability Act (HIPAA) requirements where
clinically appropriate as a modification to in-person service delivery settings. The bill would also amend GA ST ? 49-4-142 (Request

for waiver) to require the Department to authorize and implement a system of certification, recertification, and training of providers of
medical assistance via telehealth options where appropriate, in lieu of in-person observation models.

¢ 2021 GAH.B. 268 (NS), adopted May 10, 2021, adopts the Occupational Therapy Practice Acts. One of the stated purposes for the
Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The Compact
will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 GAH.B. 307 (NS), adopted May 4, 2021, amends GA ST ? 33-24-56.4 (Georgia Telehealth Act) to update the definition for
'distant site," 'originating site," and 'telemedicine" and to provide the definition for 'mHealth" and 'remote patient monitoring services."
The also prohibits an insurer from requiring an in-person consultation or contact before a patient may receive telemedicine services
from a health care provider, prohibits separate deductibles for telemedicine services, prohibits requirement that health care providers
use a specific telehealth platform or vendor, prohibits additional restrictions on prescribing medications through telemedicine, and
requires documentation by health care providers for telemedicine services that equals or exceeds in-person consultation. The bill is
effective May 4, 2021.

* 2021 GA H.B. 395 (NS), adopted May 10, 2021, adopts the Licensed Professional Counselor Interstate Compact. One of the stated
purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Professional Counseling
services. The Compact will come into effect on the date on which the Compact is enacted into law in the 10th Compact state.

¢ 2021 GA REG TEXT 576634 (NS), filed January 24, 2021, adopts GA ADC 360-2-.17 (Requirements for Telemedicine Licensure)
establishing the requirements for a new licensure category for physicians to practice by telemedicine. Adopts GA ADC 360-40,

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Interstate Medical Licensure Compact (IMLC), establishing the requirements for expedited licensure for physicians through the
Interstate Medical Licensure Compact. New rules include GA ADC 360-40-.01 (Definitions), GA ADC 360-40-.02 (Requirements for
Licensure through the IMLC with Georgia as your State of Principal license), GA ADC 360-40-.03 (Applicants Applying for Licensure to
Georgia through IMLC), GA ADC 360-40-.04 (Renewal and Continued Participation), GA ADC 360-40-.05 (Investigations) and GA ADC
360-40-.06 (Disciplinary Actions). The rules are effective January 24, 2021.

Hawaii

¢ 2021 HI H.B. 384 (NS), introduced January 25, 2021, would amend HI ST ? 431:10A-116.3 (Coverage for telehealth), HI ST ?
432:1-601.5 (Coverage for telehealth), and HI ST ? 432D-23.5 (Coverage for telehealth) to prohibit insurers from excluding coverage
of a service solely because the service is provided through telehealth and not through face-to-face contact, require parity between
telehealth services and face-to-face services for purposes of deductibles, copayments, coinsurance, benefit limits, and utilization
reviews, and update the definition for 'telehealth."

¢ 2021 HI H.B. 472 (NS), amended/substituted February 12, 2021, would adopt new sections in HI ST ? 103D (Gifts to the State

for telehealth purposes; exemption) and HI ST ? 103F (Gifts to the State for telehealth purposes; exemption) to exempt telehealth-
related gifts from procurement requirements. The bill would also amend HI ST ? 329-41 (Prohibited acts B--penalties), HI ST ?

346.59.1 (Coverage for telehealth), HI ST ? 431:10A-116.3 (Coverage for telehealth), HI ST ? 432:1-601.5 (Coverage for telehealth),

HI ST ? 432D-23.5 (Coverage for telehealth), HI ST ? 451J-1 (Definitions), HI ST ? 451J-6 (Exemptions), HI ST ? 453-1.3 (Practice of
telehealth), HI ST ? 453D-1 (Definitions), HI ST ? 453D-6 (Exemptions), HI ST ? 465-1 (Definitions), HI ST ? 465-3 (Exemptions), HI

ST ? 467E-1 (Definitions), HI ST ? 467E-6 (Exemptions), and HI ST ? 471-10 (Refusal to grant and revocation or suspension of license)
to update the definition for 'telehealth" and creates exemptions for licensed health professions related to telehealth.

¢ 2021 HI H.B. 473 (NS), amended/substituted February 18, 2021, would amend HI ST ? 453-1 (Practice of telehealth) to provide that
a physician-patient relationship may be established via a telehealth interaction, provided that the physician has a license to practice
medicine in Hawaii. Removes provision allowing a physician patient relationship to be established via telehealth if the patient is referred
to the telehealth provider by another health care provider who has conducted an in person consultation and has provided all pertinent
patient information to the telehealth provider.

¢ 2021 HI H.B. 945 (NS), introduced January 27, 2020, and 2021 HI S.B. 1099 (NS), introduced January 27, 2021, would amend HI
ST ? 453-1 (Practice of telehealth) to include telehealth in the definition of the practice of medicine.

¢ 2021 HI H.B. 1120 (NS), introduced January 27, 2021, and 2021 HI S.B. 1258 (NS), introduced January 27, 2021, would amend
HI ST ? 346-59.1 (Coverage for telehealth), HI ST ? 431:10A-116.3 (Coverage for telehealth), HI ST ? 432:1-601.5 (Coverage for
telehealth), and HI ST ? 432D-23.5 (Coverage for telehealth) to update the definition for 'telehealth."

¢ 2021 HI H.B. 1281 (NS), adopted July 6, 2021, adopts the County Emergency Medical Services System and would require the county
to employ telehealth to enhance access and improve the patient experience. The Act takes effective July 1, 2022.

* 2021 HI S.B. 324 (NS), adopted June 25, 2021, amends HI ST ? 453-1 (Practice of medicine defined) to add telehealth to the
definition for practice of medicine. The bill is effective June 25, 2021.

¢ 2021 HI S.B. 970 (NS), adopted June 7, 2021, amends HI ST ? 453-1.3 (Practice of telehealth) to allow a physician-patient
relationship to be established via a telehealth interaction, provided that the physician has a license to practice medicine in this State.
The bill is effective July 1, 2021.

¢ 2021 HI S.B. 1258 (NS), amended/substituted April 27, 2021, would amend HI ST ? 346-59.1 (Coverage for telehealth), HI ST ?
431:10A-116.3 (Coverage for telehealth), HI ST ? 432:1-601.5 (Coverage for telehealth), and HI ST ? 432D-23.5 (Coverage for
telehealth) to update the definition for 'telehealth."

Idaho

¢ 2021 ID H.B. 179 (NS), introduced February 16, 2021, would adopt ID ST ? 54-5714 (Interstate Telehealth) to authorize a provider
who is not licensed in Idaho to provide telehealth services to an Idaho resident or person located in Idaho when certain requirements
are met.

¢ 2021 ID S.B. 1126 (NS), introduced February 15, 2021, would amend ID ST ? 54-5701 et seq. (Idaho Virtual Care Access Act) to
update terminology to use 'virtual care" instead of 'telehealth," add definitions, update requirements for the provider-patient relationship,
allow prescriptions to be issued through virtual care, and provide for certain medical record requirements regarding virtual care.

¢ 2021 ID S.B. 1127 (NS), introduced February 15, 2021, would amend ID ST ? 54-5705 (Provider-Patient Relationship) to clarify that if
a provider offering telehealth services does not have an established provider-patient relationship with aperson seeking such services,
the provider must take appropriate steps to establish a provider-patient relationship by use of telehealth technologies sufficient to
diagnose and appropriate to treat the patient with the condition as presented, provided however, that the applicable Idaho community
standard of care is satisfied.

Illinois

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¢ 2021 IL H.B. 707 (NS), introduced February 8, 2021, would amend IL ST CH 215 ? 5/356z.22 (Coverage for telehealth services)

to require reimbursement for services provided through telehealth services to be equivalent to reimbursement for the same services
provided through in-person consultation.

¢ 2021 IL H.B. 1976 (NS), engrossed April 14, 2021, would amend IL ST CH 225 ? 80/9 (Definitions) to update the definition for 'direct
supervision" and to provide the definition for 'remote location," 'distant site," 'interactive telecommunications system," and 'telehealth."
The bill would also adopt L ST CH 225 ? 80/15.4 (Telehealth) to authorize an optometrist to practice optometry through telehealth and
establish the requirements for doing so.

¢ 2021 IL H.B. 2591 (NS), introduced February 19, 2021, would amend IL ST CH 305 ? 5/5-5.25 (Access to behavioral health and
medical services) to require the Department to reimburse physicians, community mental health centers, and substance abuse centers
that provide primary care and behavioral health services to medical assistance recipients via telehealth, including medical evaluations
for individuals residing in facilities licensed under the |D/DD Community Care Act and in community-integrated living arrangements.
Require the Department to establish, by rule, a method to reimburse providers for medical and behavioral health services (rather than
mental health services) provided by telehealth and require the Department to reimburse any community mental health center, facility
licensed under the ID/DD Community Care Act, and community-integrated living arrangement that acts as the location of the patient at
the time a telehealth service is rendered.

¢ 2021 IL H.B. 2896 (NS), introduced February 19, 2021, would amend IL ST CH 215 ? 5/367m (Early intervention services) to require
a policy that provides coverage for early intervention services must also provide coverage for early intervention services delivered via
telehealth. Amend IL ST CH 225 ? 150/5 (Definitions) to update the definition for 'telehealth" and IL ST CH 215 ? 15 (Use of telehealth)
to include early intervention services provided via telehealth. Amend IL ST CH 305 ? 5/5-5.25 (Access to behavioral health and medical
services) to require the Department to reimburse early intervention providers who deliver early intervention services to recipients

via telehealth. Amend IL ST CH 325 ? 20/3 (Definitions) to define 'telehealth." Adopt IL ST CH 325 ? 20/3b (Services delivered by
telehealth) to allow an early intervention provider to deliver via telehealth early intervention service. Amend IL ST CH 325 ? 20/11
(Individualized Family Service Plans) to require parents to be informed of the availability of early intervention services provided through
telehealth.

¢ 2021 IL H.B. 3025 (NS), adopted July 30, 2021, amends IL ST CH 305 ? 5/5-5.25 (Access to behavioral health, medical, and epilepsy
treatment services) changing the section title from 'Access to behavioral and medical services" and requiring the Department to
reimburse epilepsy specialties who are authorized by Illinois law to provide epilepsy treatment services to persons with epilepsy or
related disorders via telehealth. The bill is effective July 30, 2021.

¢ 2021 IL H.B. 3234 (NS), introduced February 19, 2021, would adopt IL ST CH 305 ? 5/12-4.54 (Managed Primary Care
Demonstration Project) to require the Department to contract with a health care organization that is capable of providing patient-
centered, prevention-focused services, including, clinical personal health care consultations for telehealth.

¢ 2021 IL H.B. 3308 (NS), adopted July 22, 2021, amends IL ST CH 215 ? 5/356z.22 (Coverage for telehealth services) to include

the delivery of covered health care services by way of telephone usage in the definition of 'telehealth services," provide that health
care services that are covered under an individual or group policy of accident or health insurance must be covered when delivered via
telehealth services when clinically appropriate, subject to specified conditions (rather than requiring an individual or group policy of
accident or health insurance to comply with specified conditions if it provides coverage for telehealth services). Provides that patient
cost-sharing be no more than if the health care service were delivered in person. Provides that no excepted benefit policy may deny
or reduce any benefit to a patient based on the use of clinically appropriate telehealth services in the course of satisfying the policy's
benefit criteria. The bill is effective July 22, 2021.

* 2021 IL H.B. 3498 (NS), engrossed April 13, 2021, would amend IL ST CH 215 ? 5/356z.22 (Coverage for telehealth services) to
remove the definition for 'distant site" and 'interactive telecommunications system," update the definition for 'telehealth" and require
coverage and reimbursement for telehealth services delivered by health care professionals and facilities to comply with the Telehealth
Act. The bill would also amend the Telehealth Act to update definitions and terminology and to require issuers to cover all telehealth
services rendered by a health care professional to deliver any clinically appropriate, medically necessary covered services. Restricts
health insurance issuers from engaging in specified activities.

¢ 2021 IL H.B. 3585 (NS), introduced February 22, 2021, would amend the Dietitian Nutritionist Practice Act to include telehealth in the
definition of 'practice of dietetics and nutrition" and to update the definition for 'telehealth" or 'telepractice."

¢ 2021 IL H.B. 3758 (NS), introduced February 22, 2021, would amend IL ST CH 215 ? 5/356z.22 (Coverage for telehealth services)
require individual or group policies of accident or health insurance that cover telehealth services to provide coverage for telehealth
services used to treat a mental, emotional, nervous, or substance use disorder or condition.

¢ 2021 IL H.B. 3759 (NS), introduced February 22, 20221, would create the Telehealth Parity Act to require all health insurance issuers
to cover the costs of telehealth services rendered by in-network providers to deliver any clinically appropriate, medically necessary
covered services and treatments to insureds, enrollees, and members under each policy, contract, or certificate of health insurance
coverage. Prohibit issuers from imposing upon telehealth services utilization review requirements that are unnecessary, duplicative,

or unwarranted nor impose any treatment limitations that are more stringent than the requirements applicable to the same health care
service when rendered in-person. Provide that, for telehealth services that relate to COVID-19 delivered by in-network providers, health

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insurance issuers must not impose any prior authorization requirements. Prohibit cost-sharing for telehealth services, describe eligible
services, and allow use of non-public facing remote communication products under certain circumstances.

¢ 2021 IL S.B. 332 (NS), adopted July 9, 2021, amends IL ST CH 215 ? 124/25 (Network transparency) to require a network plan to
make available through an electronic provider directory the following information in a searchable format for health care professions that
use telehealth or telemedicine. The bill is effective July 9, 2021.

¢ 2021 IL S.B. 335 (NS), adopted July 9, 2021, amends IL ST CH 225 ? 25/4 (Definitions) to update the definition for 'teledentistry" and
amends IL ST CH 225 ? 25/17 (Acts constituting the practice of dentistry) to prohibit a dentist from delegating teledentistry services
unless authorized in this Act. The bill is effective January 1, 2022.

¢ 2021 IL S.B. 567 (NS), adopted July 23, 2021, 2021, amends IL ST CH 225 ? 80/9 (Definitions) to provide the definition for 'remote
location," 'distant site," 'interactive telecommunications system," and 'telehealth." Amends IL ST CH 225 ? 80/15.1 (Telehealth) to allow
an optometrist to practice optometry through telehealth and establishing the standards for doing so. The bill is effective January 1,
2021.

¢ 2021 IL S.B. 1862 (NS), introduced February 26, 2021, would adopt the Occupational Therapy Practice Acts. One of the stated
purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

¢ 2021 IL S.B. 2017 (NS), adopted June 17, 2021, amends IL ST CH 305 ? 5/5A-12.7 (Continuation of hospital access payments on
and after July 1, 2020) requiring the Department to expand access to telehealth services among rural communities in Illinois. The bill is
effective June 17, 2021.

¢ 2021 IL S.B. 2435 (NS), adopted August 30, 2021, amends IL ST CH 225 ? 25/4 (Definitions) to update the definition for
'teledentistry." The bill is effective January 1, 2022.

¢ 2021 IL REG TEXT 582245 (NS), published April 23, 2021, amends 89 |L ADC 140.403 (Telehealth Services) allowing other qualified
health-care professionals to render virtual check-ins. The rulemaking was amended via emergency and is effective April 9, 2021.

¢ 2021 IL REG TEXT 582252 (NS), published September 10, 2021, amends 89 IL ADC 140.403 (Telehealth Services) allowing other
medical professionals to render the virtual check in services during a public health emergency. The regulation is effective August 27,
2021.

¢ 2021 IL REG TEXT 599701 (NS), published November 5, 2021, amends 77 |L ADC 295.4047 (COVID-19 Vaccination of
Establishment Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including
tests that require supervision from a health care provider through telehealth, as testing option as a replacement for being fully
vaccinated. The regulation was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless
continued.

¢ 2021 IL REG TEXT 599701 (NS), published November 5, 2021, amends 77 |L ADC 300.698 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

* 2021 IL REG TEXT 599702 (NS), published November 5, 2021, amends 77 |L ADC 330.794 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

¢ 2021 IL REG TEXT 599704 (NS), published November 5, 2021, amends 77 |L ADC 350.769 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

¢ 2021 IL REG TEXT 599705 (NS), published November 5, 2021, amends 77 |L ADC 370.4 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

¢ 2021 IL REG TEXT 599706 (NS), published November 5, 2021, amends 77 |L ADC 380.643 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

* 2021 IL REG TEXT 599707 (NS), published November 5, 2021, amends 77 |L ADC 390.759 (COVID-19 Vaccination of Facility
Personnel) removing provision allowing unvaccinated staff to use home tests or self-test kits for COVID-19, including tests that require
supervision from a health care provider through telehealth, as testing option as a replacement for being fully vaccinated. The regulation
was amended via emergency rule and is effective November 5, 2021 and will expire in 150 days unless continued.

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Indiana

¢ 2021 IN H.B. 1002 (NS), adopted April 29, 2021, amends IN ST 34-30-13.5-3 (Facility or location) to provide immunity for facilities

or locations, including locations used to provide telemedicine services, that provide health care services in response to or during a
declared state disaster emergency. The bill also amends !NN ST 34-30-13.5-1 (Criteria) to provide immunity for a person providing
health care services, whether in person or through telemedicine services, at a facility in response to or during a declared state disaster
emergency. The sections are effective retroactively to March 1, 2020.

¢ 2021 IN H.B. 1286 (NS), amended/substituted February 8, 2021, would repeal IN ST 12-7-2-190.4 ('Telemedicine services")and
amend IN ST 12-15-5-11 ('Telehealth services"; 'telemedicine services"; reimbursement of certain Medicaid providers for services;
implementation of section), |N ST 16-18-2-348.5 (Telemedicine), IN ST 16-36-1-15 (Health care provider not required to obtain
separate written consent for telemedicine services), |N ST 25-1-2-10 (Required disclosures; use of disclosed information), IN ST
25-1-9.5-1 (Application), |N ST 25-1-9.5-2 ('Distant site" defined), |N ST 25-1-9.5-3 ('Originating site" defined), |N ST 25-1-9.5-6
('Telemedicine" defined), |N ST 25-1-9.5-7 Standards of practice; use of telemedicine; provider-patient relationship; conditions), |N ST
25-1-9.5-8 (Issuance of prescription through telemedicine; requirements), |N ST 25-1-9.5-11 (Pharmacy immunity; conditions), IN ST
25-1-9.5-12 (Implementation of chapter; adoption of policies or rules), | ST 25-1-9.5-13 (''HIPAA"; conditions for device prescription),
IN ST 25-22.5-2-7 (Powers and duties), | ST 27-8-34-5 ('Telemedicine services" defined), IN ST 27-8-34-6 (Coverage for telemedicine
services; conditions), IN ST 27-8-34-7 (Coverage parameters), |N ST 27-13-1-34 ('Telemedicine services"), (IN ST 27-13-7-22
(Coverage for telemedicine services required), and to adopt new sections. The bill would update terminology to use 'telehealth"

instead of 'telemedicine," provide a standard definition for 'telehealth," prohibit the Medicaid program from specifying originating sites
and distant sites for purposes of Medicaid reimbursement, expand the application of the telehealth statute to additional licensed
practitioners instead of applying only to prescribers, provide that veterinarians may provide telehealth services only when an existing
veterinarian-client-patient relationship has been established, require that the telehealth medical records be created and maintained
under the same standards of appropriate practice for medical records for patients in an in-person setting, update the requirements for a
prescriber issuing a prescription to a patient via telehealth services, specify that a patient waives confidentiality of medical information
concerning individuals in the vicinity when the patient is using telehealth, and prohibit certain health care policies that provide coverage
for telehealth services from requiring the use of a specific information technology application for those services.

* 2021 IN H.B. 1467 (NS), amended/substituted February 8, 2021, would amend IN ST 12-15-5-11 ('Telehealth services"; 'telemedicine
services"; reimbursement of certain Medicaid providers for services; implementation of section) to include video conferencing,
telephone services, and text messaging services as telehealth for community mental health centers, add community mental health
centers as a telehealth provider, and add clinical services and rehabilitations services to the definition of 'telehealth services."

¢ 2021 IN H.B. 1468 (NS), adopted April 29, 2021, amends IN ST 12-15-5-11 ('Telehealth services"; 'telemedicine services';
reimbursement of certain Medicaid providers for services; implementation of section) to clarify that telehealth services satisfy any face
to face meeting requirement between a clinician and consumer for purposes of a community mental health center. Amends |IN ST
25-1-9.5-6 ('Telemedicine" defined) to update the definition for 'telemedicine." The bill is effective July 1, 2021.

¢ 2021 IN H.B. 1547 (NS) and 2021 IN S.B. 321 (NS), introduced January 14, 2021, would prohibit a physician who certifies a
debilitating medical condition for a qualifying patient from performing the physician examination by remote means, including
telemedicine.

¢ 2021 IN H.B. 1577 (NS), adopted April 29, 2021, amends IN ST 16-34-2-1 (Legal abortion) to prohibit the use of telehealth and
telemedicine for the provision of any medical services, including the writing or filling of a prescription that is intended to result in an
abortion. The bill is effective July 1, 2021.

¢ 2021 IN S.B. 3 (NS), adopted April 20, 2021, amends IN ST 12-15-5-11 ('Telehealth services"; 'telemedicine services"; reimbursement
of certain Medicaid providers for services; implementation of section) updating terminology to change 'telemedicine' to 'telehealth',
'telehealth services' to 'telehealth activities' and 'telemedicine services' to 'telehealth services'. Prohibits the Medicaid program

from specifying originating sites and distant sites for purposes of Medicaid reimbursement. Specifies that a Medicaid recipient

waives confidentiality of medical information concerning individuals in the vicinity when the patient is using telehealth. Adopts IN ST
25-1-9.5-0.5 prohibiting the use of telehealth to provide an abortion, including the writing or filling of a prescription for any purpose that
is intended to result in an abortion. Amends IN ST 25-1-9.5-1 (Application) updating terminology to change 'telemedicine' to 'telehealth'.
Adds a practitioner to the requirements. Amends | ST 25-1-9.5-2 ('Distant site" defined) updating terminology to change 'telemedicine'
to 'telehealth' and 'prescriber' to 'practitioner'. Adopts |N ST 25-1-9.5-2.5 ('Health care services' defined) providing a definition of 'health
care services'. Amends IN ST 25-1-9.5-3 ('Originating site' defined) updating terminology to change 'telemedicine' to 'telehealth'.
Adopts IN ST 25-1-9.5-3.5 ('Practitioner' defined) providing a definition of 'practitioner'. Amends |) ST 25-1-9.5-4 ('Prescriber' defined)
adding dentist and veterinarian to the definition of prescriber. Amends |N ST 25-1-9.5-5 ('Store and forward' defined) updating
terminology to change 'prescriber' to 'practitioner'. Amends IN ST 25-1-9.5-6 ('Telemedicine' defined) updating terminology to change
'telemedicine' to 'telehealth' and revising the definition. Amends |N ST 25-1-9.5-7 (Standards of practice; use of telemedicine; provider-
patient relationship; conditions) updating terminology and providing that a practitioner who provides health care services through
telehealth or directs an employee to perform a specified health service is held to the same standards of appropriate practice as those
standards for health care services provided at an in-person setting. Requires that the telehealth medical records be created and
maintained under the same standards of appropriate practice for medical records for patients in an in-person setting. Specifies that a

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patient waives confidentiality of medical information conceming individuals in the vicinity when the patient is using telehealth. Prohibits
an employer from requiring a practitioner to provide health care services through telehealth under certain circumstances. Requires any
contract, agreement, or policy to provide telehealth services to explicitly provide that a practitioner may refuse to provide health care
services under certain circumstances. Amends IN ST 25-1-9.5-8 (Issuance of prescription through telemedicine; requirements) updating
terminology to change 'telemedicine' to 'telehealth' and revising the requirements for a prescriber to issue a prescription for a controlled
substance to a patient who is receiving services through telehealth. Amends !N ST 25-1-9.5-10 (Violation of chapter; discipline;

Class B infraction) updating terminology to change 'prescriber' to 'practitioner'. Amends |N ST 25-1-9.5-13 ('HIPAA"; conditions for
device prescription) updating terminology to change 'telemedicine' to 'telehealth'. IN ST 27-8-34-5 ('Telemedicine services" defined)

by changing the word 'telemedicine' to 'telehealth' and allowing delivery by technology allowed in IN ST 25-1-9.5-6. Amends IN ST
27-8-34-6 (Coverage for telemedicine services; conditions) by changing the word 'telemedicine' to 'telehealth.'Adds that if a policy
provides coverage for telehealth services via secure videoconferencing, store and forward technology, or remote patient monitoring
technology bet

¢ 2021 IN S.B. 36 (NS), amended/substituted March 25, 2021, would establish the Psychology Interjurisdictional Compact to regulate
the day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 IN S.B. 80 (NS), adopted April 29, 2021, amends |N ST 25-22.5-2-7 (Powers and duties) to update terminology to use
'telehealth" instead of 'telemedicine." The bill is effective July 1, 2021.

* 2021 CO S.B. 102 (NS), adopted April 15, 2021, amends CO ST ? 12-220-104 (Definitions-rules) removes the definition for 'telehealth
by store and forward transfer." Amends CO ST ? 12-220-505 (Interim therapeutic restorations by dental hygienists--permitting process--
rules--subject to review-repeal) to update the requirements for a dental hygienist who utilizes telehealth and works under supervision
by telehealth. Amends CO ST ? 25.5-5-321.5 (Telehealth--interim therapeutic restorations--reimbursement-definitions) and CO ST ?
25.5-8-109.5 (Telehealth--interim therapeutic restorations-- reimbursement-definitions) to update the definition for 'store-and-forward
transfer." The bill is effective September 1, 2021.

¢ 2021 IN S.B. 123 (NS), amended/substituted April 1, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 IN S.B. 140 (NS), introduced January 7, 2021, would amend IN ST 34-30-13.5-1 (Criteria) and IN ST 34-30-13.5-3 (Facility

or location) to provide that a person providing health care services, whether in person or through telemedicine, at a facility or other
location where health care services are provided, may not be held civilly liable for an act or omission relating to the provision or delay of
health care services in response to an event that is declared a disaster emergency or any of these activities if the activity was materially
affected by an event that is declared a disaster emergency.

¢ 2021 IN S.B. 296 (NS), introduced January 11, 2021, would amend !N ST 25-1-9.5-8 (Issuance of prescription through telemedicine;
requirements) to remove requirements conceming prescribing a drug to a patient receiving services through telemedicine when the
individual has not been previously examined by the prescriber.

¢ 2021 IN REG TEXT 591607 (NS), filed November 5, 2021, readopts 844 IN ADC 5-8 (Telehealth Services Pilot Program) without
changes pursuant in anticipation of |N ST 4-22-2.5-2 (Dates for expiration), providing that an administrative rule expires January 1 of
the 7th year in which the rule takes effect. The regulation is effective November 5, 2021.

lowa

¢ 2021 IA H.F. 88 (NS), introduced January 15, 2021, would adopt a new section 'Telehealth or Telemedicine -- Health Care
Professionals -- Use of Audio-Only Communication) to provide that a health-related professional licensing board that authorizes the
use of telehealth or telemedicine by health-related professionals shall amend or adopt administrative rules to allow a health-related
professional under the purview of the appropriate licensing board to utilize telehealth or telemedicine to deliver health care services
through the use of interactive audio-only communication if the health care professional, through the use of audio-only telehealth or
telemedicine, is able to meet the same standards of care and professional ethics as required for that health care professional for the
provision of in-person health care.

* 2021 IA H.F. 89 (NS), introduced January 15, 2021, and 2021 IA S.F. 92 (NS), introduced January 19, 2021, would amend IA ST ?
514C.34 (Health care services delivered by telehealth--coverage) to update the definition for 'telehealth" and require a health carrier
to reimburse a health care professional or a facility for health care services for a mental health condition, illness, injury, or disease
provided to a covered person via telehealth on the same basis and at the same rate as the health carrier would apply to the same
health care services provided to the covered person by the health care professional or facility in person. The bill would also prohibit a
health carrier from requiring an additional health care professional to be located in the same room as a covered person while health
care service for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to
the covered person.

¢ 2021 IA H.F. 269 (NS), introduced January 28, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth--
coverage) to prohibit certain health carriers from excluding certain out-of-state health care professionals from participating as providers,
via telehealth, under a policy, plan, or contract offered by the health carrier if the professional is licensed in lowa, is able to deliver

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health care services via telehealth, and is able to satisfy the same criteria that the carrier uses to qualify in-state professionals, who
hold the same license as the out-of-state professional, as providers.

¢ 2021 IA H.F. 294 (NS), introduced January 19, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth--
coverage) to update the definition for 'telehealth" and require a health carrier to reimburse a health care professional or a facility for
health care services for a mental health condition, illness, injury, or disease provided to a covered person via telehealth on the same
basis and at the same rate as the health carrier would apply to the same health care services provided to the covered person by

the health care professional or facility in person. The bill would also prohibit a health carrier from requiring an additional health care
professional to be located in the same room as a covered person while health care service for a mental health condition, illness, injury,
or disease are provided via telehealth by another health care professional to the covered person.

¢ 2021 IA H.F. 431 (NS), introduced February 8, 2021, would adopt 'Telehealth or Telemedicine ? Health Care Professionals ? Use of
Audio-Only Communication) to allow a health-related professional licensing board that authorizes the use of telehealth or telemedicine
by health-related professionals to amend or adopt administrative rules to allow a health-related professional under the purview of the
appropriate licensing board to utilize telehealth or telemedicine to deliver health care services through the use of interactive audio-only
communication.

¢ 2021 IA H.F. 500 (NS), introduced February 11, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 IA H.F. 514 (NS), enrolled April 30, 2021, would amend IA ST ? 147.107 (Drug dispensing, supplying, and prescribing-
limitations) to update terminology to use 'licensed telepharmacy" instead of 'approved telepharmacy" and IA ST ? 155A.33 (Delegation
of functions) to update the delegation functions and supervision requirements for a certified pharmacy technician practicing at a
telepharmacy.

¢ 2021 IA H.F. 612 (NS), introduced February 18, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth--
coverage) to update the definition for 'telehealth" and to require a health carrier to reimburse a health care professional and a facility
for health care services provided to a covered person by telehealth on the same basis and at the same rate as the health carrier would
apply to the same health care services provided to a covered person by the health care professional and the facility in person.

* 2021 IA S.F. 619 (NS), enrolled June 3, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth--coverage)
to update the definition for 'telehealth" and require an insurer to reimburse a health care professional and a facility for health care
services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at
the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease
provided in person to a covered person by the health care professional or the facility.

* 2021 IA H.F. 685 (NS), adopted May 20, 2021, adopts IA ST ? 153.24 (Orthodontia-related services) providing that a licensee
who provides treatment for the correction of malpositions of human teeth or the initial use of orthodontic appliances must not begin
orthodontic treatment on a new patient unless the licensee performs an initial in-person or teledentistry examination of the teeth and
supporting structures of the new patient prior to beginning orthodontic treatment or the new patient provides the licensee with the
portion of the dental record taken within the prior 6 months of an in-person or teledentistry examination of the teeth and supporting
structures of the new patient prior to the licensee beginning orthodontic treatment. The bill is effective July 1, 2021.

¢ 2021 IA H.F. 706 (NS), introduced March 1, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth-
coverage) to update the definition for 'telehealth" and require a health carrier to reimburse a health care professional or facility for health
care services provided to a covered person by telehealth on the same basis and at the same rate as the carrier would apply to the
same services provided to the covered person by the professional or facility in person.

¢ 2021 IA H.F. 731 (NS), introduced March 3, 2021, would amend IA ST ? 5140.34 (Health care services delivered by telehealth-

coverage) to prohibit health carriers from excluding certain out-of-state health care professionals from participating as providers, via
telehealth, under a policy, plan, or contract offered by the carrier if the professional is licensed in lowa, is able to deliver health care
services via telehealth in compliance with this section, and is able to satisfy the same criteria that the carrier uses to qualify in-state
professionals, who hold the same license as the out-of-state professional, as providers.

¢ 2021 IA H.F. 784 (NS), introduced March 5, 2021, would amend IA ST ? 514C.34 (Health care services delivered by telehealth--
coverage) to update the definition for 'telehealth" and to require a health carrier to reimburse a health care professional and a facility
for health care services provided to a covered person by telehealth on the same basis and at the same rate as the health carrier would
apply to the same health care services provided to a covered person by the health care professional and the facility in person.

¢ 2021 IA H.S.B. 122 (NS), draft/request January 21, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 IA H.S.B. 201 (NS) and 2021 IA S.S.B. 1185 (NS), draft/request February 10, 2021, would establish the Occupational Therapy
Practice Acts. One of the stated purposes for the Act would be to facilitate the use of telehealth technology in order to increase access
to Occupational Therapy services.

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¢ 2021 IA H.S.B. 223 (NS), draft/request February 17, 2021, and 2021 IA S.S.B. 1202 (NS), draft/request February 16, 2021, would
adopt IA ST ? 153.24 (Orthodontia-related services) to prohibit a licensee who provides treatment for the correction of malpositions
of human teeth or the initial use of orthodontic appliances from beginning orthodontic treatment on a new patient unless either the
licensee performs an initial in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to
beginning orthodontic treatment, or the mew patient provides the licensee with the portion of the dental record taken within the prior
6 months of an in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to the licensee
beginning orthodontic treatment.

¢ 2021 IA H.S.B. 278 (NS) and 2021 IA S.S.B. 1276 (NS), draft/request May 5, 2021, would amend IA ST ? 514C.34 (Health care
services delivered by telehealth--coverage) to update the definition for 'telehealth" and require an insurer to reimburse a health care
professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness,
injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a
mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.

¢ 2021 IA S.F. 54 (NS), introduced January 12, 2021, would prohibit a licensee under the purview of the dental board who provides
treatment for the correction of malpositions of human teeth or the initial use of orthodontic appliances from beginning orthodontic
treatment on a new patient unless either the licensee performs an initial in-person or teledentistry examination of the teeth and
supporting structures of the new patient prior to beginning orthodontic treatment, or the new patient provides the licensee with a record
of completion within the prior two-year period of an in-person or teledentistry examination of the teeth and supporting structures of the
new patient prior to the licensee beginning orthodontic treatment.

* 2021 IA S.F. 78 (NS), introduced January 13, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 IA S.F. 416 (NS), introduced February 18, 2021, would amend IA ST ? 147.107 (Drug dispensing, supplying, and prescribing-
limitations) to update terminology to use 'licensed telepharmacy" instead of 'approved telepharmacy" and IA ST ? 155A.33 (Delegation
of functions) to update the delegation functions and supervision requirements for a certified pharmacy technician practicing at a
telepharmacy.

¢ 2021 IA S.F. 463 (NS), introduced February 25, 2021, would adopt the Occupational Therapy Licensure Compact. One of the stated
purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

* 2021 IA S.F. 508 (NS), introduced March 2, 2021, would adopt IA ST ? 146E.2 (Abortion reporting requirements ? physicians) to
require that if a drug-induced abortion was accomplished using telemedicine, the medical facility code of the location the woman used
and the medical facility code of the physician prescribing, dispensing, or otherwise providing the abortion-inducing drug.

* 2021 IA S.F. 543 (NS), introduced March 4, 2021, would adopt IA ST ? 153.24 (Orthodontia-related services) would prohibit a licensee
under the purview of the dental board who provides treatment for the correction of malpositions of human teeth or the initial use of
orthodontic appliances from beginning orthodontic treatment on a new patient unless either the licensee performs an initial in-person

or teledentistry examination of the teeth and supporting structures of the new patient prior to beginning orthodontic treatment, or the
new patient provides the licensee with the portion of the dental record taken within the prior six months of an in-person or teledentistry
examination of the teeth and supporting structures of the new patient prior to the licensee beginning orthodontic treatment.

¢ 2021 IA S.S.B. 1111 (NS), draft/request January 27, 2021, would amend IA ST ? 147.107 (Drug dispensing, supplying, and
prescribing-limitations) to update terminology to use 'licensed telepharmacy" instead of 'approved telepharmacy" and IA ST ? 155A.33
(Delegation of functions) to update the delegation functions and supervision requirements for a certified pharmacy technician practicing
at a telepharmacy.

¢ 2021 IA REG TEXT 563405 (NS), filed January 6, 2021, adopts [A ADC 645-81.17(152A,272C) establishing a licensee's rights to
provide dietetic services to an individual or a group utilizing a telehealth visit if the dietetic services, defining 'telehealth visit," and
establishing the requirements for the provision of 'telehealth visit." The regulation is effective March 3, 2021.

¢ 2021 IA REG TEXT 580744 (NS), filed October 6, 2021, amends |A ADC 645-123.4(154A) (Requirements for record keeping)
requiring a notation that the client consent, either verbally or in writing, to a service or services provided through a telehealth
appointment, if applicable. Adopts [A ADC 645-123.5(154A) (Telehealth appointments) establishing the minimum standards of care
for hearing aid specialists when providing hearing aid testing or adjustment services during a telehealth appointment. The regulation is
effective November 10, 2021.

* 2021 IA REG TEXT 580745 (NS), filed August 3, 2021, adopts |A ADC 645-301.1(147) (Telehealth visits) establishing the minimum
standards of care for speech pathologists and audiologists when they are providing services during a telehealth appointment. The
regulation is effective September 29, 2021.

¢ 2021 IA REG TEXT 580746 (NS), filed August 3, 2021, adopts [A ADC 645-327.9(147,148C,272C) (Telehealth visits) establishing
the minimum standards of care for physician assistants when they are providing services during a telehealth appointment and requiring
HIPAA-compliant technology, as well as imposing other requirements to ensure the patient's confidential health information is secure.
The regulation is effective September 29, 2021.

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¢ 2021 IA REG TEXT 581935 (NS), filed June 11, 2021, adopts [A ADC 281-14.20(280A) (Purpose and objectives: contracted
behavioral health screening and telehealth), |A ADC 281-14.21(256B,280A) (Definitions), IA ADC 281-14.23(280A) (Establishment of
provider-patient relationship for telehealth in school setting), and IA ADC 281-14.24(280A) (Behavioral health services provided via
telehealth in a school setting) establishing the responsibilities of lowa AEAs, public school districts, and accredited nonpublic school
districts and behavioral health service providers should they choose to enter into agreements for behavioral health screenings or
telehealth services. The regulation is effective August 4, 2021.

¢ 2021 IA REG TEXT 583048 (NS), filed August 18, 2021, adopts [A ADC 645-243.1(154B) (Definitions) providing the definition
for 'telepsychology" and |A ADC 645-243.7(154B) (Telepsychology) establishing the requirements for a psychologist to practice
telepsychology. The regulation is effective October 13, 2021.

Kansas

* 2021 KS H.B. 2066 (NS), adopted April 22, 2021, amends KS ST 48-3406 (Expedited state licensure procedure if licensed,
registered or certified in another state for military servicemembers or military spouses)to establish the requirements for the practice of
telemedicine by out-of-state physicians. The bill is effective July 1, 2021.

¢ 2021 KS H.B. 2206 (NS), introduced February 3, 2021, would amend KS ST 40-2,211 (Same; definitions) to update the definition for
'distant site," 'originating site," and 'telemedicine,' and amend KS ST 40-2,212 (Same; confidentiality) to clarify that telemedicine may
be used to establish a valid provider-patient relationship and referral to specialty services to the extent such services are consistent with
the standard of care and to authorize a health care providing telemedicine services to coordinate care to the greatest extent possible
with patient's medical home, primary care or other treating physician, care coordinator, or other Kansas-based healthcare provider.

¢ 2021 KS H.B. 2207 (NS), introduced February 3, 2021, would amend KS ST 40-2,215 (Abortions delivered via telemedicine not
authorized) to clarify that nothing in the Kansas telemedicine act must be construed to authorize the practice of an abortion procedure
or conversion therapy used on a minor to be delivered via telemedicine.

¢ 2021 KS H.B. 2208 (NS), adopted April 22, 2021, adopts new section to allow a physician holding a license issued by the applicable
licensing agency of another state or who otherwise meets the requirements of this section to practice telemedicine to treat patients
located in Kansas, if such physician receives a telemedicine waiver issued by the state Board of Healing Arts. The bill is effective after
its publication in the Kansas register.

* 2021 KS H.B. 2209 (NS), amended/substituted March 29, 2021, would establish the Psychology Interjurisdictional Compact to
regulate the day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological
practice.

¢ 2021 KS H.B. 2280 (NS), amended/substituted March 30, 2021, would adopt new sections to define 'telepharmacy" and 'telepharmacy
outlet" and to establish requirements for a telepharmacy outlet.

¢ 2021 KS S.B. 14 (NS), adopted January 25, 2021,amends KS ST 487963 (Same; physicians and other healthcare professionals;
use of telemedicine authorized; limitations and requirements; abortion statutes not affected; expiration of section) extends the sections
expiration date to March 31, 2021. The section is effective upon publication of the Kansas Register on January 25, 2021.

* 2021 KS 8.B. 77 (NS), adoptedMarch 30, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact comes into effect on the date on which the compact statute is enacted into law in
the 10th member state. The bill is effective April 1, 2021.

* 2021 KS 8.B. 137 (NS), introduced February 3, 2021, would amend KS ST 48-3406 (Expedited state licensure procedure if licensed,
registered or certified in another state for military servicemembers or military spouses) to define 'telemedicine" and establishing the
requirements for a physician holding a license issued by the applicable licensing agency of another state to practice telemedicine to
treat patients located in Kansas.

¢ 2021 KS S.B. 170 (NS), adopted May 17, 2021, establishes the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The bill is
effective July 1, 2021.

¢ 2021 KS S.B. 207 (NS), introduced February 10, 2021, would amend KS ST 48-963 (Same; physicians and other healthcare
professionals; use of telemedicine authorized; limitations and requirements; abortion statutes not affected; expiration of section) to
update the requirements for a physician to practice telemedicine.

* 2021 KS 8.B. 238 (NS), adopted May 19, 2021, adopts new sections to establish the requirements for the practice of telepharmacy
and define terms. The bill is effective after its publication in the Kansas register.

* 2021 KS 8.B. 248 (NS), introduced February 16, 2021, would amend KS ST 40-2, 211 (Same; definitions) to update the definition

for 'distant site," 'originating site," and 'telemedicine." The bill would also amend KS ST 40-2, 212 (Same; confidentiality) to allow
telemedicine to be used to refer to specialty services to the extent such services are consistent with the standard of care and to require
a healthcare provider providing telemedicine services to coordinate care to the greatest extent possible with a medical home, primary
care or other treating physician, care coordinator, or other Kansas-based healthcare provider.

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* 2021 KS S.B. 283 (NS), adopted March 31, 2021, amends KS ST 48-963 (Same; physicians and other healthcare professionals;
use of telemedicine authorized; limitations and requirements; abortion statutes not affected; expiration of section) allowing a physician
under quarantine, including self-imposed quarantine, to practice telemedicine, allowing a physician holding a license issued by the
applicable licensing agency of another state to practice telemedicine to treat patients located in the state of Kansas, if the out-of-state
physician holds a temporary emergency license, requiring a physician practicing telemedicine to conduct an appropriate assessment
and evaluation of the patient's current condition and document the appropriate medical indication for any prescription issued, and
defining 'telemedicine." The bill is effective April 1, 2021.

Kentucky

* 2021 KY H.B. 38 (NS), adopted March 18, 2021, establishes the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The compact
will become effective on the date the compact is enacted into law in the 7th compact state.

* 2021 KY H.B. 74 (NS), introduced January 5, 2021, would amend KY ST ? 205.559 (Requirements for Medicaid reimbursement to
participating providers for telehealth consultations; report of impact on health care delivery system required; administrative regulations).

¢ 2021 KY H.B. 136 (NS), introduced January 6, 2021, would adopt a new section of KY ST T. XVIII, Ch. 218A (Controlled Substances)
providing that a bona fide practitioner-patient relationship may be established following a referral from the patient's primary care
provider and may be maintained via telehealth, but a bona fide practitioner-patient relationship shall not be established via telehealth.
Allows for the renewal of a registry identification care to be provided electronically or during the course of a telehealth consultation.
Defines 'telehealth."

¢ 2021 KY H.B. 140 (NS), adopted March 22, 2021, creates new sections of KY ST T. XVIII, Ch. 211 (State Health Programs) to define
terms, require the Cabinet for Health and Family Services to establish minimum standards to telehealth, reestablish the requirement
for the Cabinet for Health and Family Services and managed care organizations to study the impact of telehealth on the state's

health care delivery system, prohibit certain practices in telehealth, authorize health practitioner licensure boards to promulgate
administrative regulations related to telehealth. The bill would also amend to require reimbursement rates for telehealth to be equivalent
to reimbursement rates for the same service provided in person, permit the Department for Medicaid services to approve additional
telecommunication technologies for telehealth, and to delete the requirement for the Cabinet for Health and Family Services and
managed care organizations to study the impact of telehealth on the state's health care delivery system. The bill would also amend

KY ST ? 205.5591 (Medicaid providers using telehealth; duties of cabinet and managed care organizations; reimbursement for

covered services; administrative regulations; deductible, copayment, and reinsurance requirements; policies and guidelines) to require
telehealth coverage and reimbursement rates to be equivalent to coverage requirements and reimbursement rates for the same service
provided in person, amend KY ST ? 304.17A-005 (Definitions for subtitle) to delete the definition of 'telehealth,' and amend KY ST ?
304.17A-138 (Telehealth coverage and reimbursement; requirements for health benefit plan; benefits subject to deductible, copayment,
or coinsurance payment subject to provider network arrangements; administrative regulations) to define 'telehealth' and to require that
telehealth coverage and reimbursement rates be equivalent to coverage and reimbursement for the same service provided in person.
The bill is effective January 1, 2021.

* 2021 KY H.B. 350 (NS), introduced February 3, 2021, would adopt new sections requiring the Department for Medicaid Services
and any managed care organization with which the Department contracts for the delivery of Medicaid services to provide coverage
for comprehensive lactation counseling, lactation consultation, and breastfeeding equipment. The bill would also allow the delivery of
counseling or consultation to be performed via telehealth if the beneficiary requests telehealth counseling or consultation in lieu of in-
person, one-on-one counselling or consultation.

* 2021 KY S.B. 47 (NS), adopted March 18, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact comes into effect on the date on which the Compact statute is enacted into law in
the 10th member state.

* 2021 KY S.B. 55 (NS), adopted March 22, 2021, amends KY ST ? 205.5591 (Medicaid providers using telehealth; duties of cabinet
and managed care organizations; reimbursement for covered services; administrative regulations; deductible, copayment, and
reinsurance requirements; policies and guidelines) removing provision allowing benefits for a service provided to a Medicaid recipient
through telehealth to be subject to a deductible, copayment, or coinsurance requirement and related provisions. The bill is effective
June 28, 2021.

¢ 2021 KY S.B. 92 (NS), introduced January 8, 2021, would adopt a new section of KY ST T. XVIII, Ch. 218A (Controlled Substances)
providing that a bona fide practitioner-patient relationship may be established following a referral from the patient's primary care
provider and may be maintained via telehealth, but a bona fide practitioner-patient relationship shall not be established via telehealth.
Allows for the renewal of a registry identification care to be provided electronically or during the course of a telehealth consultation.
Defines 'telehealth."

* 2021 KY S.B. 119 (NS), introduced February 2, 2021, would amend KY ST ? 304.17A-005 (Definitions for subtitle) to update the
definition for 'telehealth."

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¢ 2021 KY REG TEXT 553426 (NS), filed January 1, 2021, adopts 907 KY ADC 3:300 (Enhanced and suspended Medicaid services
and requirements if there is a declared national or state emergency) to allow Medicaid services and requirements to be enhanced or
expanded, including telehealth services. This ordinary regulation replaces a previous emergency rule and is effective December 1,
2020.

¢ 2021 KY REG TEXT 592693 (NS), filed October 15, 2021, amends 900 KY ADC 12:005E (Telehealth Terminology and Requirements)
providing the definition for 'health care provider" and clarifying that health care providers performing a telehealth or digital health

service to establish guidelines to contact, refer, and obtain treatment for a patient who needs emergent or higher level-of-care services
provided by a hospital or other facility. The rulemaking amends a previous emergency regulation and is effective October 15, 2021.

Louisiana

¢ 2021 LAH.B. 270 (NS), adopted June 14, 2021, amends LA R.S. 37:1262 (Definition) and LA R.S. 40:1223.3 (Definitions) to update
the definition for 'telemedicine." The bill is effective August 1, 2021.

¢ 2021 LA S.B. 29 (NS), adopted June 14, 2021, would amend LA R.S. 22:11 (Rules and regulations by Commissioner) to remove
telehealth and telemedicine access restraints on Medical coverage. The bill is effective August 1, 2021.

¢ 2021 LA S.B. 93 (NS), adopted June 4, 2021, would amend LA R.S. 37:2457 (Powers and duties of board) to allow the Board to
promulgate rules for the provision of telehealth services by licensed hearing aid dealers that, at a minimum, comply with the Louisiana
Telehealth Access Act.

¢ 2021 LA REG TEXT 549477 (NS), published June 20, 2021, continues previous emergency rule adopting 50 LA ADC Pt |, ? 505
(Telemedicine in the Event of an Emergency) allowing Medicaid, in the event of a declared emergency, to temporarily cover services
provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action is
determined to be necessary to ensure sufficient services are available to meet recipients' needs. The regulation was continued via
emergency and is effective July 13, 2021.

¢ 2021 LA REG TEXT 549477 (NS), published October 11, 2021, continues previous emergency rule adopting 50 LA ADC PtI, ?

505 (Telemedicine in the Event of an Emergency) allowing Medicaid, in the event of a declared emergency, to temporarily cover
services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action
is determined to be necessary to ensure sufficient services are available to meet recipients' needs. The regulation was continued via
emergency and is effective November 11, 2021.

¢ 2021 LA REG TEXT 557172 (NS), published February 20, 2021, continues previous emergency rule LAC 50:XXI.Subpart 7 (Home
and Community-Based Services Waivers Community Choices Waiver) to allow monitored in-home caregiving (MIHC) providers to
monitor participants via frequent telephone contacts and/or telehealth and LAC 50:XXxXiIll.Subpart 9 (Behavioral Health Services-
Home and Community-Based Services Waiver) to allow services to be provided telephonically or through videoconferencing means in
accordance with LDH-issued guidance. The regulations were continued via emergency and are effective March 17, 2021.

¢ 2021 LA REG TEXT 557172 (NS), published June 11, 2021, continues previous emergency rule LAC 50:XXI.Subpart 7 (Home and
Community-Based Services Waivers Community Choices Waiver) to allow monitored in-home caregiving (MIHC) providers to monitor
participants via frequent telephone contacts and/or telehealth and LAC 50:XXxXiIlII.Subpart 9 (Behavioral Health Services-Home and
Community-Based Services Waiver) to allow services to be provided telephonically or through videoconferencing means in accordance
with LDH-issued guidance. The regulations were continued via emergency and are effective July 16, 2021.

¢ 2021 LA REG TEXT 557172 (NS), published October 11, 2021, continues previous emergency rule LAC 50:XXI.Subpart 7 (Home and
Community-Based Services Waivers Community Choices Waiver) to allow monitored in-home caregiving (MIHC) providers to monitor
participants via frequent telephone contacts and/or telehealth and LAC 50:XXxXiIll.Subpart 9 (Behavioral Health Services-Home and
Community-Based Services Waiver) to allow services to be provided telephonically or through videoconferencing means in accordance
with LDH-issued guidance. The regulations were continued via emergency and are effective November 17, 2021.

¢ 2021 LA REG TEXT 558112 (NS), published February 20, 2021, continues previous emergency rule 50 LA ADC Pt XV, ? 3503
(Waiver of Payment for Other Services) to allow telemedicine visits as an alternative to provisions requiring daily visits by the hospice
provider to all clients under the age of 21. The regulation was continued via emergency and is effective February 21, 2021.

¢ 2021 LA REG TEXT 558112 (NS), published June 11, 2021, continues previous emergency rule 50 LA ADC Pt XV, ? 3503 (Waiver of
Payment for Other Services) to allow telemedicine visits as an alternative to provisions requiring daily visits by the hospice provider to
all clients under the age of 21. The regulation was continued via emergency and is effective June 22, 2021.

¢ 2021 LA REG TEXT 558112 (NS), published October 11, 2021, continues previous emergency rule 50 LA ADC Pt XV, ? 3503 (Waiver
of Payment for Other Services) to allow telemedicine visits as an alternative to provisions requiring daily visits by the hospice provider
to all clients under the age of 21. The regulation was continued via emergency and is effective October 21, 2021.

« 2020 LA REG TEXT 563003 (NS), published December 20, 2020, amends 46 LA ADC Pt LX, ? 503 (Definitions for Licensed
Professional Counselors and Provisional Licensed Professional Counselors) providing the definition for 'internet counseling" and 46 LA
ADC Pt LX, ? 505 (Teletherapy Guidelines for Licensure (Formerly Diagnosing for Serious Mental Illness) providing that teletherapy

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is a specialty area and requires Board approval, establishing the requirements for a licensee to provide teletherapy, and defining
'telesupervision." The rulemaking adopts previous emergency rules and is effective December 20, 2020.

¢ 2021 LA REG TEXT 568154 (NS), published February 20, 2021, continues previous emergency rule adopting 50 LA ADC Pt I, ?
505 (Telemedicine in the Event of an Emergency) allowing Medicaid, in the event of a declared emergency, to temporarily cover
services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action
is determined to be necessary to ensure sufficient services are available to meet recipients' needs. The regulation was continued via
emergency and is effective March 14, 2021.

* 2021 LA REG TEXT 570497 (NS), published February 20, 2021, adopts 46 LA ADC Pt XXxXIll, ? 203 (Teledentistry) allowing dentists
to perform dentistry via teledentistry and establishing the requirements for providing dental care via teledentistry. Amends 46 LA ADC
Pt XXXIll, ? 701 (Authorized Duties) allowing dental hygienists, in limited circumstances, to perform radiographs, oral prophylaxis, place
sealants and place fluoride varnish without a licensed dentist being physically present, including under the supervision of a dentist via
teledentistry. The regulations are effective February 20, 2021.

¢ 2021 LA REG TEXT 575245 (NS), published November 20, 2021, amends 46 LA ADC Pt LIll, ? 2425 (Telepharmacy Dispensing
Site) removing outdated minimum specifications for prescription department in telepharmacy dispensing sites, prohibiting pharmacy
technicians candidates from practicing in telepharmacy dispensing sites, clarifying the patient counseling requirements in telepharmacy
dispensing sites, and makes technical corrections. The regulation is effective November 20, 2021.

«2021 LA REG TEXT 583860 (NS), published August 20, 2021, amends 46 LA ADC Pt LIV, ? 319 (Use of Telehealth in the practice of
Physical Therapy) clarifying that the standard of care for telehealth services must be substantially equivalent to the standard of care for
services delivered in person. The regulation is effective August 20, 2021.

¢ 2021 LA REG TEXT 588931 (NS), published October 20, 2021, adopts 37 LA ADC Pt XIll, ? 17947 (Telemedicine Access) requiring
health insurance insurers to waive any coverage limitations restricting telemedicine access to providers included within a plan's
telemedicine network, waive any requirement that the patient and provider have a prior relationship in order to have services delivered
through telemedicine, cover mental health services provided by telemedicine consultation to the same extent the services would

be covered if provided through an in-person consultation, and waive any requirement limiting coverage to provider-to-provider
consultations only and shall cover telemedicine consultations between a patient and a provider to the extent the same services would
be covered if provided in person. The regulation is effective October 10, 2021.

¢ 2021 LA REG TEXT 592444 (NS), adopted August 26, 2021, adopts 37 LA ADC Pt XI, ? 4735 (Telemedicine Access) requiring health
insurance insurers to waive any coverage limitations restricting telemedicine access to providers included within a plan's telemedicine
network, requiring health insurance insurers to waive any requirement that the patient and provider have a prior relationship in order

to have services delivered through telemedicine, requiring health insurance insurers to cover mental health services provided by
telemedicine consultation to the same extent the services would be covered if provided through an in-person consultation, and requiring
health insurance insurers to waive any requirement limiting coverage to provider-to-provider consultations only and must cover
telemedicine consultations between a patient and a provider to the extent the same services would be covered if provided in person.
The regulation was adopted via emergency and is effective August 26, 2021 through September 27, 2021.

* 2021 LA REG TEXT 592444 (NS), adopted September 24, 2021, adopts 37 LA ADC Pt XI, ? 4735 (Telemedicine Access) requiring
health insurance insurers to waive any coverage limitations restricting telemedicine access to providers included within a plan's
telemedicine network, requiring health insurance insurers to waive any requirement that the patient and provider have a prior
relationship in order to have services delivered through telemedicine, requiring health insurance insurers to cover mental health
services provided by telemedicine consultation to the same extent the services would be covered if provided through an in-person
consultation, and requiring health insurance insurers to waive any requirement limiting coverage to provider-to-provider consultations
only and must cover telemedicine consultations between a patient and a provider to the extent the same services would be covered if
provided in person. The regulation was previously adopted via emergency and is continued through October 24, 2021.

¢ 2021 ME H.P. 42 (NS), adopted June 16, 2021, amends ME ST T. 32 ? 18302 (Definitions) to provide the definition for 'teledentistry."
The bill adopts ME ST T. 32 ? 18394 (Teledentistry) to authorize oral health care services and procedures to be provided through
teledentistry. The bill is effective June 16, 2021.

¢ 2021 ME H.P. 148 (NS), introduced April 20, 2021, would amend ME ST T. 22 ? 3173-H (Services delivered through telehealth) to
update the definition for 'telenealth" and require reimbursement to providers providing telehealth and telemonitoring services at the
same reimbursement rate as comparable services provided through in-person consultation.

¢ 2021 ME H.P. 227 (NS), introduced February 4, 2021, would amend ME ST T. 22 ? 3173-H (Services delivered through telehealth)
to allow a patient to provide verbal, electronic, or written consent for telehealth and telemonitoring services and amend ME ST T. 24-
A ? 4316 (Coverage for telehealth services) to update the definition for 'telehealth" and to repeal coverage requirements for telephonic
services.

¢ 2021 ME H.P. 237 (NS), introduced February 4, 2021, would amend ME ST T. 24-A ? 4316 (Coverage for telehealth services) to
update the definition for 'telehealth," to require insurers to reimburse a provider for the diagnosis, consultation with or treatment of an

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enrollee delivered through telehealth services on the same basis and at least the rate of reimbursement at which the insurer reimburses
a provider for the provision of the same, or substantially similar, services through in-person consultation, to prohibit an insurer from
having separate deductibles for services delivered through telehealth, and to prohibit an insurer from placing any restriction on the
prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more
restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

¢ 2021 ME H.P. 617 (NS), introduced March 10, 2021, would amend ME ST T. 22 ? 3173-H (Services delivered through telehealth)

and ME ST T. 24-A ? 4316 (Coverage for telehealth services) to update the definition for 'telehealth" and require reimbursement to
providers providing telehealth and telemonitoring services at the same reimbursement rate as comparable services provided through in-
person consultation.

¢ 2021 ME H.P. 631 (NS), adopted June 22, 2021, establishes the Interstate Psychology Interjurisdictional Compact to regulate the
day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The
Compact will come into effect on the date on which the Compact is enacted into law in the 7th Compact State.

¢ 2021 ME H.P. 745 (NS), introduced March 10, 2021, would amend ME ST T. 24-A ? 4316 (Coverage for telehealth services) to
clarify that telehealth services must be covered by insurance as they would be if provided in person and adopt ME ST T. 32 ? 60-
O (Telehealth) to allow certain licensed or registered professionals to provide necessary health care or other services to the extent
practicable through the use of all modes of telehealth, including visual and audio, audio-only, or other electronic media.

¢ 2021 ME H.P. 872 (NS), introduced March 18, 2021, would amend ME ST T. 24-A ? 4316 (Coverage for telehealth services) to
update the definition for 'telehealth," remove the definition for 'telephone services," and remove coverage requirements for telephonic
services. Adopt ME ST T. 32 ? 2213 (Licensing of nurse licensed in another state; authorized actions), ME ST T. 32 ? 2571-B
(Licensing of osteopathic physician or physician assistant licensed in another state; authorized actions), and ME ST T. 32 ? 3278-A
(Licensing of physician or physician assistant licensed in another state; authorized actions) to make permanent the authorization for
licensing out-of-state and recently retired doctors, physician assistants, and nurses that was provided through executive order during
the declared state of civil emergency related to COVID-19.

¢ 2021 ME H.P. 1277 (NS), introduced May 19, 2021, would adopt ME ST T. ? 203-C (Opioid and Substance Use Abatement Fund) to
require the Fund to establish or expand treatment alternatives that provide psychosocial supports and medication-assisted treatment to
expand access to care in rural areas including mobile health services, telehealth and pharmacist administration of medication.

¢ 2021 ME H.P. 1279 (NS), adopted June 21, 2021, amends ME ST T. 32 ? 3300-D (Interstate practice of telemedicine), ME ST T.
34-B ? 3874 (Medical examinations conducted via telemedicine technologies), ME ST T. 35-A ? 9203 (ConnectMaine Authority), and
ME ST T. 35-A ? 9211-A (Municipal Gigabit Broadband Network Access Fund) to update terminology to use 'telehealth" instead of
'telemedicine." The bill is effective June 21, 2021 pursuant to an emergency clause.

* 2021 ME S.P. 39 (NS), adopted June 22, 2021, adopts the Occupational Therapy Practice Acts. One of the stated purposes for the
Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The Compact
will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 ME S.P. 50 (NS), adopted June 21, 2021, amends the laws governing telehealth. The bill is effective June 21, 2021 pursuant to
an emergency clause.

¢ 2021 ME S.P. 207 (NS), adopted May 25, 2021, amends ME ST T. 24-A ? 4304 (Utilization review) providing that unless a waiver is
granted by the superintendent, a carrier or entity under contract toa carrier must make available to a provider in real time at the point
of prescribing one or more electronic benefit tools that are capable of integrating with at least one electronic prescribing system or
electronic medical record system to provide complete, accurate, timely, clinically appropriate formulary and benefit information specific
to an enrollee. The bill is effective January 1, 2022.

¢ 2021 ME S.P. 255 (NS), introduced March 1, 2021, would amend ME ST T. 24-A ? 4316 (Coverage for telehealth services) to

allow a provider to perform a medically necessary health care service delivered through telehealth using the patient's choice of
telecommunications technology and equipment or, with the patient's consent, the telecommunications technology and equipment that
is available to the provider and the patient and allow a provider not licensed to practice medicine in the State to provide telehealth to
a patient in the State from another jurisdiction. Amend ME ST T. 32 ? 3300 (Interstate practice of telemedicine) to allow a physician
to perform medically necessary telemedicine using the patient's choice of telecommunications technology and equipment or, with the
patient's consent, the telecommunications technology and equipment that is available to the physician and the patient.

¢ 2021 ME S.P. 448 (NS), introduced April 5, 2021, would amend ME ST T. 24-A ? 4316 (Coverage for telehealth services) to update
the definition for 'telehealth" and to repeal coverage requirements for telephonic services. Adopt ME ST T. 32 ? 2600-G (Exemption
for licensed individual consulting through telehealth) and ME ST T. 32 ? 3270-H (Exemption for licensed individual consulting
through telehealth) to define 'telehealth" and allow out-of-state physicians to consult through telehealth if the physician possesses an
unrestricted license in medicine in the state from which the physician is located when providing the consulting service.

¢ 2021 ME S.P. 542 (NS), introduced May 4, 2021, would adopt new sections related to telehealth services to provide definitions and
establish requirements for telehealth services.

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Maryland

¢ 2021 MD H.B. 78 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 4-302.3 (State Designated Exchange) authorizing the
state designated health exchange to participate in the advisory committee, maintain a data set for the Maryland Commission on Health
Equity and provide data from the data set consistent with the parameters defined by the Advisory Committee. The bill would also adopt
MD HEALTH GEN ? 13-4206 to create an Advisory Committee to establish the parameters of a health equity data set to be maintained
by the state designated health information exchange.

¢ 2021 MD H.B. 123 (NS), adopted April 13, 2021, amends MD HEALTH GEN ? 15-141.2 (Pilot program to provide telehealth
services to Program recipients regardless of the Program recipient's location at the time telehealth services are provided) updating the
definition for 'telehealth,' provide the definition for 'distant site,' 'distant site provider,' 'health care practitioner,' 'originating site,' and
'remote patient monitoring services,' and require the program to provide health care services through telehealth to program recipients
regardless of the location of the program recipient at the time telehealth services are provide and allow a distant sit provider to

provide health care services to a program recipient from any location at which the health care services may be appropriately delivered
through telehealth. Amends MD INSURANCE ? 15-139 (Health care services delivered through telehealth) to update the definition for
'telehealth,' to require an entity to reimburse a health care provider for diagnosis, consultation, and treatment of an insured patient for
a health care services when appropriately provided through telehealth, on the same basis and at the same rate as if the health care
service were delivered by the health care provider in person, and to prohibit an entity from imposing as a condition of reimbursement of
a health care service delivered through telehealth that the health care service be provided by a health care provider designated by the
entity. The bill is effective July 1, 2021.

¢ 2021 MD H.B. 161 (NS) and 2021 MD S.B. 379 (NS), adopted May 30, 2021, amends MD HEALTH OCCUP ? 2-101 (Definitions)
removing the definition for 'telehealth." The bill is effective October 1, 2021.

¢ 2021 MD H.B. 191 (NS), engrossed February 16, 2021, and 2021 MD S.B. 56 (NS), engrossed February 9, 2021, would repeal the
termination provisions for certain provisions of law relating to the eligibility of psychiatrists and psychiatric nurse practitioners who
provide Assertive Community Treatment or mobile treatment services to Maryland Medical Assistance Program recipients in a home or
community-based setting through telemedicine to receive reimbursement for the health care services from the Program.

¢ 2021 MD H.B. 288 (NS), enrolled March 28, 2021, and 2021 MD S.B. 183 (NS), engrossed March 1, 2021, would adopt the Audiology
and Speech-Language Pathology Interstate Compact and establish the requirements to practice audiology or speech-language
pathology in any member state via telehealth under a privilege to practice as provided in the Compact.

¢ 2021 MD H.B. 540 (NS), adopted April 13, 2021, adopts the Interstate Occupational Therapy Practice Acts. One of the stated
purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services. The bill is effective October 1, 2021 The Compact comes into effect on the date on which the Compact statute is enacted into
law in the 10th member state.

* 2021 MD H.B. 550 (NS), introduced January 20, 2021, would amend MD HEALTH GEN ? 15-103 (Maryland Medical Assistance
Program), MD HEALTH GEN ? 15-105.2 (Reimbursement of health care providers), MD HEALTH GEN ? 15-141.2 (Pilot program to
provide telehealth services to Program recipients regardless of the Program recipient's location at the time telehealth services are
provided), and MD HEALTH GEN ? 15-139 (Health care services delivered through telehealth) to alter the health care services the
Maryland Medical Assistance Program is required to provide through telehealth, repeal a certain limitation on the requirement that

the Program provide certain health care services through telehealth, alter the circumstances under which the Program is required

to provide health care services through telehealth, require, subject to certain requirements, that certain provisions of law relating

to coverage of and reimbursement for health care services delivered through telehealth apply to the Program and managed care
organizations in a certain manner, authorize the Maryland Department of Health to adopt certain regulations relating to telehealth
services provided to Program recipients, repeal certain authorization of the Department relating to the coverage of and reimbursement
for health care services that are delivered through store-and-forward technology or remote patient monitoring, establish, for a certain
purpose and certain standards, that a health care service provided through telehealth is equivalent to the same health care service
when provided through an in-person consultation under certain circumstances, repeal a certain requirement that the Department
apply for a certain amendment to certain waivers to implement a certain pilot program relating to the provision of certain telehealth
services, require certain insurers, nonprofit health service plans, and health maintenance organizations to provide certain coverage for
certain services delivered through telehealth regardless of the location of the patient at the time the services are provided, establish
that a certain requirement relating to coverage of certain health care services delivered through telehealth includes coverage for

the treatment for substance use disorders and mental health conditions, require certain insurers, nonprofit health service plans, and
health maintenance organizations to reimburse certain health care services provided through telehealth in a certain manner and at a
certain rate, require certain insurers, nonprofit health service plans, and health maintenance organizations to allow an insured patient
to select the manner in which a health care service is delivered, prohibit certain insurers, nonprofit health service plans, and health
maintenance organizations from requiring an insured patient to use telehealth in lieu of in-person service delivery, authorize certain
insurers, nonprofit health service plans, and health maintenance organizations to use telehealth to satisfy certain network access
standards under certain circumstances, repealing the requirement that the Department study and submit a certain report to the General
Assembly, revise, restate, and recodify certain provisions of law relating to the Program and reimbursement of services provided

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through telemedicine and telehealth, define and alter definitions, and general updates to the coverage and reimbursement of health
care services delivered through telehealth.

* 2021 MD H.B. 731 (NS) and 2021 MD S.B. 567 (NS), introduced January 26, 2021, would MD HEALTH GEN ? 15-103 (Maryland
Medical Assistance Program), MD HEALTH OCCUP ? 1-1001 (Definitions), and MD INSURANCE ? 15-139 (Health care services
delivered through telehealth) to alter the health care services the Maryland Medical Assistance Program is required to provide through
telehealth, to alter the circumstances under which the Program is required to provide health care services through telehealth, to update
the definition of 'telehealth," require insurers to reimburse certain health care services provided through telehealth to reimburse in a
certain manner and a certain rate, to prohibit insurers from imposing, as a condition of reimbursement of a health care service delivered
through telehealth, that the health care service be provide by a certain health care provider, and to repeal the termination date of
relating to the coverage for telehealth.

¢ 2021 MD H.B. 970 (NS), enrolled March 16, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 MD H.B. 1243 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 7.5-209 (Report on behavioral health services for

children and young adults) requiring the Director of the Behavioral Health Administration's annual report on behavioral health services
for children and young adults in the State to include certain information relating to outpatient and substance-related disorders program
services by children and young adults and behavioral health services provided through telehealth. The bill is effective October 1, 2021.

¢ 2021 MD H.B. 1287 (NS) and 2021 MD S.B. 646 (NS), adopted May 30, 2021, amends MD HEALTH OCCUP ? 17-406 (Practice
clinical alcohol and drug counseling without license) allowing an individual to practice alcohol and drug counseling through telehealth.
The bill is effective October 1, 2021.

¢ 2021 MD H.B. 1328 (NS), adopted May 30, 2021, amends MD ECON DEV ? 5-1102 (Established) allowing the Fund to provide
financial assistance in the form of grants to authorities to expand high-speed internet access in underserved areas of the state to
establish telemedicine services in underserved areas of the state. The bill is effective July 1, 2021.

¢ 2021 MD H.B. 1375 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 4-302.2 (Regulations relating to privacy and security
of health information), MD HEALTH GEN ? 4-302.3 (State designated exchange), MD HEALTH GEN ? 19-142 (Definitions), and

MD HEALTH GEN ? 19-143 (Health information exchange; recommendations, regulations) requiring the State-designated health
information exchange to develop and maintain a certain consent management application, allowing certain entities to use electronic
health information for certain purposes, excluding certain payors from the application of certain provisions of law governing health
information exchanges, updating definitions, and requiring certain health information exchanges to transmit to the State-designated
health information exchange. The bill is effective October 1, 2021.

¢ 2021 MD S.B. 56 (NS), engrossed February 9, 2021, would repeal the termination provisions for certain provisions of law relating
to the eligibility of psychiatrists and psychiatric nurse practitioners who provide Assertive Community Treatment or mobile treatment
services to Maryland Medical Assistance Program recipients in a home or community-based setting through telemedicine to receive
reimbursement for the health care services from the Program.

¢ 2021 MD S.B. 139 (NS), adopted April 13, 2021, adopts the Occupational Therapy Licensure Compact. One of the stated purposes for
the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The
Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 MD S.B. 278 (NS), adopted May 18, 2021, adopts uncodified section requiring the State Department of Education and the
Maryland Department of Health to authorize a certain health care practitioner to provide health care services through telehealth under
certain circumstances and prohibiting the State Department of Education and the Maryland Department of Health from establishing
certain requirements for a certain school-based health center to provide health care services through telehealth. The bill is effective
May 18, 2021.

* 2020 MD S.B. 500 (NS), enrolled March 14, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

* 2021 MD S.B. 520 (NS), adopted May 30, 2021, amends MD HEALTH GEN ? 7.5-209 (Report on behavioral health services for
children and young adults) to require the annual report to include the number and percentage of children and young adults who, during
the reported year, used a public behavioral health services provided through telehealth. The bill is effective October 1, 2021.

* 2020 MD S.B. 571 (NS), adopted May 18, 2021, adopts the Licensed Professional Counselor Interstate Compact. One of the stated
purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Professional Counseling
services. The Compact comes into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 MD S.B. 646 (NS), adopted May 30, 2021, amends MD HEALTH OCCUP ? 1-1001 (Definitions) to update the definition for
'telehealth" and MD HEALTH OCCUP ? 17-406 (Practice clinical alcohol and drug counseling without license) to allow an individual to
practice clinical alcohol and drug counseling through telehealth. The bill is effective October 1, 2021.

¢ 2021 MD S.B. 828 (NS), introduced February 9, 2021, would adopt MD INS ? 15-856 to prohibit an entity from imposing any cost-
sharing requirements, including copayments, coinsurance, or deductibles, for medically necessary and appropriate services related

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to the use of postexposure prophylaxis or preexposure prophylaxis, including provider office and telehealth visits for prescribing and
medication management.

¢ 2021 MD REG TEXT 593579 (NS), published December 3, 2021, amends IMD ADC 10.37.10.07-1 (Outpatient Services - At the
Hospital Determination) updating the definition for 'telehealth services," prohibiting a hospital from billing a separate hospital facility fee
when a health care provider who provided telehealth services is authorized to bill independently for the professional services rendered,
and providing that the delivery of telehealth services in this regulation constitute outpatient services provided at the hospital. The
regulation is effective December 13, 2021.

Massachusetts

¢ 2021 MA H.D. 2533 (NS), draft/request February 17, 2021, would amend MA ST 32A ? 30 to prohibit carriers from imposing any prior
authorization requirements to obtain medically necessary health services via telehealth that would not apply to the receipt of those
same services on an in-person basis.

¢ 2021 MA H.D. 3757 (NS) and 2021 MA S.D. 2256 (NS), draft/request February 19, 2021, would adopt MA ST 112 ? 51B to provide
that pursuant to a collaborative management agreement, a dental therapist may provide procedures and services permitted under
general supervision when the supervising dentist is not on-site and has not previously examined or diagnosed the patient provided the
supervising dentist is available for consultation and supervision if needed through telemedicine or by other means of communication.

¢ 2021 MA H.D. 3880 (NS) and 2021 MA S.D. 2041 (NS), draft/request February 19, 2021, would allow evaluation via telemedicine,
electronic, or telephone consultation, as deemed appropriate by the Department.

* 2021 MA S.D. 2086 (NS), draft/request February 19, 2021, would allow a provider acting within the scope of their license to prescribe
medication abortion and provide correlating abortion-related services via telemedicine.

* 2021 MA S.D. 2099 (NS), draft/request February 19, 2021, would provide that coverage for telehealth services must not include a
copayment requirement for a health care service provided via telehealth, provide that coverage for telehealth services must include
reimbursement for interpreter services for patients with limited English proficiency or those who are deaf or hard of hearing, and prohibit
a Medicaid managed care organization or primary care clinician plan from imposing any prior authorization requirements to obtain
medically necessary health services via telehealth that would not apply to the receipt of those same services on an in-person basis.

¢ 2021 MA S.D. 2133 (NS), draft/request February 19, 2021, would adopt new sections to require regulations to permit evaluation
via telemedicine, electronic or telephonic consultation, as deemed appropriate by the Department and to have a protocol to require
a behavioral health evaluation to occur, in person or through the use of telehealth technology, within 12 hours of admission to the
emergency department or satellite emergency facility.

¢ 2021 MA S.B. 2572 (NS), introduced November 9, 2021, and 2021 MA S.B. 2584 (NS), introduced November 22, 2021, would adopt
MA ST 111 ? 51 ? to require the Department of Mental Health to promulge regulations to permit evaluation via telemedicine, electronic
or telephonic consultation, as deemed appropriate by the Department.

«2019 MA S.B. 2984 (NS), adopted January 1, 2021, removes financial and insurance barriers to telehealth services. The Act makes
telehealth services permanently available for Massachusetts patients after the COVID-19 state of emergency has ended by requiring
insurance carriers, including MassHealth, to cover telehealth services in any case where the same in-person service would be covered
and the use of telehealth is appropriate. This bill extends payment rate parity beyond the current COVID-19 state of emergency by
requiring that behavioral health services delivered via telehealth be permanently reimbursed by insurers at the same level as in-
person services. The bill recognizes that expanded use of telehealth will affect our health care system in a variety of ways. The bill also
includes an analysis of telehealth coverage and payment to inform future policy decisions. The bill is effective April 1, 2021.

* 2021 MA REG TEXT 562134 (NS), published January 8, 2021, amends 935 MA ADC 501.002 (Definitions) including a telehealth

visit in the definition of 'clinical visit" and 935 MA ADC 501.010 (Written Certification of a Debilitating Medical Condition for a Qualifying
Patient) allowing a clinical visit to occur in-person or by telehealth means and establishing the requirements for a clinical visit conducted
by telehealth means. The regulations are effective January 8, 2021.

Michigan
¢ 2019 MI H.B. 4910 (NS), enrolled December 21, 2020, would adopt the Misrepresentation of Emotional Support Animal Acts to

regulate the certification of an individual's need for an emotional support animal by health care providers and requests for reasonable
accommodation for emotional support animals in housing. The Act also defines 'bone fide provider-patient relationship" and 'telehealth."

¢ 2021 MI H.B. 4355 (NS), engrossed March 24, 2021, would amend Vil ST 333.16171 (Exemptions from licensure requirement;
circumstances and limitations) to allow an individual who is authorized to practice a health profession in another state and who, while
located in the state in which he or she is authorized to practice the health profession, to provide a health service to a patient in Michigan
through telehealth if the individual receives consent for the health service in the same manner as provided in Ml ST 333.16284
(Telehealth services; consent for treatment) and the individual provides only those health services he or she would be permitted to
provide if he or she were authorized under this article to engage in that health profession in Michigan.

¢ 2021 MI H.B. 4356 (NS), engrossed March 24, 2021, would amend MV! ST 333.5555 (Definitions; terms commencing 'I' to 's') to define
'telemedicine.'

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¢ 2021 MI H.B. 4410 (NS), engrossed June 24, 2021, would adopt new sections requiring the Department to expand the utilization of
telemedicine and telepsychiatry.

¢ 2021 MI H.B. 5488 (NS), engrossed December 9, 2021, would adopt I! ST 333.18201 to authorize a psychologist who has temporary
authorization to practice under the psychology interjurisdictional compact or is authorized to practice interjurisdictional telepsychology
under the psychology interjurisdictional compact to engage in the practice of psychology under MI ST Ch. 333 Art. 15 (Occupations)
and provide that such an individual is considered a psychologist who is licensed under MI ST Ch. 333 Art. 15 Pt 182 (Psychology).

¢ 2021 MI H.B. 5489 (NS), engrossed December 9, 2021, would establish the Psychology Interjurisdictional Compact to regulate the
day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 MI S.B. 707 (NS), introduced October 28, 2021, would amend Ml ST 500.3476 (Telemedicine services) to require an insurer to
provide the same coverage for a service provided through telemedicine as if the service had involved face-to-face contract between the
health care professional and the patient.

¢ 2019 MI S.B. 758 (NS), enrolled December 18, 2020, would establish the Psychology Interjurisdictional Compact to regulate the day
to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2019 MI S.B. 1185 (NS), enrolled December 18, 2020, would adopt the Pandemic Response Health Care Immunity Act" to provide
immunity for health care providers and health care facilities in the event of a pandemic. The Act defines 'health care services" as
services provided to an individual by a health care facility or health care provider regardless of the location where those services are
provided, including the provision of health care services via telehealth or other remote method.

¢ 2021 MI REG TEXT 559996 (NS), filed March 31, 2021, amends M! ADC R 338.2921 (Definitions) to define 'telehealth" and adopts
MI ADC R 338.2930 (Telehealth services) to require a social service technician registrant or social work licensee to obtain consent
before providing a telehealth service and requiring a social service technician registrant or social work licensee providing a telehealth
service to act within the scope of his or her practice, exercise the same standard of care applicable to a traditional, in-person health
care service, and ensure that the technology methods and equipment used complies with all current privacy-protection laws when
providing a telehealth service. The regulations are effective March 31, 2021.

¢ 2021 MI REG TEXT 565312 (NS), filed April 1, 2021, adopts MM! ADC R 338.702 (Telehealth) requiring consent for treatment to be
obtained before providing telehealth service and requiring a massage therapist providing a telehealth service to act within the scope
of their practice and exercise the same standard of care applicable to a traditional, in-person health care service. The regulation is
effective April 1, 2021.

¢ 2021 MI REG TEXT 565313 (NS), filed April 1, 2021, adopts | ADC R 338.13003 (Telehealth) requiring an acupuncturist to obtain
consent before providing a telehealth service and requiring an acupuncturist providing a telehealth service to act within the scope

of their practice and exercise the same standard of care applicable to a traditional, in-person health care service. The regulation is
effective April 1, 2021.

¢ 2021 MI REG TEXT 569913 (NS), filed June 4, 2021, adopts Vi] ADC R 338.1302 (Telehealth services) requiring consent for
treatment be obtained before providing a telehealth service. The regulation is effective June 4, 2021.

¢ 2021 MI REG TEXT 569914 (NS), filed October 28, 2021, adopts | ADC R 338.2201b (Telehealth) establishing the requirements for
a respiratory therapist providing services by telehealth, including the requirements for consent for treatment. The regulation is effective
October 28, 2021.

* 2021 MI REG TEXT 586817 (NS), filed November 1, 2021, amends ll ADC R 418.10901 (General Information) and | ADC R
418.101004 (Modifier code reimbursement) updating the procedure codes for telemedicine services. The amendments are effective
November 1, 2021.

Minnesota

¢ 2019 MN H.F. 19 (NS), adopted December 16, 2020, amends Laws 2020, chapter 70, article 3, section 1 (Coverage of Telemedicine
Services Provided Directly to a Patient's Residence; Response to COVID-19) extending the expiration date to June 30, 2021. The
amendment is effective December 17, 2020.

* 2021 MN H.F. 33 (NS), adopted June 29, 2021, adopts MN ST ? 62A.673 (Coverage of Services Provided Through Telehealth)
to provide definitions and require health plans to cover benefits delivered through telehealth in the same manner as any other
benefits covered under the health plan. Amends MN ST ? 147.033 (Practice of Telehealth) changing the section title from 'Practice
of Telemedicine," updating definition for 'telehealth," and update terminology to use 'telehealth" instead of 'telemedicine." Amends
MN ST ? 151.37 (Legend drugs; who may prescribe, possess) to allow for a required examination of the patient to be conducted
via telehealth. Amends MN ST ? 245G.01 (Telehealth) changing the section title from 'Telemedicine" and update the definition

for 'telehealth." Amends MN ST ? 245G.06 (Comprehensive assessment and assessment summary) to allow a comprehensive
assessment of the client's substance use disorder to be administered in person or via telehealth. Amends MN ST ? 245A.19 (HIV
training in chemical dependency treatment program) to update terminology to use 'telehealth" instead of 'telemedicine." Amends
MN ST ? 254B.05 (Vendor eligibility) to allow chemical dependency services that are otherwise covered as direct in-person services
to be provided via telehealth. Amends MN ST ? 256B.0625 (Covered Services) to update terminology to use 'telehealth" instead

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of 'telemedicine," update the definition for 'telehealth," and to allow mental health services that are otherwise covered by medical
assistance as direct in-person services to be provided via telehealth. The bill is effective July 1, 2021.

¢ 2021 MN H.F. 269 (NS), engrossed March 4, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 MN H.F. 319 (NS), introduced January 25, 2021, would amend MN ST ? 148.01 (Chiropractic) to allow, when appropriate, a
service to be delivered via telemedicine.

* 2021 MN HLF. 511 (NS), introduced January 28, 2021, would amend MN ST ? 245G.01 (Definitions), MN ST ? 245G.01 (Definitions),
MN ST ? 245G.06 (Individual treatment plan), MN ST ? 254A.19 (Chemical use assessments), MN ST ? 254B.05 (Vendor eligibility),
MN ST ? 256B.0625 (Covered services), and MN ST ? 256B.0625 (Covered Services) to modify the requirements for substance use
disorder and mental health treatment provided via telemedicine.

¢ 2021 MN H.F. 600 (NS), engrossed May 14, 2021, would adopt MN ST ? 342.51 (Distribution of Medical Cannabis and Medical
Cannabis Products) to allow a consultation to be conducted remotely using a videoconference as long as: (1) the pharmacist engaging
in the consultation is able to confirm the identity of the patient; (2) the consultation occurs while the patient is at the cannabis retailer
or medical cannabis business; and (3) the consultation adheres to patient privacy requirements that apply to health care services
delivered through telemedicine. Adopt MN ST ? 342.54 (Duties of Health Care Practitioners; Registry Program) to allow a patient
assessment to be conducted via telemedicine.

¢ 2021 MN H.F. 816 (NS), introduced February 8, 2021, would adopt MN ST ? 62K.10 (Geographic Accessibility; Provider Network
Adequacy) to allow an insurer to address network inadequacy in a county by providing for patient access to providers of that type or
specialty via telemedicine.

¢ 2021 MN H.F. 1040 (NS), introduced February 11, 2021, would MN ST ? 256B.0625 (Covered Services) to remove the limitation

on the coverage of telemedicine services and to allow telemedicine visits to satisfy the face-to-face requirement for consideration of
reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health service,
638 tribal clinic, and certified community behavioral health clinic, if the service would have otherwise qualified for payment if performed
in person. The bill would also amend MN ST ? 256B.0947 (Intensive rehabilitative mental health services) to allow services and
responsibilities of the psychiatric provider to be provided through telemedicine when necessary to prevent disruption in client services
or to maintain the required psychiatric staffing level. The bill would adopt new section MN ST ? 9505.0370 (Definitions) to define 'mental
health telemedicine" and MN ST ? 9505.0371 (Medical Assistance Coverage Requirements for Outpatient Mental Health Services) to
establish the requirements for mental health services to be provided via telemedicine.

¢ 2021 MN H.F. 1094 (NS), introduced February 15, 2021, would amend MN ST ? 256B.0625 (Covered Services) to reduce the
reimbursement rate for services delivered by telemedicine and MN ST ? 256B.69 (Prepaid health plans) to modify the capitation rate to
reflect the reduced reimbursement rate for services delivered by telemedicine.

¢ 2021 MN H.F. 1411 (NS), introduced February 22, 2021, and 2021 MN H.F. 1412 (NS), engrossed March 4, 2021, would adopt MN
ST ? 62A.673 (Coverage of Services Provided Through Telehealth) to provide definitions and require health plans to cover benefits
delivered through telehealth in the same manner as any other benefits covered under the health plan. Amend MN ST ? 147.033
(Practice of Telehealth) changing the section title from 'Practice of Telemedicine," update definition for 'telehealth," and update
terminology to use 'telehealth" instead of 'telemedicine." Amend MN ST ? 151.37 (Legend drugs; who may prescribe, possess) to
allow for a required examination of the patient to be conducted via telehealth. Amend MN ST ? 245G.01 (Telehealth) changing the
section title from 'Telemedicine' and update the definition for 'telehealth." Amend MN ST ? 245G.06 (Comprehensive assessment
and assessment summary) to allow a comprehensive assessment of the client's substance use disorder to be administered in person
or via telehealth. Amend MN ST ? 245A.19 (HIV training in chemical dependency treatment program) to update terminology to use
'telehealth" instead of 'telemedicine." Amend MN ST ? 254B.05 (Vendor eligibility) to allow chemical dependency services that are
otherwise covered as direct in-person services to be provided via telehealth. MN ST ? 256B.0625 (Covered Services) to update
terminology to use 'telehealth" instead of 'telemedicine," update the definition for 'telehealth," and to allow mental health services that
are otherwise covered by medical assistance as direct in-person services to be provided via telehealth.

¢ 2021 MN H.F. 2128 (NS), adopted May 25, 2021, would amend MN ST ? 256B.0622 (Assertive community treatment and intensive
residential treatment services) to allow a psychiatric care provider to provide services by telemedicine when necessary to ensure

the continuation of psychiatric and medication services availability for clients to maintain statutory requirements for psychiatric care
provider staffing levels. Amend MN ST ? 256B.0625 (Covered services) to update telemedicine coverage requirements. Amend MN
ST ? 256B.0947 (Intensive rehabilitative mental health services) to allow services and responsibilities of the psychiatric provider to be
provided through telemedicine when necessary to prevent disruption in client services or to maintain the required psychiatric staffing
level. The bill is effective July 1, 2021.

¢ 2021 MN H.F. 2176 (NS), introduced March 15, 2021, would adopt new section to require a comprehensive SBHC to collaborate and
consult with one or more partnering organization to fully complement the basic net health services, including emerging services such as
mobile health and telehealth.

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¢ 2021 MN S.F. 7 (NS), engrossed June 28, 2021, would amend MN ST ? 241.021 (Licensing and supervision of facilities) to require
the Commissioner to promulgate rules establishing minimum standards for these facilities with respect to their management, operation,
physical condition, and the security, safety, health, treatment, and discipline of persons confined or incarcerated, including a policy
regarding the use of telehealth.

¢ 2021 MN S.F. 193 (NS), adopted May 25, 2021, would adopt the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The Compact
will come into effect on the date on which the compact is enacted into law in the seventh compact state.

¢ 2021 MN S.F. 780 (NS), introduced February 11, 2021, would amend MN ST ? 62A.671 (Definitions), MN ST ? 147.032 (Interstate
practice of telemedicine), and MN ST ? 147.033 (Practice of telemedicine) to update the definition for 'telehealth," update terminology
to use 'telehealth" instead of 'telemedicine," and clarify that a physician providing medical services through interstate telehealth is
engaged in the practice of medicine.

¢ 2021 MN S.F. 970 (NS), engrossed April 22, 2021, would amend MN ST ? 241.021 (Licensing and supervision of facilities) requiring
correctional facilities to have a policy regarding the use of telehealth.

¢ 2021 MN S.F. 1028 (NS), engrossed February 25, 2021, would new section MN ST ? 9505.0370 (Definitions) to define 'mental health
telemedicine" and MN ST ? 9505.0371 (Medical Assistance Coverage Requirements for Outpatient Mental Health Services) to establish
the requirements for mental health services to be provided via telemedicine.

¢ 2021 MN S.F. 1160 (NS), engrossed April 17, 2021, would adopt MN ST ? 62A.673 (Coverage of Services Provided Through
Telehealth) to provide definitions and require health plans to cover benefits delivered through telehealth in the same manner as

any other benefits covered under the health plan. Amend MN ST ? 147.033 (Practice of Telehealth) changing the section title from
'Practice of Telemedicine," update definition for 'telehealth," and update terminology to use 'telehealth" instead of 'telemedicine." Amend
MN ST ? 151.37 (Legend drugs; who may prescribe, possess) to allow for a required examination of the patient to be conducted

via telehealth. Amend MN ST ? 245G.01 (Telehealth) changing the section title from "Telemedicine" and update the definition for
'telehealth." Amend MN ST ? 245G.05 (Comprehensive assessment and assessment summary) to allow a comprehensive assessment
of the client's substance use disorder to be administered in person or via telehealth. Amend MN ST ? 245A.19 (HIV training in chemical
dependency treatment program) to update terminology to use 'telehealth" instead of 'telemedicine." Amend MN ST ? 254B.05 (Vendor
eligibility) to allow chemical dependency services that are otherwise covered as direct in-person services to be provided via telehealth.
MN ST ? 256B.0625 (Covered Services) to update terminology to use 'telehealth" instead of 'telemedicine,' update the definition for
'telehealth," and to allow mental health services that are otherwise covered by medical assistance as direct in-person services to be
provided via telehealth.

¢ 2021 MN S.F. 1768 (NS), introduced March 4, 2021, would adopt MN ST ? 254B.17 (School-Linked Substance Abuse Grants) to
provide that delivering substance use disorder treatment and services to students and their families via telemedicine is an allowable
grant activity and related expense.

¢ 2021 MN S.F. 2360 (NS), engrossed April 26, 2021, and 2021 MN S.F. 1160 (NS), engrossed April 27, 2021, would adopt MN ST ?
62A.673 (Coverage of Services Provided Through Telehealth) to provide definitions and require health plans to cover benefits delivered
through telehealth in the same manner as any other benefits covered under the health plan. Amend MN ST ? 147.033 (Practice of
Telehealth) changing the section title from 'Practice of Telemedicine," update definition for 'telehealth," and update terminology to use
'telehealth" instead of 'telemedicine." Amend MN ST ? 151.37 (Legend drugs; who may prescribe, possess) to allow for a required
examination of the patient to be conducted via telehealth. Amend MN ST ? 245G.01 (Telehealth) changing the section title from
'Telemedicine" and update the definition for 'telehealth." Amend MN ST ? 245G.05 (Comprehensive assessment and assessment
summary) to allow a comprehensive assessment of the client's substance use disorder to be administered in person or via telehealth.
Amend MN ST ? 245A.19 (HIV training in chemical dependency treatment program) to update terminology to use 'telehealth" instead
of 'telemedicine." Amend MN ST ? 254B.05 (Vendor eligibility) to allow chemical dependency services that are otherwise covered

as direct in-person services to be provided via telehealth. MN ST ? 256B.0625 (Covered Services) to update terminology to use
'telehealth" instead of 'telemedicine," update the definition for 'telehealth," and to allow mental health services that are otherwise
covered by medical assistance as direct in-person services to be provided via telehealth.

Mississippi
¢ 2021 MS H.B. 160 (NS), adopted March 25, 2021, reenacts IMS ST 41-3-15 to authorize the State Board of Health to promulgate rules

and regulations, and to collect data and information, on (i) the delivery of services through the practice of telemedicine; and (ii) the use
of electronic records for the delivery of telemedicine services. The bill is effective March 25, 2021.

* 2021 MS H.B. 200 (NS), adopted March 10, 2021, amends MS ST ? 83-9-353 (Requirement to provide coverage and reimburse for
telemedicine and remote patient monitoring services) to clarify that a remote patient monitoring prior authorization request form may be
required for approval of telemonitoring services. The section is effective July 1, 2021.

¢ 2021 MS H.B. 201 (NS), introduced January 14, 2021, and 2021 MS S.B. 2631 (NS), amended/substituted February 9, 2021, would
amend MS ST ? 83-9-351 (Telemedicine services coverage) to update the definition for 'telemedicine."

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¢ 2021 MS H.B. 208 (NS), adopted March 10, 2021, adopts MS ST ? 73-31-3, MS ST ? 73-31-14, and MS ST ? 73-31-17 providing that
the practice of psychology must be construed without regard to the means of service provision (e.g. face-to-face, telephone, internet, or
telehealth). The new sections are effective July 1, 2021.

¢ 2021 MS H.B. 863 (NS), introduced January 18, 2021, would authorize licensed health care providers to provide health care services
for primary care, mental health, or dental care through the use of telemedicine to Mississippi residents that live in an area designated a
health professional shortage area, to provide that this authority applies to health care providers licensed under a comparable provision
of the law of another state, territory, district, or possession of the United States, and to provide that licensed health care providers who
provide health care services to a person under the authority of this Act must be immune from liability for any civil action arising out of
the provision of such health care services in good faith on a charitable basis. The bill would also amend MS ST ? 41-127-1 (Medical
treatment via electronic means), MS ST ? 73-25-19 (Unlicensed nonresident physicians), and MS ST ? 73-25-34 (Telemedicine or
practice across state lines) to conform to the new section above.

¢ 2021 MS H.B. 889 (NS), introduced January 18, 2021, would amend MS ST ? 43-13-117 (Care and services covered; discontinuation
of optional services) to provide that for telehealth services provided by federally qualified health centers and community health centers,
the distant or hub site provider mustbe reimbursed the applicable Medicaid fee for the telehealth services provided and provide that
telehealth services provided by federally qualified health centers and community health centers shall be considered to be billable at the
same face-to-face encounter rate used for all other Medicaid reimbursements to federally qualified health centers and community health
centers under the prospective payment system.

¢ 2021 MS H.B. 1086 (NS), introduced January 18, 2021, would amend MS ST ? 43-13-117 (Care and services covered;
discontinuation of optional services) to provide Medicaid coverage for substance abuse and mental health services for pregnant and
postpartum women, delivered in a community-based, telehealth, or faith-based care setting.

¢ 2021 MS H.B. 1168 (NS), introduced January 18, 2021, would amend MS ST ? 83-9-351 (Telemedicine services coverage) to update
the definition for 'telemedicine' and updating the coverage and reimbursement requirements for telemedicine services.

¢ 2021 MS H.B. 1205 (NS), engrossed February 11, 2021, would amend MS ST ? 83-9-351 (Telemedicine services coverage) to update
the definition for 'telemedicine."

¢ 2021 MS S.B. 2345 (NS), introduced January 15, 2021, would amend MS ST ? 43-13-117 (Care and services covered;
discontinuation of optional services) to provide that for telehealth services provided by federally qualified health centers and community
health centers, the distant or hub site provider mustbe reimbursed the applicable Medicaid fee for the telehealth services provided and
provide that telehealth services provided by federally qualified health centers and community health centers shall be considered to be
billable at the same face-to-face encounter rate used for all other Medicaid reimbursements to federally qualified health centers and
community health centers under the prospective payment system. The bill would also extend the repeal date to July 1, 2023.

* 2021 MS S.B. 2631 (NS), engrossed February 9, 2021, would amend MS ST ? 83-9-351 (Telemedicine services coverage) to update
the definition for 'telemedicine" and updating the coverage and reimbursement requirements for telemedicine services.

¢ 2021 MS S.B. 2733 (NS), introduced January 18, 2021, would amend MS ST ? 43-13-117 (Care and services covered;
discontinuation of optional services) to require the Division to reimburse for telemedicine treatment for recipients that have attention
deficit hyperactivity disorder. The bill would also extend the repeal date to July 1, 2022.

¢ 2021 MS S.B. 2738 (NS), introduced January 18, 2021, and 2021 MS S.B. 2799 (NS), engrossed February 9, 2021, would amend MS
ST ? 43-13-117 (Care and services covered; discontinuation of optional services) to require the Division to recognize federally qualified
health centers (FQHCs), rural health clinics (RHCs)) and community mental health centers (CMHCs) as both an originating and distant
site provider for the purposes of telehealth reimbursement and to require the Division to reimburse FQHCs, RHCs and CMHCs for both
distant site and originating site services when such services are appropriately provided by the same organization.

¢ 2021 MS S.B. 2758 (NS), introduced January 18, 2021, would amend MS ST ? 73-25-34 (Telemedicine or practice across state lines)
to allow health care providers to provide services through the use of interactive audio, video, or other electronic medica to a Mississippi
resident who lives in an area designated a health professional shortage area for primary care, mental health, or dental care, to establish
the requirements that a provider must meet to practice under this Act, and to provide immunity from liability for any civil action arising
out of the provision of such care if provided in good faith on a charitable basis.

¢ 2021 MS S.B. 2772 (NS), introduced January 18, 2021, would amend MS ST ? 83-9-351 (Telemedicine services coverage) to update
the definition for 'telemedicine" and updating the coverage and reimbursement requirements for telemedicine services.

¢ 2021 MS S.B. 2799 (NS), adopted April 20, 2021, amends MS ST ? 43-13-117 (Care and services covered; discontinuation of optional
services) to require the Division to recognize federally qualified health centers (FQHCs), rural health clinics (RHCs)) and community
mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement and to
require the Division to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are
appropriately provided by the same organization. The bill is effective July 1, 2021.

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¢ 2021 MS S.C.R. 535 (NS), adopted March 18, 2021, requires the Division of Medicaid to recognize federally qualified health centers
(FQHC), rural health clinics (RHC), and Community Mental Health Centers (CMHC) as both originating and distant site provider for the
purposes of telehealth reimbursement. The bill is effective May 17. 2021.

¢ 2021 MS REG TEXT 575340 (NS), filed December 24, 2020, amends, on an emergency basis, 20 MS ADC Pt. 2, Ch. 2 (Medical Fee
Schedule) by allowing for a broader range of providers offering telemedicine services and increasing provider reimbursement amounts
due to the pandemic. The amendment is effective December 24, 2020.

Missouri

¢ 2021 MO H.B. 273 (NS) and 2021 MO H.B. 476 (NS), adopted June 22, 2021, adopts the Occupational Therapy Practice Acts. One
of the stated purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational
Therapy services. The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member
state.

* 2021 MO H.B. 432 (NS) and 2021 MO S.B. 53 (NS), adopted July 14, 2021, amends MO ST 197.135 (Forensic examinations, victims
of sexual offense, requirements--waiver of telehealth requirements or this section, when-- reimbursement of costs) providing that
providers are not required to utilize the training offered by the statewide telehealth network, as long as the training utilized is, at a
minimum, equivalent to the training offered by the telehealth network. Provides that an individual hospital is not required to comply with
the provisions of this section unless and until the Department provides the hospital with access to the statewide telehealth network for
the purposes of mentoring and training services without charge to the hospital. The section is effective January 1, 2023.

¢ 2021 MO H.B. 495 (NS), engrossed March 9, 2021, and 2021 MO S.B. 284 (NS), introduced January 6, 2021, would amend MO ST
191.1145 (Definitions-- telehealth services authorized, when) to update the definition for 'telehealth" or 'telemedicine," MO ST 191.1146
(Physician-patient relationship required, how established) and MO ST 334. 108 (Telemedicine or internet prescriptions and treatment,
establishment of physician-patient relationship required) allowing the use of an adaptive question are to be utilized to establish a
physician-patient relationship through telemedicine.

¢ 2021 MO H.B. 916 (NS), engrossed March 9 2021, would amend MO ST 334.037 (Assistant physicians, collaborative practice
arrangements, requirements--rulemaking authority--identification badges required, when-- prescriptive authority) to require the
collaboration between the collaborating physician and the assistant physician to maintain geographic boundaries within the state for
practice and telemedicine, as long as the collaborative practice management includes alternative plans.

¢ 2021 MO H.B. 1110 (NS), introduced February 9, 2021, would adopt MO ST 376.1905 to define 'telemedicine' and to provide that
telemedicine benefits offered by employers are not insurance and must not be treated as insurance or insurance product in Missouri.

¢ 2021 MO H.B. 1179 (NS), amended/substituted March 29, 2021, would adopt a new section to require a hospital to utilize telehealth
services during a forensic examination of a victim of sexual offense when a sexual assault nurse examiner (SANE) or another similarly
trained physician or nurse is not available.

¢ 2021 MO H.B. 1224 (NS), introduced February 22, 2021, would amend MO ST 335.175 (Utilization of telehealth by nurses
established--rulemaking authority) to remove requirement that telehealth services are provided in a rural area of need.

¢ 2021 MO S.B. 193 (NS), introduced January 6, 2021, would amend MO ST 333.175 (Utilization of telehealth by nurses established--
rulemaking authority) removing provision allowing an advanced practice registered nurse (APRN) providing nursing services under

a collaborative practice arrangement under [iO ST 334.104 (Collaborative practice arrangements, form, contents, delegation of
authority--rules, approval, restrictions--disciplinary actions-- notice of collaborative practice or physician assistant agreements to board,
when--certain nurses may provide anesthesia services, when--contract limitations) to provide such services outside the geographic
proximity requirements of MO ST 334.104 if the collaborating physician and APRN utilize telehealth in the care of the patient and if the
services are provided in a rural area of need.

«2021 MO S.B. 330 (NS), amended/substituted April 27, 2021, and 2021 MO H.B. 542 (NS), amended/substituted May 6, 2021, would
adopt the Occupational Therapy Licensure Compact. One of the stated purposes for the Compact would be to facilitate the use of
telehealth technology in order to increase access to Occupational Therapy services.

¢ 2021 MO S.B. 550 (NS), amended/substituted May 5, 2021, would iO ST 197.135 (Forensic examinations, victims of sexual offense,
requirements-waiver of telehealth requirements or this section, when--reimbursement of costs) to clarify that the section does not
require providers to utilize the training offered by the statewide telehealth network, as long as the training utilized is, at a minimum,
equivalent to the training offered by the statewide telehealth network and clarifying that no individual hospital is required to comply with
the provisions of this section unless and until the Department provides such hospital with access to the statewide telehealth network for
the purposes of mentoring and training services without charge to the hospital.

¢ 2021 MO S.B. 624 (NS), introduced March 1, 2021, would adopt MO ST 334.1115 to allow training hours to be documented by the
licensee and verified by the licensee's either in person, through electronic communication, or telehealth practices and MO ST 334.1125
to allow a person who has been engaged in the practice of radiologic imaging or radiation therapy, other than a radiologist assistant,
and who does not hold a current certification and registration by a certification organization recognized by the department to continue

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to practice in the radiologic imaging or radiation therapy modality provided that the person practices only under the supervision of a
licensed practitioner, either in person or virtually through approved telehealth practices.

Montana

¢ 2021 MT H.B. 43 (NS), adopted April 19, 2021, amends IMT ST 2-18-704 (Mandatory provisions), MT ST 20-25-1303 (Duties

of commissioner--group benefits plans and employee premium levels not mandatory subjects for collective bargaining), MT ST
20-25-1403 (Authorization to establish self-insured health plan for students--requirements--exemption), iT ST 33-22-138 (Coverage
for telemedicine services), MT ST 37-11-1014 (Definitions), and MT ST 37-11-105 (Supervision of physical therapist assistant, physical
therapy aide, physical therapy student, or physical therapist assistant student) to update terminology to use 'telehealth' instead of
'telemedicine,' prohibit certain contract provisions that impose site restrictions on telehealth; provide that a previously established
patient-health care provider relationship is not required to receive services by telehealth, and revise the definition of telemedicine. The
bill is effective January 1, 2022.

¢ 2021 MT S.B. 357 (NS), amended/substituted April 14, 2021, would adopt new sections to allow a licensee to provide health care in
the ordinary course of business or practice of a profession may provider services by means of telehealth when the use of telehealth is
appropriate for the service being provide, meets the standard of care for delivery of services, and complies with any administrative rules
for telehealth adopted by the Board. Amend MT ST 37-7-101 (Definitions) and MT ST 37-7-201 (Organization -- powers and duties) to
update terminology to use 'pharmacy by means of telehealth" instead of 'telepharmacy."Amend MT ST 37-11-101 (Definitions), MT ST
37-11-105 (Supervision of physical therapist assistant, physical therapy aide, physical therapy student, or physical therapist assistant
student), MT ST 37-15-102 (Definitions), and MMT ST 37-15-202 (Powers and duties of board and department) to update terminology to
use 'telehealth" instead of 'telemedicine' and update the definition for 'telehealth." Amend MT ST 37-15-3714 (Telehealth -- audiology
aides and assistants) to update terminology to use 'telehealth" instead of 'telepractice" and clarify that an audiology aide or assistant
or a speech-language pathology aide or assistant may not engage in telehealth but may serve as a facilitator for telehealth services.
Amend MT ST 37-15-315 (Scope of telehealth -- requirements) to update terminology to use 'telehealth" instead of 'telepractice."
Amend MT ST 53-6-113 (Department to adopt rules) to allow the Department to consider delivery services by means of telehealth
when establishing rates for reimbursement of services. Amend MT ST 53-6-155 (Definitions) to define 'originating site provider' and
'telehealth."

¢ 2021 MT S.B. 380 (NS), introduced March 16, 2021, would adopt a new section (Certified family health facilitator -- requirements --
rulemaking) to require the Department to provide for certification of individuals to serve as family health facilitators to support behavioral
health services for a child and the child's family when the child resides in a county with a per capita population of fewer than 6 people
for each square mile and is receiving behavioral health services and supports by means of telehealth or teleconference from a mental
health professional as defined in MT ST 37-38-102 who is located in the another community.

¢ 2021 MT REG TEXT 585680 (NS), certified September 14, 2021, amends IMT ADC 37.97.906 (Therapeutic Group Homes (TGH):
Therapeutic Service Requirements) allowing the mental health professional to provide therapy electronically via video conferencing or
telehealth if the youth is on a home visit or the family is unable to participate in therapy on-site. The regulation is effective October 1,
2021.

Nebraska

¢ 2021 NE L.B. 14 (NS), adopted March 31, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact will come into effect on the date on which the Compact statute is enacted into law in
the 10th member state.

¢ 2021 NE L.B. 139 (NS), adopted May 25, 2021, establishes the COVID-19 Liability Protection Act to provide immunity for health care
facility and health care providers in response to COVID-19, except for gross negligence or willful misconduct and includes persons
engaged in telemedicine or telehealth in the definition of health care provider. The bill is effective May 25, 2021.

¢ 2021 NE L.B. 314 (NS), introduced January 13, 2021, would amend NE ST ? 44-312 (Telehealth and telemonitoring services covered
under policy, certificate, contract, or plan; insurer; duties) providing that the reimbursement rate for a telehealth consultation must, at a
minimum, be the same as for a comparable in-person consultation.

¢ 2021 NE L.B. 400 (NS), adopted April 21, 2021, amends NE ST ? 44-312 (Telehealth and telemonitoring services covered under
policy, certificate, contract, or plan; insurer; duties) and NE ST ? 71-8503 (Terms, defined) to provide that telehealth includes audio-
only services for the delivery of behavioral health services. The bill also amends NE ST ? 44-7, 107 (Telehealth; asynchronous review
by dermatologist; coverage) to prohibit an insurer from excluding a service from coverage solely because the service is delivered
through telehealth, including services originating from any location where the patient is located, and is not provided through in-person
consultation or contract between a licensed health care provider and a patient. The bill also amends NE ST ? 71-8505 (Written
statement; requirements) to require the patient to sign a statement prior to or during an initial telenealth consolation, or give verbal
consent during the telehealth consultation, indicating that the patient understands the written information provided and this information
has been discussed with the health care practitioner or the practitioner's designee and providing that if the patient gives verbal consent
during the initial telehealth consultation, the signed statement must be collected within 10 days after such telehealth consultation. The
bill is effective September 10, 2021.

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¢ 2021 NE L.B. 474 (NS), introduced January 15, 2021, would adopt new sections for the sale of medical cannabis products including
requiring a pharmacist to be available during business hours to advise and educate patients by telemedicine.

¢ 2021 NE L.B. 487 (NS), adopted April 21, 2021, amends NE ST ? 44-793 (Mental health conditions; coverage; requirements) to
prohibit a health insurance plan, that provides coverage for treatment of mental health conditions other than alcohol or substance
abuse, from establishing any rate, term, or condition that places a greater financial burden on an insured for accessing treatment for a
mental health condition using telehealth or telemonitoring and to require a health insurance plan, that provides coverage for treatment
of mental health conditions other than alcohol or substance abuse, toprovide, at a minimum, a reimbursement rate for accessing
treatment for a mental health condition using telehealth or telemonitoring services that is the same as the rate for a comparable
treatment provided or supervised in person. The bill also requires a plan that provides coverage for serious mental illness to cover
treatment of serious mental illness using telehealth or telemonitoring services. The bill is effective August 27, 2021.

¢ 2021 NE L.B. 554 (NS), introduced January 19, 2021, would adopt the Licensed Professional Counselor Interstate Compact. One of
the stated purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Professional
Counseling services.

Nevada

¢ 2021 NV S.B. 5 (NS), adopted June 4, 2021, requires the Department of Health and Human Services to establish an electronic tool to
analyze certain data concerning access to telehealth, require certain entities to review access to services provided through telehealth
and evaluate policies to make such access more equitable, and revising provisions governing services provided through telehealth and
insurance coverage of such services. The bill is effective October 1, 2021.

¢ 2021 NV S.B. 56 (NS), engrossed April 19, 2021, would amend NV ST 689A.0463 (Coverage for services provided through telehealth;
prohibited actions by insurer; exclusions), N\V ST 6898.0369 (Required provision concerning coverage for services provided through
telehealth), NV ST 689C.195 (Coverage for services provided through telehealth), NV ST 695A.265 (Coverage for services provided
through telehealth), N\V ST 695B.1904 (Required provision concerning coverage for services provided through telehealth), NV ST
422.2721 (State Plan for Medicaid: Payment for services provided through telehealth), and adopt new sections to require coverage and
reimbursement for behavioral health services provided through telehealth or by standard telephone to be at the same extent and in the
same amount as though provided in person or by other means.

¢ 2021 NV S.B. 105 (NS), introduced February 9, 2021, would authorize a patient, under certain circumstances, to self-administer
a controlled substance that is designed to end the life of the patient but prohibits the interaction between a patient and an attending
physician, consulting physician, psychiatrist, or psychologist from using telehealth.

* 2021 NV S.B. 229 (NS), adopted June 2, 2021, amends NV ST ? 639.2623 (Authority; requirements to enter into collaborative
practice agreement; duties of pharmacist; patient consent required; conditions and limitations) prohibiting a practitioner from entering
a collaborative practice agreement that includes diagnosis or initiating treatment unless the practitioner actively practices his or her
profession in this State or provider those services using telehealth. The bill is effective October 1, 2021.

¢ 2021 NV S.B. 266 (NS), introduced March 17, 2021, would amend NV ST 616C.040 (Claim for compensation: Duty of treating
physician or chiropractor to file or delegate duty to medical facility; electronic filing; form and contents; maintenance of forms; penalty)
to authorize the examination and treatment of an injured employee in person or through telehealth, authorize a claim to be filed by mail
or electronic transmission, and authorize an injured employee, an employer's insurer or the third-party administrator of a self-insured
employer to request that a medical examination of the injured employee be performed in person by a physician or chiropractor if the
initial examination or treatment of the injured employee was performed through telehealth.

¢ 2021 NV S.B. 326 (NS), introduced March 22, 2021, would adopt new sections to authorize a provider of health care who is licensed
or certified in another state to register to use telehealth to provide services to patients located in Nevada. Define 'originating site' and
'telehealth.'

¢ 2021 NV S.B. 391 (NS), enrolled May 27, 2021, would require hospitals and issuers of Medicaid managed care plans to take certain
measures to ensure access by recipients of Medicaid to teledentistry. Require a public or private school or child care facility to accept
a dental examination, screening or assessment provided through teledentistry for certain purposes. Require certain providers of

dental care to receive training concerning teledentistry. Prescribe certain requirements relating to the electronic storage of records.
Define terms related to teledentistry. Require a dentist, dental hygienist or dental therapist providing services through teledentistry to
adhere to the applicable laws, regulations and standards of care to the same extent as when providing services in person. Require

a dentist, dental hygienist or dental therapist who provides services through teledentistry to be insured against liabilities arising from
services provided through teledentistry. Authorize the use of teledentistry for certain purposes relating to the provision of a diagnosis or
treatment. Require a dentist, dental hygienist or dental therapist to establish a bona fide practitioner-patient relationship, confirm certain
facts about a patient and obtain informed consent before providing services through teledentistry. Require a dentist, dental hygienist

or dental therapist to: (1) use communications technology that complies with certain federal requirements concerning the privacy of
information relating to patients when providing services through teledentistry; and (2) create a complete record of each encounter

with a patient through teledentistry. Impose certain requirements to ensure that adequate, in-person care is available to a patient who
receives services through teledentistry if needed. Require the Board of Dental Examiners of Nevada to adopt regulations governing
teledentistry. Require an applicant for a license to practice dentistry or dental therapy or a special endorsement to practice public

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health dental hygiene or the holder of such a license or endorsement to complete certain training concerning teledentistry. Require the
Board to adopt regulations prescribing specific criteria for the accreditation of a course in teledentistry. Prescribe certain requirements
concerning the secure electronic storage of information concerning patients. Require hospitals and issuers of Medicaid managed care
plans to take certain measures to improve the access of recipients of Medicaid to teledentistry. Require a public school, private school
or child care facility that requires a dental examination, screening or assessment of a child as a condition of admission to accept a
dental examination, screening or assessment provided through teledentistry that meets certain criteria for that purpose.

¢ 2021 NV REG TEXT 575511 (NS), adopted December 1, 2021, adopts R001-21 s 3 establishing the requirements for a licensee to
provide occupation therapy services by telehealth.

New Hampshire

* 2021 NH S.B. 133 (NS), amended/substituted June 3, 2021, would adopt NH ST ? 329-B:16 (Electronic Practice of Psychology,
Telehealth, Telemedicine) to provide that telepsychology, telehealth, and telemedicine services, as provided by psychologists, include
those psychology services that utilize electronic means to engage in visual or virtual presence in contemporaneous time. Require a
New Hampshire tele-pass license for provision of such care to people in New Hampshire.

¢ 2021 NH S.B. 155 (NS), adopted July 9, 2021, adopts NH ST ? 318:37-a (Out-of-state Pharmacies as Temporary Limited Licensed) to
allow out-of-state pharmacies to ship investigational drugs to clinical trial participants who reside in New Hampshire and who are unable
to retrieve the investigational drugs from the out-of-state pharmacy due to the coronavirus. The bill is effective July 9, 2021.

New Jersey

* 2020 NJ A.B. 5237 (NS), introduced January 11, 2021, would extend the period for the expanded use of telemedicine and telehealth
services for the duration of the declared COVID-19 public health emergency.

* 2020 NJ A.B. 5255 (NS), introduced January 12, 2021, and 2020 NJ S.B. 2559 (NS), amended/substituted January 14, 2021,

would amend NJ ST 26:2S-29 (Telemedicine and telehealth; coverage and payment for services), NJ ST 30:4D-6k (Telemedicine

and telehealth; coverage and payment for services), NJ ST 45:1-62 (Use of telemedicine and telehealth by health care providers;
requirements), NJ ST 52:14-17.29w (Telemedicine and telehealth; coverage and payment for services), and NJ ST 52:14-17.46.6h
(Telemedicine and telehealth; coverage and payment for services) to require health benefits plans, Medicaid and NJ FamilyCare, and
the State Health Benefits Program (SHBP) and School Employees' Health Benefits Program (SEHBP) to provide expanded coverage
for services provided using telemedicine and telehealth. The bill would also require that reimbursement for telemedicine and telehealth
services be equal to the reimbursement rate for the same services when they are provided in person. The bill would also prohibit health
benefits plans, Medicaid and NJ FamilyCare, and the SHBP and SEHBP from imposing 'place of service' requirements on services
provided using telemedicine and telehealth, and expressly allows health care providers to provide services using telemedicine and
telehealth regardless of whether the provider is located in New Jersey when providing services, provided that the provider is otherwise
licensed to practice health care in New Jersey. The bill would also prohibit health benefits plans, Medicaid and NJ FamilyCare, and the
SHBP and SEHBP from placing restrictions on the electronic or technological platform used to provide telemedicine and telehealth,

if the services provided when using that platform would meet the in-person standard of care for that service, and if the platform is
otherwise compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164. The bill would also
require telemedicine and telehealth systems to include accessible communication features to facilitate the use of telemedicine and
telehealth by individuals with a disability and individuals with a sensory impairment, including, but not limited to, individuals who are
deaf, hard of hearing, visually impaired, blind, or deaf-blind.

¢ 2020 NJ A.B. 5362 (NS), introduced February 23, 2021, would amend NJ ST 45:1-62 (Use of telemedicine and telehealth by health
care providers; requirements) to allow health care professionals located outside New Jersey to provide services using telemedicine and
telehealth to patients in New Jersey.

¢ 2020 NJ A.B. 5451 (NS), introduced March 15, 2021, would amend NJ ST 45:1-62 (Use of telemedicine and telehealth by health care
providers; requirements) to provide that an emergency care plan is to pertain to areas where patients are located during a telemedicine
or telehealth visit. The bill would require professional licensing boards to include in their rules and regulations implementing the
telemedicine and telehealth law requirements for emergency care plans that include standards and protocols for activating and
coordinating with emergency care service providers serving the area in which the patient is located at the time of the telemedicine or
telehealth encounter.

¢ 2020 NJ A.B. 5466 (NS), introduced March 15, 2021, would a new section concerning network adequacy and clarify that the network
access plan must not include services provided by telemedicine.

* 2020 NJ A.B. 5988 (NS), amended/substituted December 6, 2021, would amend NJ ST 45:1-7.5 (Out-of-state holders of valid
professional or occupational license or certificate; application requirements; 'good standing", 'state', and 'substantially equivalent"
defined; board or committee discretion to grant license, certificate of registration, or certification) to establish the reciprocity
requirements for a person who resides in another jurisdiction of the United States or in another country and has provided services as
a mental health professional for at least 10 years and will provide services in the same mental health profession in this State using
telehealth and telemedicine. Require these individuals to provide a minimum of 40 hours of therapy services on a volunteer basis to
individuals in this State using telehealth or telemedicine during each biennial renewal period.

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¢ 2020 NJ S.B. 619 (NS), adopted June 24, 2021, amends NJ ST 24:6I-5.1 (Authorizing patients for the medical use of cannabis;
registry) allowing a health care practitioner to authorize medical use of cannabis via telemedicine or telehealth. The bill is effective June
24, 2021.

¢ 2020 NJ S.B. 2506 (NS), amended/substituted January 14, 2021, would establish the Psychology Interjurisdictional Compact to
regulate the day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological
practice.

¢ 2020 NJ S.B. 2559 (NS), amended/substituted December 2, 2021, would amend NJ ST 26:2S-29 (Telemedicine and telehealth;
coverage and payment for services), NJ ST 30:4D-6k (Telemedicine and telehealth; coverage and payment for services), NJ ST
45:1-61 (Definitions), NJ ST 45:1-62 (Use of telemedicine and telehealth by health care providers; requirements), and NJ ST
52:14-17.46.6h (Telemedicine and telehealth; coverage and payment for services) updating the requirements for health insurance
providers and Medicaid to cover services provided using telemedicine and telehealth. The bill would adopt new sections to require
insurers to cover, without cost-sharing, COVID-19 testing, including telemedicine and telehealth encounters.

¢ 2020 NJ S.B. 3372 (NS), introduced January 21, 2021, would amend NJ ST 26:2S-29 (Telemedicine and telehealth; coverage and
payment for services), NJ ST 30:4D-6K (Telemedicine and telehealth; coverage and payment for services), NJ ST 45:1-62 (Use of
telemedicine and telehealth by health care providers; requirements), NJ ST 52:14-17.29w (Telemedicine and telehealth; coverage
and payment for services), NJ ST 52:14-17.46.6h (Telemedicine and telehealth; coverage and payment for services) to require health
benefits plans, Medicaid and NJ FamilyCare, and the State Health Benefits Program (SHBP) and School Employees' Health Benefits
Program (SEHBP), to provide expanded coverage for services provided using telemedicine and telehealth. The bill would require
that reimbursement for telemedicine and telehealth services be equal to the reimbursement rate for the same services when they are
provided in person. The bill would also prohibit health benefits plans, Medicaid and NJ FamilyCare, and the SHBP and SEHBP from
imposing 'place of service' requirements on services provided using telemedicine and telehealth, and expressly allows health care
providers to provide services using telemedicine and telehealth regardless of whether the provider is located in New Jersey when
providing services, provided that the provider is otherwise licensed to practice health care in New Jersey. The bill would prohibit health
benefits plans, Medicaid and NJ FamilyCare, and the SHBP and SEHBP from placing restrictions on the electronic or technological
platform used to provide telemedicine and telehealth, if the services provided when using that platform would meet the in-person
standard of care for that service, and if the platform is otherwise compliant with the requirements of the federal health privacy rule set
forth at 45 CFR Parts 160 and 164. The bill would require telemedicine and telehealth systems to include accessible communication
features to facilitate the use of telemedicine and telehealth by individuals with a disability and individuals with a sensory impairment,
including, but not limited to, individuals who are deaf, hard of hearing, visually impaired, blind, or deaf-blind.

¢ 2020 NJ S.B. 3518 (NS), introduced March 9, 2021, would adopt an Act concerning network adequacy and prohibit a network access
plan from including services provided by telemedicine.

¢ 2020 NJ S.B. 3610 (NS), introduced April 19, 2021, would amend NJ ST 45:1-62 (Use of telemedicine and telehealth by health care
providers; requirements) to provide that an emergency care plan is to pertain to areas where patients are located during a telemedicine
or telehealth visit. The bill would require professional licensing boards to include in their rules and regulations implementing the
telemedicine and telehealth law requirements for emergency care plans that include standards and protocols for activating and
coordinating with emergency care service providers serving the area in which the patient is located at the time of the telemedicine or
telehealth encounter.

* 2020 NJ S.B. 4032 (NS), introduced November 8, 2021, would adopt new section to authorize licensed adult day health services
facilities to provide adult day health services on a remote basis, including daily wellness checks conducted using telemedicine or
telehealth and define 'telehealth."

* 2021 NJ A.B. 4205 (NS), adopted September 24, 2021, established the Psychological Interjurisdictional Compact to regulate the day
to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The
Compact comes into effect on the date on which the Compact is enacted into law in the 7th Compact State.

New Mexico
¢ 2021 NM H.B. 147 (NS), amended/substituted February 11, 2021, would amend NM ST ? 61-7A-3 (Definitions) to define 'telehealth."

* 2021 NM H.B. 210 (NS), amended/substituted February 22, 2021, would adopt the Audiology and Speech-Language Pathology
Interstate Compact and establish the requirements to practice audiology or speech-language pathology in any member state via
telehealth under a privilege to practice as provided in the Compact.

¢ 2021 NM S.B. 200 (NS), adopted April 5, 2021, would amend NM ST ? 61-5A-3 (Definitions) to update the definition for 'teledentistry."
The bill is effective June 18, 2021.

¢ 2021 NM S.B. 279 (NS), adopted April 5, 2021, amends NM ST ? 61-6-11.1 (Telemedicine license) to clarify that the Board must
issue a licensed physician a telemedicine license to allow the practice of medicine across state lines to an applicant who holds a full
and unrestricted license to practice medicine in another state or territory of the United States and amends NM ST ? 61-6-19 (Fees) to
increase the application and renewal fee for a telemedicine license not to exceed $900. The bill is effective June 18, 2021.

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¢ 2021 NM S.B. 363 (NS), introduced February 10, 2021, would amend NM ST ? 26-2B-3 (Definitions) to remove the definition for
'telemedicine."

¢ 2021 NM REG TEXT 578945 (NS), published August 10, 2021, amends NM ADC 8.310.2 (General Benefit Description) to update
terminology to use 'telehealth" instead of 'telemedicine" and update the coverage requirements for telehealth services. The regulation is
effective August 10, 2021.

¢ 2021 NM REG TEXT 583146 (NS), published August 10, 2021, amends NM ADC 7.27.11 (Supplemental Licensing Provisions) to
allow community emergency medical services and mobile integrated health programs to facilitate telemedicine clinician contract. The
regulation is effective August 10, 2021.

¢ 2021 NM TEXT 578947 (NS), published May 25, 2021, amends NM ADC 16.5.1.7 (Definitions) updating the definition for
'teledentistry." The regulation is effective May 30, 2021.

New York

¢ 2021 NY A.B. 645 (NS) and 2021 NY S.B. 2998 (NS), amended/substituted March 10, 2021, would amend NY PUB HEALTH ?
2999-cc (Definitions) to update the definition of 'telehealth provider' to make certified peer recovery advocate telehealth services and
credentialed family peer advocates eligible for reimbursement.

¢ 2021 NY A.B. 660 (NS), introduced January 6, 2021, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of services)
provides that health care services delivered by means of telehealth must be entitled to reimbursement on the same basis and to the
same extent as if the services were provided in person.

¢ 2021 NY A.B. 669 (NS), amended/substituted March 18, 2021, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of
services) to provide that health care services delivered by means of telehealth must be entitled to reimbursement on the same basis
and to the same extent as if the services were provided in person.

¢ 2021 NY A.B. 2245 (NS), introduced January 14, 2021, 2021 NY S.B. 2210 (NS), introduced January 20, 2020, would establish
the Orthodontic Tele-dentistry Consumer Protection Act to place additional requirements on licensed dental procedures entities and
licensed dentists who perform cosmetic dental procedures including the posting of specific notices.

¢ 2021 NY A.B. 2674 (NS), introduced January 19, 2021, would amend NY INS ? 3217-h (Telehealth delivery of services), NY INS ?
4306-g (Telehealth delivery of services), and NY PUB HEALTH ? 4406-g (Telehealth delivery of services) to require an insurer to
reimburse primary care services delivered via telehealth, where both the insured and the provider are located in a clinical setting, on
the same basis and at the same rate as would apply to such services if the services had been delivered in person and to provide the
definition for 'clinical setting."

¢ 2021 NY A.B. 4195 (NS), introduced February 1, 2021, would establish and authorize telepharmacy in New York, define terms, create
telepharmacy satellite consultation sites and telepharmacy in hospitals, authorize the filling of prescriptions at remote sites connected to
central pharmacies via computer link, videolink, and audiolink, and make exceptions.

¢ 2021 NY A.B. 4839 (NS), introduced February 8, 2021, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of services),
NY INS ? 3217-h (Telehealth delivery of services), and NY INS ? 4306-g (Telehealth delivery of services) would require services
provided by telehealth reimbursed at the same rate as an in-office visit.

¢ 2021 NY A.B. 5281 (NS), introduced February 12, 2021, would adopt NY PUB HEALTH ? 2805-II (Sexual assault forensic
examination telemedicine pilot program) to establish the sexual assault forensic examination telemedicine pilot program to provide
expert, comprehensive, compassionate care to patients and training to support providers in health care facilities that do not have a
designated sexual assault forensic examination program.

¢ 2021 NY A.B. 6256 (NS), introduced March 11, 2021 and 2021 NY S.B. 5505 (NS), introduced March 9, 2021, would amend NY PUB
HEALTH ? 2999-dd (Telehealth delivery of services) updates the provisions regarding the delivery of health services via telehealth
including requiring coverage and setting reimbursement rates under certain health care plans.

* 2021 NY A.B. 6579 (NS), introduced March 19, 2021, would adopt NY PUB HEALTH ? 2559-c (Early intervention rate adequacy
review) to require the early intervention rate adequacy review to consider appropriate payment methodologies and rates for in-
person and telehealth early intervention evaluations and services to address barriers in timely service provision as well as racial and
socioeconomic disparities in access, with consideration of factors including, but not limited to, payment for bilingual services, travel
time, geographic variability, access to and cost of technology, cost of living, and other barriers to timely service provision.

¢ 2021 NY A.B. 6644 (NS), introduced March 23, 2021, would amend NY INS ? 3217-h (Telehealth delivery of services), NY INS ?
4306-g (Telehealth delivery of services), and NY PUB HEALTH ? 2805-u (Credentialing and privileging of health care practitioners
providing telemedicine services) requiring insurers to provide telehealth services without first requiring patients to make contact in-
person before providing such telehealth services. Require plans to include reimbursement for health care providers for any diagnosis,
consultation or treatment of a patient, client enrollee or subscriber delivered through telehealth services in the same manner and to the
same extent as the health care service plan would be responsible for reimbursement for the same service through in-person diagnosis,
consultation or treatment. Require telemedicine services providers to obtain and document a patient or client's consent before initiating
telemedicine services, provided, however, such consent does not need to be provided in-person.

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¢ 2021 NY A.B. 6741 (NS), amended/substituted August 25, 2021, would amend NY INS ? 3217-h (Telehealth delivery of services),
NY INS ? 3216 (Individual accident and health insurance policy provisions), NY INS ? 3221 (Group or blanket accident and health
insurance policies; standard provisions), NY INS ? 4303 (Benefits), NY INS ? 4306-g (Telehealth delivery of services), and NY PUB
HEALTH ? 2999-cc (Definitions) requiring insurance policies cover services provided through telemedicine, including requirement that
insurer provide coverage for contraceptive care, and update the definition for 'store and forward technology."

¢ 2021 NY A.B. 7149 (NS), introduced April 23, 202, to require the Commissioner to conduct a study to analyze the adequacy of health
networks and the delivery of gerontological services and senior health care in New York and require the study to consider the utilization
of telehealth and telemedicine in senior populations and any impediments thereto.

¢ 2021 NY S.B. 2300 (NS), introduced January 20, 2021, would adopt NY PUB HEALTH ? 2999-jj (Definitions) to define 'distant site,"
'emergency medicine triage provider," 'originating site," and 'emergency medicine triage."

¢ 2021 NY S.B. 2507 (NS), adopted April 19, 2021, amends NY PUB HEALTH ? 2999-cc (Definitions) to update the definition for
'distant site' and 'originating site.' The bill is effective April 19, 2021.

¢ 2021 NY S.B. 2898 (NS), introduced January 26, 2021, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of services)
to provide that health care services delivered by means of telehealth must be entitled to reimbursement on the same basis and to the
same extent as if the services were provided in person.

¢ 2021 NY S.B. 2998 (NS), amended/substituted March 10, 2021, would amend NY PUB HEALTH ? 2999-cc (Definitions) to update the
definition of 'telehealth provider."

¢ 2021 NY S.B. 2990 (NS), amended/substituted March 9, 2021, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of
services) to require telehealth services, including any additional provider categories and originating sites, to be reimbursed at the

same rate as an in-office visit. Amend NY INS ? 3217-h (Telehealth delivery of services) and NY INS ? 4306-g (Telehealth delivery of
services) to require insurers to reimburse for a services that is otherwise covered under a policy that provides comprehensive coverage
for hospital, medical, or surgical care and is delivered via telehealth on the same basis and at the same rate as the insurer would apply
to those services if the services had been delivered in person.

* 2021 NY S.B. 6846 (NS), introduced May 19, 2021, would amend NY PUB HEALTH ? 2999-cc (Definitions) to update the definition for
'telehealth provider."

¢ 2021 NY S.B. 6954 (NS), introduced May 20, 2021, would amend NY MENT HYG ? 7.41 (Geriatric service demonstration program)
to allow grants to be awarded to program which offer homebound or socially isolated geriatric patients with the use of two-way real-time
interactive audio and video equipment access to provide and support mental health services at a distance.

¢ 2021 NY REG TEXT 559715 (NS), filed August 18, 2021, amends 18 NY ADC 505.14 (Personal care services) and 18 NY ADC
505.28 (Consumer directed personal assistance program) allowing assessments to be performed via telehealth modalities. The
regulation is effective November 11, 2021.

* 2020 NY REG TEXT 564989 (NS), filed December 14, 2020, amends 14 NY ADC 635-10.5 (Reimbursement of HCBS waiver
services) requiring providers to continue to work in partnership with OPWDD to make more available non-center-based and telehealth
modalities in an effort to increase community involvement of waiver enrollees and to protect the delivery of services during future
emergencies. The rule was adopted via emergency and is effective December 14, 2020.

* 2021 NY REG TEXT 564989 (NS), filed February 10, 2021, continues previous emergency rule amending 14 NY ADC 635-10.5
(Reimbursement of HCBS waiver services) to require providers to continue to work in partnership with OPWDD to make more available
non-center-based and telehealth modalities in an effort to increase community involvement of waiver enrollees and to protect the
delivery of services during future emergencies. The regulation was continued via emergency and is effective February 10, 2021.

¢ 2021 NY REG TEXT 564989 (NS), filed March 3, 2021, amends NY ADC 635-10.5 (Reimbursement of HCBS waiver services)
requiring providers to continue to work in partnership with OPWDD to make more available non-center-based and telehealth modalities
in an effort to increase community involvement of waiver enrollees and to protect the delivery of services during future emergencies.
The regulation adopts a previous emergency rule as final without changes and is effective March 24, 2021.

¢ 2021 NY REG TEXT 575554 (NS), filed January 7, 2021, amends 11 NY ADC 52.16 Prohibited provisions and coverages) prohibiting
policies from imposing and insured's from being required to pay, copayments, coinsurance, or annual deductibles for visits to diagnose
COVID-19 through telehealth. The rulemaking was adopted via emergency and is effective January 7, 2021.

¢ 2021 NY REG TEXT 575555 (NS), filed January 12, 2021, amends 12 NY ADC 325-1.8 (Emergency medical aid and telemedicine)
updating the section title from 'Emergency medical aid' and adding a requirement to allow the use of telemedicine in certain
circumstances for social distancing purposes due to the outbreak of COVID-19, or irrespective of purely social distancing
considerations, in the clinical judgment of the authorized provider, the potential risk of COVID-19 infection to an individual patient
outweighs any real or perceived incremental benefit derived from an in-person versus remote or virtual appointment. Amends 12

NY ADC 329-1.3 (Medical fee schedule; incorporation by reference), 12 NY ADC 329-4.2 (Acupuncture and physical therapy and
occupational therapy fee schedule; incorporation by reference), 12 NY ADC 333.2 (Behavioral Health fee schedule; incorporation by
reference), and 12 N'Y ADC 348.2 (Chiropractic fee schedule; incorporation by reference) to allow authorized providers to use modifier

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95 and indicating 11 as the place of service when treatment is rendered by telemedicine. The rulemaking was adopted via emergency
and is effective January 18, 2021.

¢ 2021 NY REG TEXT 579635 (NS), filed March 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) prohibiting
the imposition of copayments, coinsurance, or annual deductibles for in-network laboratory tests to diagnose the novel coronavirus
('COVID-19") and visits to diagnose COVID-19 at the following locations, including through telehealth: an in-network provider's office,
an in-network urgent care center, any other in-network outpatient provider setting able to diagnose COVID-19, or an emergency
department of a hospital. The regulation was adopted by emergency and is effective March 5, 2021.

¢ 2021 NY REG TEXT 579636 (NS), filed March 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) prohibiting
the imposition of copayments, coinsurance, or annual deductibles for in-network laboratory tests to diagnose the novel coronavirus
('COVID-19') and visits to diagnose COVID-19 at the following locations, including through telehealth: an in-network provider's office,
an in-network urgent care center, any other in-network outpatient provider setting able to diagnose COVID-19, or an emergency
department of a hospital. The regulation was adopted by emergency and is effective March 5, 2021.

¢ 2021 NY REG TEXT 575553 (NS), filed January 7, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) waiving
cost-sharing for in-network telehealth services and defining 'telehealth." The rulemaking was adopted via emergency and is effective
January 7, 2021.

¢ 2020 NY REG TEXT 581129 (NS), filed May 11, 2020, amends 14 NY ADC 635-10.5 (Reimbursement of HCBS waiver services)
requiring providers to continue to work in partnership with OPWDD to make more available non-center-based and telehealth modalities
in an effort to increase community involvement of waiver enrollees and to protect the delivery of services during future emergencies.
The rule was adopted via emergency and is effective May 11, 2020.

¢ 2021 NY REG TEXT 581129 (NS), filed June 16, 2021, amends 14 NY ADC 635-10.5 (Reimbursement of HCBS waiver services)
requiring providers, as a condition of billing for services, to continue to work in partnership with OPWDD to make more available non-
center-based and telehealth modalities in an effort to increase community involvement of waiver enrollees and to protect the delivery of
services during future emergencies. The regulation is effective July 7, 2021.

* 2021 NY REG TEXT 581809 (NS), filed April 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) which

adds that during the state of emergency related to the novel coronavirus (COVID-19), a policy or contract that provides coverage for
hospital, surgical, or medical care must not impose, and an insured must not be required to pay, copayments, coinsurance, or annual
deductibles for an in-network service delivered via telehealth when the service would have been covered under the policy if it had been
delivered in person. Requires insurers to provide written notification to its in-network providers that they must not collect any deductible,
copayment, or coinsurance. Defines 'telehealth.' The rulemaking continues a previous emergency rule and is effective April 5, 2021 and
expires May 4, 2021.

* 2021 NY REG TEXT 581810 (NS), filed April 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) which
prohibits hospital, surgical, or medical expense insurers from imposing, and provides that an insured must not be required to pay,
copayments, coinsurance, or annual deductibles for the following services when covered under the policy or contract: 1) in-network
laboratory tests to diagnose the novel coronavirus (COVID-19) and 2) visits to diagnose the novel coronavirus (COVID-19) at listed
locations, including through telehealth. The rulemaking continues a previous emergency rule and is effective April 5, 2021 and expires
May 4, 2021.

¢ 2021 NY REG TEXT 582283 (NS), filed April 13, 2021, amends 12 NY ADC 325-1.8 (Emergency medical aid and telemedicine) by
allowing for telemedicine during situations requiring emergency medical aid due to the COVID-19 public health emergency. Notes
requirements for telemedicine providers in emergency situations. Amends 12 NY ADC 329-1.3 (Medical fee schedule; incorporation by
reference), 12 NY ADC 329-4.2 (Acupuncture and physical therapy and occupational therapy fee schedule; incorporation by reference),
12 NY ADC 333.2 (Behavioral Health fee schedule; incorporation by reference), and 12 NY ADC 348.2 (Chiropractic fee schedule;
incorporation by reference) adding medical codes for providers to use when practicing telemedicine. This rulemaking continues the
previous emergency rulemaking (2021 NY REG TEXT 575555 (NS)) without any changes. The rulemaking is effective April 13, 2021
and expires July 11, 2021.

¢ 2021 NY REG TEXT 584264 (NS), filed May 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) waiving cost-
sharing for in-network telehealth services and defining 'telehealth." The rulemaking was adopted via emergency and is effective May 5,
2021.

¢ 2021 NY REG TEXT 584265 (NS), filed May 5, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) prohibiting
policies from imposing and insured's from being required to pay, copayments, coinsurance, or annual deductibles for visits to diagnose
COVID-19 through telehealth. The rulemaking was adopted via emergency and is effective May 5, 2021.

¢ 2021 NY REG TEXT 586230 (NS), filed June 4, 2021, amends 11 NY ADC 52.17 (Rules relating to content of forms for individual
insurance) and 11 NY ADC 52.18 (Rules relating of forms for group insurance) clarifying that an audio-only visit falls within the meaning
of telehealth and allowing an insurer to engage in reasonable fraud, waste, and abuse detection efforts, including efforts to prevent
payments for services that do not warrant a separate billable encounter. The regulation was adopted via emergency and is effective
June 4, 2021.

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¢ 2021 NY REG TEXT 586231 (NS), filed June 4, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) to waive cost-
sharing for in-network visits and laboratory tests necessary to diagnose the novel coronavirus (COVID-19), including through telehealth.
The regulation was adopted via emergency and is effective June 4, 2021.

¢ 2021 NY REG TEXT 588003 (NS), filed June 25, 2021, adopts 18 NY ADC 538.1 (Authorized providers) providing that for purposes
of medical assistance reimbursement during the federally declared public health emergency related to the COVID-19 pandemic, all
Medicaid providers authorized to provide in-person services are authorized to provide such services via telehealth, as long as such
telehealth services are appropriate to meet a patient's health care needs and are within a provider's scope of practice. Adopts 18 NY
ADC 538.2 (Acceptable telehealth modalities) providing that in addition to the telehealth modalities set forth in NY PUB HEALTH ?
2999-cc (Definitions), reimbursement shall be made for telehealth services provided by use of telephone and other audio-only
technologies. The rulemaking was made via emergency and is effective July 6, 2021.

* 2021 NY REG TEXT 588640 (NS), filed July 6, 2021, amends 11 NY ADC 52.17 (Rules relating to content of forms for individual
insurance) by adding new section (d) titled 'telehealth' and provides that telehealth has the meaning in NY INS ? 3217-h and NY INS ?
4306-g and includes audio-only visits. Amends11 NY ADC 52.18 (Rules relating to content of forms for group insurance)by adding new
section (h) titled 'telehealth' and provides that telehealth has the meaning in NY INS ? 3217-h and NY INS ? 4306-g and includes audio-
only visits. The rulemaking was made via emergency and is effective July 6, 2021.

¢ 2021 NY REG TEXT 588641 (NS), filed July 6, 2021, adopts 11 NY ADC 52.16(p) (Prohibited provisions and coverages) (aka
Regulation 62) which prohibits hospital, surgical, or medical expense insurers from imposing, and provides that an insured must

not be required to pay, copayments, coinsurance, or annual deductibles for the following services when covered under the policy or
contract: 1) in-network laboratory tests to diagnose the novel coronavirus (COVID-19) and 2) visits to diagnose the novel coronavirus
(COVID-19) at listed locations, including through telehealth. Requires insurers to provide written notification to providers to not collect
any deductible, copayment, or coinsurance. The rulemaking was made via emergency and is effective July 6, 2021.

¢ 2021 NY REG TEXT 589248 (NS), filed July 13, 2021, amends 12 NY ADC 325-1.8 (Emergency medical aid and telemedicine)

by adding subsection (b) allowing for telemedicine during situations requiring emergency medical aid due to the COVID-19 public

health emergency. Notes requirements for telemedicine providers in emergency situations. Amends 12 NY ADC 329-1.3 (Medical

fee schedule; incorporation by reference) by adding subsections (c) and (d) noting the appropriate medical codes for providers to use
when practicing telemedicine. Amends 12 NY ADC 329-4.2 (Acupuncture and physical therapy and occupational therapy fee schedule;
incorporation by reference) by adding subsection (d) noting the appropriate code for providers to use when practicing telemedicine.
Amends 12 NY ADC 333.2 (Behavioral Health fee schedule; incorporation by reference) by adding subsection (c) noting the appropriate
codes for providers to use when practicing telemedicine. Amends 12 NY ADC 348.2 (Chiropractic fee schedule; incorporation by
reference) by adding subsection (c) noting the appropriate codes for providers to use when practicing telemedicine. This rulemaking
continues previous emergency rules without change and is effective July 13, 2021.

¢ 2021 NY REG TEXT 596094 (NS), filed September 23, 2021, adopts 18 NY ADC 538.1 (Authorized providers) providing that for
purposes of medical assistance reimbursement during the federally declared public health emergency related to the COVID-19
pandemic, all Medicaid providers authorized to provide in-person services are authorized to provide such services via telehealth, as
long as such telehealth services are appropriate to meet a patient's health care needs and are within a provider's scope of practice.
Adopts 18 NY ADC 538.2 (Acceptable telehealth modalities) providing that in addition to the telehealth modalities set forth in NY PUB
HEALTH ? 2999-cc (Definitions), reimbursement shall be made for telehealth services provided by use of telephone and other audio-
only technologies. The rulemaking was made via emergency and is effective September 23, 2021.

¢ 2021 NY REG TEXT 596652 (NS), filed October 1, 2021, amends 11 NY ADC 52.17 (Rules relating to content of forms for individual
insurance) and 11 NY ADC 52.18 (Rules relating of forms for group insurance) clarifying that an audio-only visit falls within the meaning
of telehealth and allowing an insurer to engage in reasonable fraud, waste, and abuse detection efforts, including efforts to prevent
payments for services that do not warrant a separate billable encounter. The regulation was adopted via emergency and is effective
October 1, 2021.

¢ 2021 NY REG TEXT 596653 (NS), filed October 1, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) to waive
cost-sharing for in-network visits and laboratory tests necessary to diagnose the novel coronavirus (COVID-19), including through
telehealth. The regulation was adopted via emergency and is effective October 1, 2021.

¢ 2021 NY REG TEXT 597199 (NS), filed October 12, 2021, amends 12 NY ADC 325-1.8 (Emergency medical aid and telemedicine)
updating the section title from 'Emergency medical aid' and adding a requirement to allow the use of telemedicine in certain
circumstances for social distancing purposes due to the outbreak of COVID-19, or irrespective of purely social distancing
considerations, in the clinical judgment of the authorized provider, the potential risk of COVID-19 infection to an individual patient
outweighs any real or perceived incremental benefit derived from an in-person versus remote or virtual appointment. Amends 12

NY ADC 329-1.3 (Medical fee schedule; incorporation by reference), 12 NY ADC 329-4.2 (Acupuncture and physical therapy and
occupational therapy fee schedule; incorporation by reference), 12 NY ADC 333.2 (Behavioral Health fee schedule; incorporation by
reference), and 12 NY ADC 348.2 (Chiropractic fee schedule; incorporation by reference) providing the appropriate medical codes for
providers to use when practicing telemedicine. This rulemaking continues the previous emergency rulemaking (2021 NY REG TEXT
589248 (NS)) with certain changes and is effective October 12, 2021.

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¢ 2021 NY REG TEXT 599724 (NS), filed November 8, 2021, amends 14 NY ADC 830.3 (Definitions) and 14 NY ADC 830.5
(Telehealth) updating terminology to use 'telehealth" instead of 'telepractice." Provides that all services may be delivered via telehealth
unless otherwise specified by the Office in the Telehealth Standards for OASAS Designated Providers (the Telehealth Standards),

as incorporated in this Title, posted on the Office website. Updates the requirements, limitations, and payment for telehealth. The
regulation was amended via emergency rulemaking and is effective November 8, 2021.

¢ 2021 NY REG TEXT 600117 (NS), filed November 15, 2021, amends 14 NY ADC 596 (Telehealth Services) to expand the opportunity
to offer telehealth services in the New York State regulated mental health system. Replaces use of the term 'Telemental Health' with
'Telehealth', updates definitions, allows for the use of audio-only, revises consent and recipient preferences, clarifies requirements for
practitioners, allows services to be delivered from outside the state, and generally updates requirements for use of telehealth services.
Relevant sections include: 14 NY ADC 596.4 (Definitions), 14 NY ADC 596.5 (Approval to Utilize Telehealth Services), 14 NY ADC
596.6 (Requirements for Telehealth Services), 14 NY ADC 596.7 (Reimbursement for Telehealth Services), and 14 NY ADC 596.8
(Contracts for the Provision of Telehealth Services). The regulations were amended via emergency rulemaking and are effective
November 15, 2021.

North Carolina

¢ 2021 NC H.B. 144 (NS), amended/substituted May 5, 2021, would adopt NC ST ? 90-30.2 (Teledentistry practice; definitions;
requirements) to establish the practice standards for the practice of teledentistry. Amend NC ST ? 90-41 (Disciplinary actions) to
prohibit fee-splitting for the use of teledentistry services.

¢ 2021 NC H.B. 146 (NS), adopted July 23, 2021, adopts NC ST ? 90-30.2 (Teledentistry practice; definitions; requirements) to
establish the practice standards for the practice of teledentistry. Amend NC ST ? 90-41 (Disciplinary actions) to prohibit fee-splitting for
the use of teledentistry services. The bill is effective July 23, 2021.

¢ 2021 NC H.B. 149 (NS), amended/substituted May 5, 2021, would adopt NC ST ? 58-50-305 (Coverage for the delivery of health care
services through telehealth) to require health benefit plan coverage for the delivery of health care services through telehealth.

¢ 2021 NC H.B. 224 (NS), adopted June 11, 2021, adopts the Occupational Therapy Interstate Compact. One of the stated purposes for
the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The
Compact becomes effective when at least 10 states have enacted the Occupational Therapy Licensure Compact.

* 2021 NC H.B. 734 (NS), adopted July 2, 2021, amends NC ST ? 122C-263 (Duties of law enforcement officer; first examination),
NC ST ? 122C-266 (Inpatient commitment; second examination and treatment pending hearing), NC ST ? 122C-283 (Duties of law
enforcement officer; first examination by commitment examiner), and NC ST ? 122C-285 (Commitment; second examination and
treatment pending hearing) to update terminology to use 'telehealth" andto allow the examinations to be conducted utilizing telehealth.
The bill is effective July 2, 2021.

¢ 2021 NC H.B. 791 (NS), amended/substituted July 21, 2021, would adopt the Professional Counseling Licensure Compact. One of
the stated purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Professional
Counseling services.

¢ 2021 NC S.B. 105 (NS), engrossed August 12, 2021, would adopt NC ST ? 58-50-305 (Coverage for the delivery of health care
services through telehealth) to require health benefit plan coverage for the delivery of health care services through telehealth.

«2021 NC S.B. 173 (NS), amended/substituted June 23, 2021, would adopt the Occupational Therapy Interstate Compact. One of the
stated purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

¢ 2021 NC S.B. 373 (NS), introduced March 30, 2021, would amend NC ST ? 90-21.102 (Definitions) to include telehealth as a health
care service.

«2021 NC REG TEXT 574684 (NS), published July 1, 2021, amends 21 NC ADC 64.0219 (Telepractice) to update the definition for
'telepractice" and providing that registered Speech and Language Pathology Assistants and Audiology Assistants under the supervision
of licensed providers must be allowed to engage in telepractice under the same level of direct supervision. Adopts 21 NC ADC 64.1104
(Authorized Tasks of Audiology Assistants) clarifying that an audiology assistant may provide services through telehealth to extend
access to clinical care.

North Dakota

¢ 2021 ND H.B. 1151 (NS), adopted April 19, 2021, would amend ND ST 43-28-01 (Definitions) to define 'telehealth" and adopt a new
section of ND ST 43-28 (Dentists) to establish the standard of care and professional ethics for a person practicing telehealth. The bill is
effective August 1, 2021.

¢ 2021 ND H.B. 1175 (NS), adopted April 23, 2021, establishes immunity from liability of health care providers and health care facilities
for any act or omission in response to COVID-19 that causes or contributes, directly or indirectly, to the death or injury of an individual
and providing that a health care provider includes a person engaged in telemedicine or telehealth. The bill declared this Act an
emergency measure and applies retroactively to January 1, 2020.

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¢ 2021 ND H.B. 1465 (NS), adopted May 7, 2021, amends ND ST ? 26.1-36-09.15 (Coverage of telehealth services) to define 'e-visit,"
'nonpublic facing product," 'secure connect," and 'virtual check-in" and update the definition for 'telehealth." The bill is effective May 7,
2021.

¢ 2021 ND S.B. 2060 (NS), adopted April 14, 2021, amends ND ST 43-06-01 (Definitions) to provide the definition for 'telehealth.'The
bill is effective August 1, 2021.

¢ 2021 ND S.B. 2179 (NS), amended/substituted April 1, 2021, would provide for a legislative management study relating to coverage of
telehealth.

* 2021 ND S.B. 2187 (NS), adopted April 16, 2021, amends ND ST 43-44-01 (Definitions) to define 'telehealth' and adopts ND ST
43-44-19 (Telehealth) to establish the requirements for the provision of medical nutrition therapy and nutrition care services for the
purpose of treating or managing a disease or medical condition provide by way of telehealth to an individual in North Dakota. The bill is
effective August 1, 2021.

Ohio

¢ 2019 OH S.B. 236 (NS), engrossed December 17, 2020, would establish and modify requirements regarding the provision of
telehealth services. The bill would require insurers to reimburse a health care professional for telehealth services and coverage the
telehealth services at the same rate as in-person services. The bill would also require health care licensing boards o permit a health
care professional to provide the professional's services as telehealth services.

¢ 2019 OH S.B. 258 (NS), engrossed December 17, 2020, would establish the Psychology Interjurisdictional Compact to regulate the
day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

* 2021 OH H.B. 122 (NS), engrossed April 15, 2021, would amend OH ST ? 3902.30 (Telemedicine services coverage; basis and
extent) to update the definition for 'telehealth' and require an insurer to reimburse a health care professional for a telehealth service
that is covered under a patient's health benefit plan and prohibit cost-sharing requirement for telehealth services that exceeds that for
comparable in-person services. Amend OH ST ? 4723.94 (Prohibition on advanced practice registered nurse providing telemedicine
services charging certain fees) to allow an advanced practice registered nurse to provide telehealth services. Adopt OH ST ? 4725.35,
OH ST ? 4729.284, OH ST ? 4730.60, OH ST ? 4731.741, OH ST ? 4734.60, OH ST ? 4753.20, OH ST ? 4755.90, OH ST ? 4757.50,
OH ST ? 4758.80, OH ST ? 4759.20, OH ST ? 4778.30 to allow an optometrist, pharmacist, physician assistant, physician, chiropractor,
audiologist or speech-language pathologist, occupational therapist or physical therapist, professional clinical counselor, independent
social worker, independent marriage and family therapist, independent chemical dependency counselor, dietitian, and genetic
counselor to provide telehealth services. The bill would also update terminology to use 'telehealth' instead of 'telemedicine.

¢ 2021 OH H.B. 252 (NS), adopted July 1, 2021, adopts the Audiology and Speech-Language Pathology Interstate Compact and
establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a privilege to
practice as provided in the Compact. The Compact will come into effect on the date on which the Compact is enacted into law in the
10th Compact state. The regulations are effective June 1, 2021.

¢ 2021 OH S.B. 2 (NS), adopted April 27, 2021, establishes the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The Compact
will come into effect on the date on which the Compact is enacted into law in the 7th Compact State.

* 2021 OH S.B. 7 (NS), adopted March 31, 2021, adopts the Occupational Therapy Licensure Compact. One of the stated purposes for
the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The
Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 OH S.B. 125 (NS), introduced March 9, 2021, would adopt OH ST ? 3738.20 to allow a hospital or birthing center to use
telemedicine services for a consultation with an obstetrician, certified nurse-midwife, or physician assistant with obstetric expertise to
provide input on patient management and follow-up.

¢ 2021 OH S.B. 204 (NS), engrossed November 10, 2021, would adopt the Counseling Compact. One of the stated purposes for the
Compact would be to facilitate the use of telehealth technology in order to increase access to Professional Counseling services.

¢ 2021 OH S.B. 261 (NS), introduced November 9, 2021, would adopt OH ST ? 4731.303 to allow a physician certified to recommend
treatment of a qualifying medical condition with medical marijuana to make such a recommendation via telemedicine.

* 2021 OH REG TEXT 567282 (NS), filed January 20, 2021, amends OH ADC 5160-56-01 (Hospice services: definitions) updating

the definition for 'Attending physician' and adding definitions for 'Physician assistant' and 'Telehealth'. Amends OH ADC 5160-56-05
(Hospice services: covered services) providing that core and non-core hospice services may be provided through a combination of
contracting services and telehealth services as necessary. Provides that physicians' services includes services rendered by physician
assistants acting as attending physicians. Amends OH ADC 5160-56-06 (Hospice services: reimbursement) providing that Ohio
Department of Medicaid (ODM) will allow telehealth services to be provided where in-person visits are mandated. Provides that hospice
providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate
procedure code. Provides that services billed with T2044 and T2045 are not eligible to be provided via telehealth. The regulations are
effective January 30, 2021.

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¢ 2020 OH REG TEXT 567938 (NS), filed December 21, 2020, amends OH ADC 5160-3-19 (Nursing facilities (NFs): relationship
of NF services to other covered Medicaid services) allowing physician visits to be provided via telehealth. The rule was adopted via
emergency and is effective December 21, 2020.

¢ 2021 OH REG TEXT 568757 (NS), filed January 4, 2021, adopts OH ADC 4725-25-01 (Telehealth Communication) establishing
telehealth standards for optometrists. Provides definitions, service delivery models, guidelines for the use of telehealth, limitations
of telehealth services, and requirements of personnel providing telehealth services. This regulation replaces a previous emergency
regulation and is effective January 14, 2021.

¢ 2021 OH REG TEXT 568983 (NS), certified January 7, 2021, adopts OH ADC 5160-8-52 (Services provided by a pharmacist)
requiring payment for covered telehealth and amends OH ADC 5160-27-02 (Coverage and limitations of behavioral health services)
clarifying that when permitted, provision of any service by telehealth must comply with the appropriate telehealth requirements. The
rules are effective January 17, 2021.

* 2021 OH REG TEXT 568984 (NS), filed May 12, 2021, rescinds OH ADC 4731-10-11 (Telemedicine certificates). The rulemaking is
effective May 31, 2021.

¢ 2021 OH REG TEXT 570750 (NS), filed March 15, 2021, adopts OH ADC 5160-3-80 (Health Care Isolation Centers) to require that
HCICs providing isolation services to have access 24 hours per day, seven days per week, including via telehealth, to a pulmonologist
or clinician who can help manage individuals with COVID-19. The regulation adopts a previous emergency rule and is effective March
25, 2021.

¢ 2021 OH REG TEXT 570751 (NS), filed February 25, 2021, amends OH ADC 5160-12-01 (Home health services: provision
requirements, coverage and service specification) allowing a face-to-face encounter to be completed using telehealth and allowing
home health nursing services performed by an RN and/or an LPN and skilled therapies to be provided using telehealth if clinically
appropriate given the needs of the individual, the nature of the service, and the technology that is available. Amends OH ADC
5160-12-04 (Home health and private duty nursing: visit policy) clarifying that a visit includes an in-person or telehealth encounter.
Amends OH ADC 5160-12-05 (Reimbursement: home health services) providing that the 'place of service" code '02" will be used to
indicate a visit was completed using telehealth. Amends OH ADC 5160-12-08 (Registered nurse assessment and registered nurse
consultation services) allowing the RN assessment to be completed using telehealth. The regulations are effective March 7, 2021.

¢ 2020 OH REG TEXT 572942 (NS), filed December 23, 2020, adopts OH ADC 5160-3-80 (Health Care Isolation Centers) requiring
HCICs providing isolation services to have access 24-hours per day, 7 days per week, including via telehealth, to a pulmonologist or
clinician who can help manage individuals with COVID-19. The rule was adopted via emergency and is effective December 23, 2020.

¢ 2021 OH REG TEXT 574727 (NS), filed March 22, 2021, amends OH ADC 5160-5-01 (Dental Services) adding cross-reference to
telehealth services, rule OH ADC 5160-1-18 (Telehealth). The regulation is effective April 1, 2021.

¢ 2021 OH REG TEXT 579728 (NS), filed June 1, 2021, amends OH ADC 5122-40-05 (Personnel) clarifying that telehealth meetings
may only be conducted for stable patients. Amends OH ADC 5122-40-15 (Medication units) allowing medication units to provide
telecounseling services with appropriately credentialed staff in accordance with all federal and state regulation, including approval from
SAMHSA, providing that telecounseling services may include individual or group sessions, and requiring medication units that choose
to provide telecounseling to have the first counseling appointment in-person at the primary treatment program, be in compliance with
OH ADC 5122-40-09(F)(3) (Non-medication services), and have in-person counseling sessions that continue to occur at least once
every 3 months as long as the person is in treatment. The regulations are effective June 11, 2021.

¢ 2021 OH REG TEXT 585919 (NS), filed June 17, 2021, amends OH ADC 5123-9-14 (Home and community-based services waivers -
vocational habilitation under the individual options, level one, and self-empowered life funding waivers) and OH ADC 5123-9-39 (Home
and community-based services waivers - waiver nursing services under the individual options waiver) clarifying that ongoing support
may be provided in-person or remotely via technology. The regulation was amended via emergency and is effective June 17, 2021.

Oklahoma

¢ 2021 OK H.B. 1021 (NS), introduced February 1, 2021, would amend OK ST T. 43A ? 1-110 (Law enforcement responsibility

for transporting persons for mental health services--Reimbursement of expenses) to require sheriffs and peace offices to utilize
telemedicine, when such capability is available, to have a person whom the officer reasonably believes is a person requiring treatment,
as defined in OK ST T. 43A ? 1-103 (Definitions), assessed by a licensed mental health professional employed by or under contract
with a facility operated by or contracted with the Department of Mental Health and Substance Abuse Services.

¢ 2021 OK H.B. 1689 (NS), amended/substituted April 5, 2021, would amend OK ST T. 36 ? 6802 (Telemedicine defined) to update
the definition for 'telemedicine' and OK ST T. 59 ? 478 (Definitions) to update the definition for 'store-and-forward technologies' and
'telemedicine.'

¢ 2021 OK H.B. 2120 (NS), adopted May 28, 2021, amends OK ST T. 36 ? 6802 (Telemedicine defined) updating terminology to use
'health benefits plan" instead of 'health benefit plan" and removing the definition for 'mHealth" or 'mobile health." The bill is effective
January 1, 2022.

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¢ 2021 OK H.B. 2546 (NS), adopted May 28, 2021, adopts OK ST T. 21 ? 142C-3 to provide that a sexual assault victim has the
right to consult, either in person or via telemedicine, with a sexual assault victims' advocate before the commencement of any
medical evidentiary or physical examination, unless no sexual assault victims' advocate is available, and during any interview by law
enforcement authorities or district attorneys. Provide that where a sexual assault victims' advocate is not available for an in-person
consultation, consultations via telemedicine must be provided. The bill is effective November 1, 2021.

¢ 2022 OK H.B. 2798 (NS), prefiled November 2, 2021, would amend OK ST T. 36 ? 6802 (Telemedicine defined), OK ST T. 59 ? 478
(Definitions), and OK ST T. 43A ? 1-103 (Definitions) to update the definition for 'telemedicine."

* 2022 OK H.B. 2840 (NS), prefiled November 2, 2021, would amend OK ST T. 36 ? 6803 (Coverage of telemedicine services) to
require any health benefit plan that is offered, issued, or renewed on or after November 1, 2021, to reimburse health care practitioners
for telemedicine services at the same rate as in-person visits pursuant to the terms of the health benefit plan.

* 2022 OK H.B. 2877 (NS), prefiled November 2, 2021, would amend OK ST T. 43A ? 1-110 (Law enforcement responsibility for
transporting persons for mental health services--Use of telemedicine--Reimbursement of expenses) to all sheriffs and peace officers to
utilize telemedicine, when such capability is available and is in the possession of the local law enforcement agency, to have a person
whom the officer reasonably believes is a person requiring treatment, assessed by a licensed mental health professional employed by
or under contract with a facility operated by or contracted with the Department of Mental Health and Substance Abuse Services. Amend
OK ST T. 43A ? 5-207 (Local Law Enforcement Mental Health Manpower Act) to allow an officer to get a person an initial assessment
via telemedicine with a licensed mental health professional employed or under contract with a facility operated by or contracted with the
Department of Mental Health and Substance Abuse Services.

¢ 2021 OK H.B. 2877 (NS), adopted April 13, 2021, amends OK ST T. 43A ? 1-110 (Law enforcement responsibility for transporting
persons for mental health services--Reimbursement of expenses) to require sheriffs and peace offices to utilize telemedicine, when
such capability is available, to have a person whom the officer reasonably believes is a person requiring treatment, as defined in OK ST
T. 43A ? 1-103 (Definitions), assessed by a licensed mental health professional employed by or under contract with a facility operated
by or contracted with the Department of Mental Health and Substance Abuse Services. Amends OK ST T. 43A ? 5-207 (Local Law
Enforcement Mental Health Manpower Act) to require that if the person is medically stable, the officer must immediately transport the
person to an urgent recovery clinic or to the nearest facility, as defined by OK ST T. 43A ? 1-103 (Definitions), for an initial assessment
within a thirty (30) mile radius of the peace officer's operational headquarters, or may use telemedicine with a licensed mental health
professional employed or under contract with a facility operated by, certified by, or contracted with the Department of Mental Health and
Substance Abuse Services to perform an initial assessment. The bill is effective November 1, 2021

¢ 2021 OK S.B. 3 (NS), adopted April 19, 2021, amends OK ST T. 43A ? 1-110 (Law enforcement responsibility for transporting persons
for mental health services-Reimbursement of expenses) to require sheriffs and peace officer to utilize telemedicine, when such
capability is available and is in the possession of the local law enforcement agency, to have a person whom the officer reasonably
believes is a person requiring treatment assessed by a licensed mental health professional employed by or under contract with a

facility operated by or contracted with the Department of Mental Health and Substance Abuse Services. The bill also amends OK ST

T. 43A ? 5-207 (Local Law Enforcement Mental Health Manpower Act) to require if the person is medically stable, the officer must
immediately transport the person to the nearest facility for an initial assessment within a 30 mile radius of the peace officer's operational
headquarters, or may use telemedicine with a licensed mental health professional employed or under contract with a facility operated
by or contracted with the Department of Mental Health and Substance Abuse Services to perform an initial assessment. The bill is
effective November 1, 2021

* 2021 OK S.B. 7 (NS), engrossed February 8, 2021, would amend OK ST T. 43A ? 5-207 (Local Law Enforcement Mental Health
Manpower Act) to require the office to have an individual assessed by a licensed mental health professional employed by or under
contract with a facility or a community mental health center via telemedicine if such capability is available.

* 2021 OK S.B. 104 (NS), adopted April 20, 2021, amends OK ST T. 59 ? 887.2 (Definitions) to update the definition for 'practice of
physical therapy" to allow physical therapy services to be provided in person or remotely, via telehealth, to individuals or groups and
provide the definition for 'telehealth." The bill is effective November 11, 2021.

¢ 2021 OK S.B. 270 (NS), adopted May 28, 2021, amends OK ST T. 59 ? 698.2 (Definitions) to update the definition for 'telemedicine"
or 'telehealth." The bill is effective November 1, 2021.

¢ 2021 OK S.B. 397 (NS), introduced February 1, 2021, would adopt OK ST T. 63 ? 5025.1 to require the Oklahoma Health Care
Authority to reimburse a contracted provider for the diagnosis, consultation or treatment of a patient delivered through telemedicine
services on the same basis and at least at the rate of reimbursement that the Authority is responsible for coverage for the provision of
the same, or substantially similar, service through in-person diagnosis, consultation, or treatment.

* 2021 OK S.B. 408 (NS), adopted May 28, 2021, amends OK ST T. 59 ? 328.54 (Dental practice--Diagnosis via the Internet) to allow a
dentist holding a valid dental license in Oklahoma to consult, diagnose, and treat a patient of record via synchronous or asynchronous
telecommunication between the patient and dentist and require the dentist to record all activities relating to teledentistry in the patient
record and to have an office location in Oklahoma available for follow-up treatment and maintenance of records. Amends OK ST T.

59 ? 328.3 (Definitions) to define 'teledentistry." The bill is effective May 28, 2021.

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¢ 2021 OK S.B. 673 (NS), adopted April 27, 2021, amends OK ST T. 36 ? 6802 (Telemedicine defined), OK ST T. 43A ? 1-103
(Definitions), and OK ST T. 59 ? 478 (Definitions) to update definitions related to telemedicine. The bill amends OK ST T. 59 ? 478.1
(Establishment of physician-patient relationship through telemedicine) to update the requirements for an allopathic or osteopathic
physician to establish a valid physician-patient relationship with a patient located in Oklahoma through telemedicine. The bill is effective
November 1, 2021.

¢ 2021 OK S.B. 674 (NS), adopted May 5, 2021, amends OK ST T. 36 ? 6802 (Telemedicine defined) to update definitions related to
telemedicine and OK ST T. 36 ? 6803 (Coverage of telemedicine services) to establish the coverage and reimbursement requirements
for services provided via telemedicine. The bill is effective January 1, 2022.

* 2021 OK S.B. 681 (NS), introduced February 1, 2021, would amend OK ST T. 59 ? 478 (Definitions) to update the definition for 'store-
and-forward technologies" and 'telemedicine."

* 2021 OK S.B. 690 (NS), engrossed March 10, 2021, would amend OK ST T. 59 ? 478.1 (Establishment of physician-patient
relationship through telemedicine) to update the licensing requirements for an allopathic or osteopathic physician to establish a valid
physician-patient relationship with a patient located in Oklahoma through telemedicine.

«2021 OK S.B. 718 (NS), adopted May 5, 2021, amends OK ST T. 59 ? 492 (Designation of physicians-Employment by hospitals--
Practice of medicine defined--Services rendered by trained assistants--Persons practicing nonallopathic healing) clarifying that the
practice of medicine and surgery does not include any person who is licensed to practice medicine and surgery in another state or
territory of the United States who engages in consultation through telehealth with a patient physically located in Oklahoma for the sole
purpose of providing an expert second opinion. The bill is effective November 1, 2021.

¢ 2021 OK S.B. 779 (NS), adopted May 28, 2021, adoptsOK ST T. 63 ? 1-757.4 to prohibit an abortion-inducing drug from being
provided directly to the patient through the mail, telemedicine, or otherwise outside of the parameters of the Oklahoma Abortion-
Inducing Drug Certification Program. The bill is effective November 1, 2021.

* 2021 OK REG TEXT 562940 (NS), approved July 1, 2021, amends OK ADC 317:30-5-211.1 (Definitions) updating the definition

for 'face-to-face encounter' and adopts OK ADC 317:30-5-211.25 (Continuous glucose monitoring) to require documentation of
telehealth visits between the treating provider, member and/or family to evaluate their diabetes control. The rulemaking was adopted via
emergency and is effective July 1, 2021.

* 2021 OK REG TEXT 570165 (NS), adopted June 11, 2021, amends OK ADC 310:281-1-2 (Definitions) updating the definition for
'ACR Technical Standard for Teleradiology," removing the definition for 'telemedicine," and updates and removes related definitions.
The regulation is effective September 11, 2021.

¢ 2021 OK REG TEXT 575088 (NS), approved January 1, 2021, adopts OK ADC 317:30-5-241.7 (Medication-assisted treatment (MAT)
services for eligible individuals with opioid use disorder (OUD)) to exclude telephone calls or other electronic contacts (not inclusive of
telehealth) from coverage. The rulemaking was adopted via emergency and is effective January 1, 2021 through September 14, 2021.

¢ 2021 OK REG TEXT 575142 (NS), approved June 11, 2021, adopts OK ADC 317:30-5-95.50 (Residential substance use disorder
(SUD) ? Reimbursement) providing that telephone calls or other electronic contracts (not inclusive of telehealth) are excluded from
coverage/reimbursement. The regulation is effective September 15, 2021.

¢ 2021 OK REG TEXT 575144 (NS), approved June 11, 2021, adopts OK ADC 317:30-5-241.7 (Medication-assisted treatment (MAT)
services for eligible individuals with opioid use disorder (OUD)) providing that telephone calls or other electronic contracts (not inclusive
of telehealth) are excluded from coverage. The regulation is effective September 15, 2021.

* 2021 OK REG TEXT 575183 (NS), approved June 11, 2021, amends OK ADC 450:17-5-178 (Preliminary screening) removing
provision allowing the initial assessment to be conducted by telemedicine for consumers presenting with emergency or urgent needs.
Amends OK ADC 450:17-5-183 (Care coordination) allowing a team member to connect with the consumer through telehealth as a
face to face meeting. Amends OK ADC 450:17-5-184 (Crisis services) requiring a hospital to have 24 hour mobile crisis teams that
are available via telehealth/secure tablet, or if an in-person response is required, arrival within 1 hour from the time requested. The
regulation is effective September 15, 2021.

¢ 2021 OK REG TEXT 593783 (NS), approved August 18, 2021, adopts OK ADC 510:15-1-6 (Telemedicine and Telehealth) allowing
licensed osteopathic physicians or surgeons to utilize telemedicine or telehealth to provide care for new or existing patients. The
regulation was adopted via emergency and is effective August 18, 2021 and expires September 14, 2022, unless superseded by
another rule or disapproved by the Legislature.

Oregon

¢ 2021 OR H.B. 2508 (NS), adopted June 1, 2021, adopts a new section to define 'audio only" and 'telemedicine," require the

Oregon Health Authority to reimburse the cost of health services delivered using telemedicine, require the Authority to pay the same
reimbursement for a health services regardless of whether the service is provided in person or using any permissible telemedicine
application or technology, and require the Authority to include the costs of telemedicine services in its rate assumptions for payments
made to clinics or other providers on a prepaid capitated basis. Amends OR ST ? 743A.058 (Coverage of health service provided using

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synchronous two-way interactive video conferencing) to provide telemedicine related definitions and update the coverage requirements
for telemedicine services. The bill is effective June 1, 2021. 2021.

¢ 2021 OR H.B. 2591 (NS), adopted July 27, 2021, adopts new sections to define 'distant site" and 'telehealth" and require the Oregon
Health Authority to award grants to 3 school-based health centers to operate pilot projects to expand student access to mental and
physical health care services through use of telehealth. The bill is effective July 1, 2021.

* 2021 OR H.B. 3036 (NS), adopted June 23, 2021, makes permanent the ability of physician assistants to use telehealth to provide
care for patients located in another state. The bill is effective June 23, 2021.

¢ 2021 OR H.B. 3118 (NS), introduced February 9, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 OR S.B. 629 (NS), adopted June 15, 2021, adopts a new section to define 'telepharmacy' and establishing the requirements for
when a pharmacist may use telepharmacy. The bill is effective September 25, 2021.

¢ 2021 OR S.B. 697 (NS), introduced January 22, 2021, would amend OR ST ? 743A.058 (Coverage of health service provided using
synchronous two-way interactive video conferencing) and OR ST ? 743A.185 (Health benefit plans; diabetes; telemedical health service
coverage) to update the definition for 'originating site" and require reimbursement for telemedicine services on the same basis and at
the same rate that applies to services when provided in person, unless the provider has voluntarily agreed to accept reimbursement on
a different basis or rate.

* 2021 OR S.B. 780 (NS), engrossed May 4, 2021, would adopt new sections to define 'telemedicine' as it applies to COVID-19
immunity.

* 2020 OR REG TEXT 568302 (NS), filed December 18, 2020, repeals OR ADC 410-130-0610 (Telemedicine) and replaces with OR
ADC 410-120-1990 (Telehealth) establishing the authority and providing the framework for allowed physical, behavioral and oral health
services for covered conditions to be provided using various telecommunications technologies. The regulation is effective January 1,
2021.

¢ 2020 OR REG TEXT 568303 (NS), filed December 11, 2020, amends OR ADC 410-123-1060 (Definition of Terms) providing the
definition for 'COVID-19 Emergency," 'originating site," 'teledentistry," and 'telehealth." Amends OR ADC 410-123-1265 (Teledentistry)
separates and makes distinct the meaning of telehealth and teledentistry. The rules are effective January 1, 2021.

¢ 2020 OR REG TEXT 568304 (NS), filed December 16, 2020, amends OR ADC 410-141-3566 (Telehealth Service and
Reimbursement Requirements) changing the regulation title from 'Telemedicine Payment Parity Requirements," providing the definition
for 'telehealth," and updating the coverage and reimbursement requirements for telehealth services. Also removes outdated provisions
related to telemedicine. The regulation is effective January 1, 2021.

* 2020 OR REG TEXT 569422 (NS), filed December 18, 2020, adopts the Oregon Reproductive Health Program (RH Program) to
establish the coverage of all services provided under the RH Program. The regulations also detail the requirements for services
provided via telehealth. The regulations are effective January 1, 2021.

* 2020 OR REG TEXT 573076 (NS), filed December 18, 2020, adopts OR ADC 333-006-0170 (Newborn Nurse Home Visiting Services
Provided by Telehealth) allowing Newborn Nurse Home Visiting services provided under OR ADC 333-006-0120 (Visit and Service
Requirements) to be provided by telehealth during the COVID-19 pandemic to protect the health and safety of the home visiting
workforce and families receiving the services. The regulation was adopted on a temporary basis and is effective January 1, 2021
through June 29, 2021.

¢ 2021 OR REG TEXT 573475 (NS), filed February 18, 2021, adopts OR ADC 850-010-0310 (Duty to Create, Maintain and Retain
Medical Records) providing that if examination is via telemedicine, vitals may be reported by the patient. The regulation is effective
February 18, 2021.

¢ 2021 OR REG TEXT 576502 (NS), filed March 3, 2021, amend OR ADC 436-009-0012 (Telehealth) providing that medical services
that may be provided through telemedicine are not limited to those listed in Appendix P of CPT? 2021 and increasing the maximum
payment for HCPCS facility fee code Q 3014 from $35.00 to $35.70. The regulation replaces a temporary rule and is effective April 1,
2021.

* 2021 OR REG TEXT 583155 (NS), filed June 24, 2021, adopts OR ADC 333-006-0170 (Newborn Nurse Home Visiting Services
Provided by Telehealth) allowing Newborn Nurse Home Visiting services provided under OR ADC 333-006-0120 (Visit and Service
Requirements) to be provided by telehealth during a public health emergency to protect the health and safety of the home visiting
workforce and families receiving the services. This rulemaking replaces the previous temporary rulemaking (2020 OR REG TEXT
573076 (NS)) and is effective June 24, 2021.

* 2021 OR REG TEXT 583568 (NS), filed June 28, 2021, amends OR ADC 410-141-3585 (MCE Member Relations: Education

and Information) requiring MCEs to notify enrollees of the available telehealth services, including, but not limited to, how to access
telehealth services and information on supports available to the member to assist them in accessing telehealth services. The regulation
is effective July 1, 2021.

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«2021 OR REG TEXT 584134 (NS), filed May 13, 2021, amends OR ADC 339-010-0006 (Standards of Practice for Telehealth) to
require occupational therapy practitioners to have procedures in place in the event of a medical or clinical emergency at the patient's
location when providing telehealth services. The regulation is effective August 9, 2021.

¢ 2021 OR REG TEXT 591839 (NS), filed August 18, 2021, amends OH ADC 309-088-0125 (CMHP Responsibilities) allowing all
community consultations to be completed either through an in-person meeting or via video conference to align with telehealth changes
due to the COVID-19 pandemic. The regulation was amended via a temporary administrative order and is effective August 18, 2021
through February 13, 2022.

«2021 OR REG TEXT 592512 (NS), filed August 30, 2021, adopts OR ADC 944-001-0020 (Operational, Policy, and Service and
Support Requirements of Behavioral Health Resource Networks) requiring services to be offered face-to-face or through telehealth. The
regulations were adopted on a temporary basis and are effective September 1, 2021 through February 2, 2021.

¢ 2021 OR REG TEXT 593225 (NS), filed September 3, 2021, establishing the Long-Term Capital Improvement Program to allow for
grants to be issued for technology to facilitate virtual visits and telehealth for residents. The regulations were adopted on a temporary
basis and are effective September 7, 2021 through March 5, 2021.

¢ 2021 OR REG TEXT 593830 (NS), filed September 14, 2021, amends OR ADC 410-172-0600 (Acronyms and Definitions) providing
the definition for 'face to face." Amends OR ADC 410-172-0830 (Personal Care Attendant Service Assessment, Authorization and
Monitoring) providing that monitoring is necessary to ensure the service plan is effectively implemented and adequately addresses the
needs of the individual and includes documentation of quarterly, or more frequent, in-person, face-to-face asynchronous audio/video
telehealth, or telephone interviews with the individual or their legal representative were completed by the PCA Service Coordinator, as
directed by the individual. The rulemaking is temporary and is effective September 14, 2021 through March 12, 2021.

¢ 2021 OR REG TEXT 595961 (NS), filed October 1, 2021, amendsOR ADC 944-001-0020 (Operational, Policy, and Service and
Support Requirements of Behavioral Health Resource Networks) requiring licensees to designate if they are a telehealth only licensee.
The regulation was adopted on a temporary basis and is effective October 1, 2021 through March 29, 2021.

Pennsylvania

¢ 2021 PA H.B. 642 (NS), introduced February 24, 2021, would adopt PA ST T. 40 P.S., Ch. 41 (Telemedicine) to authorize the
regulation of telemedicine by professional licensure boards and provide insurance coverage for telemedicine.

¢ 2021 PA H.B. 1020 (NS), introduced March 26, 2021, would amend PA ST 63 P.S. ? 212 (Definitions) include telehealth in the
definition of 'practice of dietetics and nutrition" and to update the definition for 'telehealth" or 'telepractice."

¢ 2021 PA H.B. 1172 (NS), introduced April 14, 2021, would amend the act of November 29, 2006 (P.L. 1471, No. 165), titled 'An act
providing for a sexual assault evidence collection program and for powers and duties of the Department of Health and the Pennsylvania
State Police; establishing civil immunity; and providing for rights of sexual assault victims," to define 'store-and-forward," 'telehealth,"
and 'telehealth technologies." Allow grant funding to be provided for the purpose of supporting telehealth service and infrastructure to
facilitate the delivery of sexual assault nurse examiner services. Require the Department to promulgate regulations to govern the use
of telehealth services in facilitating the provisions of this section. Prohibit a fee being charged for medical forensic examination and all
subsequent medical services related to the sexual assault, including telehealth services.

¢ 2021 PA H.B. 1573 (NS), introduced June 8, 2021, would adopt the Telemedicine Act to authorize the regulation of telemedicine by
professional licensing boards and requiring insurance coverage of telemedicine.

* 2021 PA §.B. 642 (NS), introduced May 24, 2021, would adopt a new section to allow the Department to award a grant to cover the
cost of programs to address behavioral health and postacute capacity and barriers, including equipment and software to implement

telepsychiatry programs, community programs to recruit, train or retain behavioral health care providers in high-need areas, programs
to support personal care home capacity in communities experiencing discharge delays and computerized bed management systems.

¢ 2021 PA S.B. 705 (NS), amended/substituted June 23, 2021, would adopt new sections to authorize the regulation of telemedicine by
professional licensing boards and requiring insurance coverage of telemedicine.

¢ 2021 PA S.B. 923 (NS), introduced October 26, 2021, would adopt PA ST 35 ? 52C01 (Definitions) to provide the definition for 'health
care professional," 'risk evaluation and mitigation strategy," and 'telemedicine." Adopt PA ST 35 ? 52C02 (Prohibition) to prohibit a
health care professional from using telemedicine to administer or communicate with a patient located in this Commonwealth regarding a
medication for which the FDA has issued a risk evaluation and mitigation strategy.

Rhode Island

¢ 2021 RI H.B. 6032 (NS) and 2021 RI S.B. 4 (NS), adopted July 6, 2021, amends RI ST ? 27-81-3 (Definitions) to update definitions
related to telemedicine, RI ST ? 27-81-4 (Coverage of telemedicine services) to require medically necessary telemedicine services
delivered by in-network providers to be reimbursed at rates not lower than services delivered through in-person methods, and adopts RI
ST ? 27-81-7 (Telemedicine data reporting and telemedicine advisory committee) to require insurers to collect and provide to the Office
of the Health Insurance Commissioner information and data reflecting its telemedicine policies, practices, and experience. The bill
adopts RI ST ? 5-31.1-40 (Telemedicine in the practice of dentistry) to providing that professionals licensed under this chapter utilizing

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telemedicine in the practice of dentistry are subject to the same standard of care that would apply to the provision of the same dental
care service or procedure in an in-person setting. The bill is effective July 6, 2021.

¢ 2021 RI H.B. 6122 (NS), introduced March 11, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

South Carolina

* 2021 SC H.B. 3230 (NS), introduced January 12, 2021, would adopt SC ST ? 44-6-38 to require the Department to reimburse any
authorized practitioner for mental health telehealth services delivered to patients enrolled in Medicaid, provided the practitioner adheres
to any legal requirements applicable to the delivery of mental health telehealth services. Defines 'authorized practitioner' and 'mental
health telehealth services."

¢ 2021 SC H.B. 3361 (NS), introduced January 12, 2021, and 2021 SC S.B. 150 (NS), amended/substituted March 31, 2021, would
adopt new sections for the sale of medical cannabis products including allowing a follow-up appointment with a qualifying patient
applicant's physician to be conducted through telemedicine and allowing the pharmacist, physician assistant, or clinical practice nurse
to be available during business hours to advise and educate patients by telemedicine.

¢ 2021 SC H.B. 3599 (NS), introduced January 12, 2021, would adopt the Occupational Therapy Licensure Compact. One of the stated
purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

* 2021 SC H.B. 3833 (NS), introduced February 9, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day
to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

* 2021 SC H.B. 3840 (NS), introduced February 9, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 SC H.B. 3867 (NS), introduced February 10, 2021, would adopt SC ST ? 37-71-295 to provide definitions and establish
guidelines for contracting for telemedicine services and amend SC ST ? 40-47-37 (Practice of telemedicine, requirements) to update
the requirements to practice telemedicine, so as to provide requirements to allow for the provision of out-of-state telemedicine services.

¢ 2021 SC H.B. 4085 (NS), introduced March 17, 2021, would adopt SC ST ? 40-15-610, SC ST ? 40-15-620, SC ST ? 40-15-630. SC
ST ? 40-15-640, SC ST ? 40-15-650, and SC ST ? 40-15-660, SC ST ? 40-15-670 to regulate the practice of teledentistry. Amend SC
ST ? 40-15-85 (Definitions) to define 'teledentistry."

¢ 2021 SC H.B. 4296 (NS), introduced April 29, 2021, would adopt SC ST ? 40-47-196 to prohibiting a CMA from performing a clinical
decision-making task by means of telemedicine.

¢ 2021 SC S.B. 150 (NS), amended/substituted March 31, 2021, would adopt SC ST ? 44-53-2130 to allow a follow-up appointment to
be conducted through telemedicine. Adopt SC ST ? 44-53-2470 to require a pharmacist, physician assistant, or clinical practice nurse
to be reasonably available during business hours to advise and educate patients, in person or by telemedicine.

¢ 2021 SC S.B. 265 (NS), introduced January 12, 2021, would adopt SC ST ? 44-7-400 prohibiting a hospital from utilizing telemedicine
to deliver intensive or critical care services and requiring intensive or critical care services to be provided or supervised by a physician
who is board-certified in critical care medicine.

¢ 2021 SC S.B. 613 (NS), introduced February 25, 2021, would adopt SC ST ? 40-47-196 to prohibit a CMA from performing a task by
means of telemedicine.

South Dakota

* 2021 SD S.B. 96 (NS), adopted March 9, 2021, amend SD ST ? 35-52-1 (Definitions) and SD ST ? 35-52-3 (Provider-patient
relationship required-- Exceptions) to update definitions related to telehealth and to update the requirements for provide-patient
relationships that utilize telehealth. The bill is effective July 1, 2021.

¢ 2021 SD REG TEXT 586186 (NS), filed August 2, 2021, amends SD ADC 67:61:01:01 (Definitions) updating the definition for 'family
counseling," group counseling," and 'individual counseling" to include telehealth and providing the definition for 'telenealth." Amends
SD ADC 67:61:12:03 (Reimbursable services), SD ADC 67:61:13:04 (Reimbursable services), SD ADC 67:61:14:04 (Reimbursable
services), SD ADC 67:62:10:03 (Reimbursable Services), SD ADC 67:62:11:03 (Reimbursable services), SD ADC 67:62:12:03
(Reimbursable services), and SD ADC 67:62:13:07 (Reimbursable services) providing reimbursement for telehealth contacts. The
regulations are effective August 22, 2021.

Tennessee

¢ 2021 TN H.B. 455 (NS), introduced February 8, 2021, would adopt the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 TN H.B. 508 (NS), adopted April 20, 2021, would amend TN ST ? 63-1-155 (Delivery of telehealth services; authority to practice
telemedicine; creation of provider-patient relationship) to provide that an individual licensed in another state who would, if licensed in

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this state, qualify as a healthcare provider to practice telehealth while providing healthcare services on a volunteer basis through a free
clinic. The bill is effective April 20, 2021.

¢ 2021 TN H.B. 522 (NS), introduced February 8, 2021, and 2021 TN S.B. 1589 (NS), introduced February 11, 2021, would amend TN
ST ? 63-1-155 (Delivery of telehealth services; authority to practice telemedicine; creation of provider-patient relationship) to update the
definition for 'store-and-forward telemedicine services" and 'telehealth," 'telemedicine," and 'provider-based telemedicine."

¢ 2021 TN H.B. 620 (NS), introduced February 10, 2021, and 2021 TN S.B. 429 (NS), introduced February 8, 2021, would amend TN
ST ? 56-7-1002 (Healthcare services delivered through telehealth encounter) to update the definition for 'qualified site" and 'telehealth"

¢ 2021 TN H.B. 636 (NS), introduced February 10, 2021, would enact the Health Benefit Plan Network Access and Adequacy Act to
establish standards for the creation and maintenance of networks by insurers and assure the adequacy, accessibility, transparency,
and quality of healthcare services. The bill would define 'telemedicine' or 'telehealth" and require the access plan to describe the
insurer's network, including how the use of telemedicine, telehealth, or other technology may be used to meet network access
standards.

¢ 2021 TN S.B. 161 (NS), adopted May 11, 2021, establishes the Psychology Interjurisdictional Compact to regulate the day to day
practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The Compact
comes into effect on the date on which the Compact is enacted in the 7th Compact state.

¢ 2021 TN S.B. 929 (NS), adopted May 11, 2021, amends TN ST ? 63-1-155 (Delivery of telehealth services; authority to practice
telemedicine; creation of provider-patient relationship) to provide that an individual licensed in another state who would, if licensed in
this state, qualify as a healthcare provider to practice telehealth while providing healthcare services on a volunteer basis through a free
clinic. The bill is effective May 11, 2021, the public welfare requiring it take effect upon becoming law.

¢ 2021 TN S.B. 1072 (NS) adopted April 13, 2021, amends TN ST ? 63-13-103 (Definitions) to update the definition for 'occupational
therapy practice" and 'practice of physical therapy" to include the practice of telehealth, telemedicine, or provider-based telemedicine.
The bill is effective July 1, 2021.

¢ 2021 TN S.B. 1265 (NS), introduced February 11, 2021, would amend TN ST ? 63-1-155 (Delivery of telehealth services; authority to
practice telemedicine; creation of provider-patient relationship) to update the definition for 'healthcare provider."

¢ 2021 TN S.B. 1589 (NS), adopted April 13, 2021, amends TN ST ? 63-1-155 (Delivery of telehealth services; authority to practice
telemedicine; creation of provider-patient relationship) to update the definition for 'store-and-forward telemedicine services" and
'telehealth," 'telemedicine," and 'provider-based telemedicine." The bill is effective April 13, 2021.

¢ 2021 TN REG TEXT 573029 (NS), filed July 21, 2021, adopts the following new rules concerning telehealth and Workers'
Compensation: TN ADC 0800-02-31-.01 (Purpose and Scope of Rules), TN ADC 0800-02-31-.02 (Definitions), TN ADC 0800-02-31-.03
(General Requirements), TN ADC 0800-02-31-.04 (Consent and Agreement of Injured Worker), and TN ADC 0800-02-31-.05 (Billing
and Reimbursement for Telehealth Services). The rulemaking is effective October 19, 2021.

Texas

* 2021 TX H.B. 4 (NS), adopted June 15, 2021, adopts TX GOVT ? 531.02161 (Service Coordination Using Telecommunications

or Information Technology) to require the Commission to ensure that Medicaid recipients, child health plan program enrollees, and
other individuals receiving benefits under a public benefits program administered by the commission or a health and human services
agency, regardless of whether receiving benefits through a managed care delivery model or another delivery model, have the option
to receive services as telemedicine medical services, telehealth services, or otherwise using telecommunications or information
technology. Amends TX GOVT ? 531.02164 (Medicaid Services Provided Through Home Telemonitoring Services) to allow a Medicaid
managed care organization to reimburse providers for home telemonitoring services not specifically defined in this section and

must consider other factors, including whether reimbursement is cost-effective and whether the provision of the service is clinically
effective, in making the determination. Amends TX GOVT ? 533.0061 (Provider Access Standards; Report) to require provider access
standards to consider and include the availability of telemedicine and telehealth services within the provider network of a managed
care organization. Adopts TX GOVT ? 533.039 (Delivery of Benefits Using Telecommunications and Information Technology) to
require the Commission to establish policies and procedures to improve access to care under the Medicaid managed care program
by encouraging the use of telehealth services, telemedical services, home telemonitoring services, and other telecommunications

or information technology under the program. Amends TX HEALTH & S ? 62.1571 (Telemedicine Medical Services and Telehealth
Services) to include telehealth services. The bill is effective June 15, 2021.

¢ 2021 TX H.B. 76 (NS), prefiled September 16, 2021, would adopt new TX HEALTH & S T. 9, Subt. B, Ch. 771, Subch. F (Next
Generation -1 Telemedicine Medical Services and Telehealth Services Pilot Project) to establish a pilot project to provide emergency
telemedicine medical services and telehealth services in rural areas.

¢ 2021 TX H.B. 280 (NS), introduced February 25, 2021, would require the Commission to develop and implement an action plan to
expand telemedicine medical services and telehealth services and increase access to critical medical care and health care services in
Texas.

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¢ 2021 TX H.B. 515 (NS), 2021 TX H.B. 522 (NS), and 2021 TX H.B. 887 (NS), introduced March 1, 2021, and 2021 TX H.B. 980 (NS),
amended/substituted May 7, 2021, would adopt TX INS ? 1455.007 (Reimbursement and Payment) requiring a health benefit plan
insurer to reimburse a preferred or contracted health professional for providing a covered health care service or procedure to a covered
patient as a telemedicine medical service or telehealth service on the same basis and at least at the same rate that the insurer provides
reimbursement to that health professional for the service or procedure in an in-person setting.

¢ 2021 TX H.B. 745 (NS), introduced March 1, 2021, would adopt TX EDUC ? 38.040 (Telehealth Program) to define 'telehealth
service."

¢ 2021 TX H.B. 974 (NS), introduced March 1, 2021, would amend TX GOVT ? 531.0216 (Participation and Reimbursement of
Telemedicine Medical Service Providers and Telehealth Service Providers Under Medicaid) to require the Commissioner to implement
reimbursement for telemedicine medical services and telehealth services in the following programs, services, and benefits: (1) Children
with Special Health Care Needs program, (2) Early Childhood Intervention, (3) School and Health Related Services, (4) physical
therapy, occupational therapy and speech therapy, (5) targeted case management, (6) nutritional counseling services, (7) Texas
Health Steps checkups, (8) Medicaid 1915(c)waiver programs, including the Community Living and Support Services waiver, and

(9) any other program, benefit, or service under the commission's jurisdiction that the commissioner determines to be cost effective
and clinically effective. Amend TX GOVT ? 531.02164 (Medicaid Services Provided Through Home Telemonitoring Services) to

allow a Medicaid managed care organization to reimburse providers for home telemonitoring services not specifically defined in this
section and must consider other factors, including whether reimbursement is cost-effective and whether the provision of the service is
Clinically effective, in making the determination. Adopt TX GOVT ? 533.00252 (Delivery of Telecommunication Services) to require the
Commission to implement policies and procedures to improve access to care through telemedicine, telehealth, tele-monitoring, and
other telecommunication or information technology solutions. Amend TX GOVT ? 533.0061 (Provider Access Standards; Report) to
require provider access standards to consider and include the availability of telemedicine and telehealth services within the provider
network of a managed care organization.

* 2021 TX H.B. 980 (NS), amended/substituted May 7, 2021, and 2021 TX S.B. 228 (NS), introduced March 3, 2021, would adopt

TX INS ? 1455.007 (Reimbursement and Payment) to require a health benefit plan issuer to reimburse a preferred or contracted

health professional for providing a covered health care service or procedure to a covered patient as a telemedicine medical service or
telehealth service on the same basis and at least at the same rate that the issuer provides reimbursement to that health professional
for the service or procedure in an in-person setting. Provide that for purposes of processing payment of a claim, a health benefit plan
issuer may not require a preferred or contracted health professional to provide documentation of a covered health care service or
procedure delivered by the health professional to a covered patient as a telemedicine medical service or telehealth service beyond that
which is required for the service or procedure in an in-person setting.

¢ 2021 TX H.B. 1164 (NS), adopted June 15, 2021, adopts TX HEALTH & S ? 241.1837 (Patient Safety Practices Regarding Placenta
Accreta Spectrum Disorder) to provide the definition for 'telemedicine medical service" and require a hospital to foster telemedicine
medical services with other hospitals for the treatment and management of placenta accrete spectrum disorder. The bill is effective
September 1, 2021.

¢ 2021 TX H.B. 1254 (NS), introduced January 21, 2021, would amend TX HEALTH & S ? 573.012 (Issuance of Warrant) to provide
that if a law enforcement agency has entered into a memorandum of understanding with a local mental health authority to use
telehealth service a peace officer who apprehends a person under this section may arrange for a physician to conduct a telehealth
appointment with the apprehended person to determine whether emergency detention is necessary before transporting the person to a
facility. The bill would also provide that if the physician conducting the telehealth appointment determines that emergency detention is
not required, the peace office must release the person.

¢ 2021 TX H.B. 1633 (NS), engrossed May 14, 2021, would adopt the Audiology and Speech-Language Pathology Interstate Compact
and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under a
privilege to practice as provided in the Compact.

¢ 2021 TX H.B. 2056 (NS), adopted June 15, 2021, amends TX OCC ? 111.001 (Definitions), TX OCC ? 111.002 (Informed Consent),
TX OCC ? 111.004 (Rules), TX OCC ? 111.005 (Practitioner-Patient Relationship for Telemedicine Medical Services or Teledentistry
Dental Services), TX OCC ? 111.006 (Coordination to Adopt Rules That Determine Valid Prescription), TX OCC ? 111.007 (Standard
of Care for Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services), TX OCC ? 251.003 (Practice

of Dentistry), TX OCC ? 258.001 (Impermissible Delegations), TX OCC ? 262.152 (Performance of Delegated Duties), TX OCC ?
562.056 (Practitioner-Patient Relationship Required), T X GOVT ? 531.001 (Definitions), TX GOVT ? 531.0216 (Participation and
Reimbursement of Telemedicine Medical Service Providers, Teledentistry Dental Service Providers, Teledentistry Dental Services,
and Telehealth Service Providers Under Medicaid), TX GOVT ? 531.02162 (Medicaid Services Provided Through Telemedicine
Medical Services and Telehealth Services to Children With Special Health Care Needs), TX HEALTH & S ? 62.157 (Telemedicine
Medical Services and Telehealth Services for Children With Special Health Care Needs), TX HEALTH & S ? 62.1571 (Telemedicine
Medical Services and Teledentistry Dental Services), TX INS ? 1455.001 (Definitions), TX INS ? 1455.004 (Coverage for Telemedicine
Medical Services, Teledentistry Dental Services, and Telehealth Services), and TX INS ? 1455.006 (Telemedicine Medical Services,
Teledentistry Dental Services, and Telehealth Services Statement), and adopts TX OCC ? 111.0075 (Licensing for Teledentistry
Dental Services), TX OCC ? 111.009 (Limitation on Certain Prescriptions), TX GOVT ? 531.02172 (Reimbursement for Teledentistry

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Dental Services) to update the requirements for the practice of dentistry and the provision of teledentistry dental services and to
require Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in Texas. The
bill is effective September 1, 2021 except for TX INS ? 1455.004 (Coverage for Telemedicine Medical Services, Teledentistry Dental
Services, and Telehealth Services) and TX INS ? 1455.006 (Telemedicine Medical Services, Teledentistry Dental Services, and
Telehealth Services Statement) which are effective January 1, 2022.

¢ 2021 TX H.B. 2706 (NS), adopted June 16, 2021, adopts TX HEALTH & S ? 323.052 (Operation of SAFE Program; Designation

of SAFE Program as SAFE-ready facility) to require the Health and Human Services Commission to designate a SAFE program as

a SAFE-ready facility if the program notifies the Commission that the program employs or contracts with a sexual assault forensic
examiner or uses a telemedicine system of sexual assault forensic examiners to provide consultation during a sexual assault forensic
medical examination to a nurse or physician licensed to practice in Texas. The bill is effective September 1, 2021.

* 2021 TX H.B. 3098 (NS), engrossed May 11, 2021, would amend TX LABOR ? 408.123 (Certification of Maximum Medical
Improvement; Evaluation of Impairment Rating) to allow a medical examination conducted to certify maximum medical improvement or
assign an impairment rating to be performed using telehealth services or telemedicine medical services.

* 2021 TX S.B. 40 (NS), adopted June 3, 2021, adopts TX OCC ? 51.501 to allow a health professional to provide telehealth services.
Amends TX OCC ? 403.151 (Practice Setting) to allow a licensed dyslexia practitioner to provide telehealth services from a remote
location and allow license holders to provide telehealth services only in the practice settings allowed, regardless of the physical
location of the license holder or the recipient of the telehealth services. Repeals TX OCC ? 401.2022 (Rules for Fitting and Dispensing
of Hearing Instruments by Telepractice) and TX OCC ? 402.1023 (Rules for Fitting and Dispensing of Hearing Instruments by
Telepractice). The bill is effective June 3, 2021.

¢ 2021 TX S.B. 412 (NS), introduced January 25, 2021, would amend TX GOVT ? 531.0216 (Participation and Reimbursement of
Telemedicine Medical Service Providers and Telehealth Service Providers Under Medicaid) to require the Commission to implement
reimbursement for telemedicine medical services and telehealth services in the following programs, services, and benefits: Children
with Special Health Care Needs program; Early Childhood Intervention; School and Health Related Services; physical therapy,
occupational therapy, and speech therapy; targeted case management; nutritional counseling services; Texas Health Steps checkups;
Medicaid 1915(c) waiver programs, including the Community Living and Support Services Waiver; and any other program, benefit,

or service under the Commission's jurisdiction that the Commissioner determines to be cost effective and clinically effective. The bill
would also TX GOV ? 533.0061 (Provider Access Standards; Report) requiring provider access standards to consider and include the
availability of telemedicine and telehealth services within the provider network of a managed care organization.

¢ 2021 TX S.B. 434 (NS), introduced January 26, 2021, would adopt TX GOVT ? 531.02161 (Service Coordination Using
Telecommunications or Information Technology) defining 'service coordination" and requiring the Commission to ensure that, to the
extent appropriate, a Medicaid recipient or child health plan program enrollee who is eligible to receive service coordination benefits,
including a recipient or enrollee receiving program benefits through a managed care delivery model, has the option to receive delivery
of those benefits as a telehealth service or otherwise using telecommunications or information technology. The bill would also adopt
TX INS ? 1455.007 (Reimbursement and Payment) to require a health benefit plan issuer to reimburse a preferred or contracted
health professional for providing a covered health care service or procedure to a covered patient as a telemedicine medical service or
telehealth service on the same basis and at least at the same rate that the issuer provides reimbursement to that health professional
for the service or procedure in an in-person setting and to require for purposes of processing payment of a claim, a health benefit plan
issuer may not require a preferred or contracted health professional to provide documentation of a covered health care service or
procedure delivered by the health professional to a covered patient as a telemedicine medical service or telehealth service beyond that
which is required for the service or procedure in an in-person setting.

¢ 2021 TX S.B. 458 (NS), introduced January 26, 2021, would adopt the Occupational Therapy Practice Acts. One of the stated
purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

«2021 TX S.B. 488 (NS), introduced January 27, 2021, would amend TX OCC ? 111.001 (Definitions), TX OCC ? 111.002 (Informed
Consent), TX OCC ? 111.004 (Rules), TX OCC ? 111.005 (Practitioner-Patient Relationship for Telemedicine Medical Services or
Teledentistry Dental Services), TX OCC ? 111.006 (Coordination to Adopt Rules That Determine Valid Prescription), TX OCC ?
111.007 (Standard of Care for Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services), TX OCC ?
251.003 (Practice of Dentistry), TX OCC ? 258.001 (Impermissible Delegations), TX OCC ? 262.152 (Performance of Delegated
Duties), TX OCC ? 562.056 (Practitioner-Patient Relationship Required), T X GOVT ? 531.001 (Definitions), TX GOVT ? 531.0216
(Participation and Reimbursement of Telemedicine Medical Service Providers, Teledentistry Dental Service Providers, Teledentistry
Dental Services, and Telehealth Service Providers Under Medicaid), TX GOVT ? 531.02162 (Medicaid Services Provided Through
Telemedicine Medical Services and Telehealth Services to Children With Special Health Care Needs), TX HEALTH & S ? 62.157
(Telemedicine Medical Services and Telehealth Services for Children With Special Health Care Needs), TX HEALTH & S ? 62.1571
(Telemedicine Medical Services and Teledentistry Dental Services), TX INS ? 1455.001 (Definitions), TX INS ? 1455.004 (Coverage
for Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services), and TX INS ? 1455.006 (Telemedicine
Medical Services, Teledentistry Dental Services, and Telehealth Services Statement), and adopt TX OCC ? 111.0075 (Licensing for
Teledentistry Dental Services), TX OCC ? 111.009 (Limitation on Certain Prescriptions), TX GOVT ? 531.02172 (Reimbursement for

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Teledentistry Dental Services) to update the requirements for the practice of dentistry and the provision of teledentistry dental services
and to require Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in Texas.

¢ 2021 TX S.B. 992 (NS), introduced March 3, 2021, would adopt amend TX OCC ? 111.009 (Health Professional Located Outside of
State) to allow a health professional located outside of Texas who holds an active and unencumbered license issued by another state
to provide a patient located in Texas a telehealth service if the professional is authorized to provide the service by the state in which the
professional is licensed.

¢ 2021 TX S.B. 1896 (NS), adopted June 14, 2021, adopts TX HUM RES ? 42.260 (Telehealth Pilot Program) to require the
commission in coordination with the Department and single source continuum contractors to establish guidelines in the STAR health
program to improve the use of telehealth services to provide and enhance mental health and behavioral health care for children placed
in the managing conservatorship of the state. The bill is effective June 14, 2021.

¢ 2021 TX S.B. 2009 (NS), introduced March 12, 2021, would adopt TX HEALTH & S ? 32.204 (Priority Considerations for Center
Designations) the rules must prioritize awarding a designation to a health care entity or program that fosters telemedicine, referral, and
transport relationships with rural hospitals in this state.

¢ 2021 TX S.B. 2121 (NS), introduced March 12, 2021, would adopt TX INS ? 1219.006 (Covered Health Care Service or Supply for
Purposes of Deductible) to require a health benefit plan issuer to include a covered health care service or supply for purposes of an
enrollee's deductible any amount the enrollee pays for ahealth care service delivered as a telemedicine medical service or telehealth
service or under a direct primary care arrangement.

¢ 2021 TX S.B. 2255 (NS), introduced May 10, 2021, would adopt TX Health & S ? 44 (Pilot Program to Provide Telemedicine Medical
Services to Certain Cancer Patients) to establish a pilot program to provide telemedicine medical services to certain cancer patients
receiving pain management services and supportive palliative care.

¢ 2021 TX REG TEXT 570087 (NS), filed February 8, 2021, amends 1 TX ADC ? 355.8261 (Federally Qualified Health Center Services
Reimbursement) to reimburse a federally qualified health center for a covered telemedicine medical service or telehealth service
delivered by a health care provider to a Medicaid recipient. The regulation is effective February 28, 2021.

¢ 2020 TX REG TEXT 571075 (NS), filed January 21, 2021, amends 22 TX ADC ? 337.1 (Display of License) requiring licensees who
provide physical therapy services through telehealth, home visits, or other non-traditional modes to provide information on accessing
the Board's online license verification system. The regulation is effective March 1, 2021.

¢ 2020 TX REG TEXT 571076 (NS), filed January 21, 2021, amends 22 TX ADC ? 337.2 (Consumer Information Sign) requiring
licensees who provide physical therapy services through telehealth, home visits, or other non-traditional modes to provide information
on directing complaints regarding non-compliance with the Texas Physical Therapy Practice Act/Rules to the Texas Board of Physical
Therapy Examiners. The regulation is effective March 1, 2021.

¢ 2021 TX REG TEXT 571665 (NS), filed May 12, 2021, adopts 16 TX ADC ? 121.71 (Professional Services Practice Responsibilities of
License Holders) establishing standards and responsibilities for delivering behavior analysis services by license holders who choose to
provide their services using telehealth. The regulation is effective June 1, 2021.

* 2021 TX REG TEXT 572607 (NS), filed February 23, 2021, adopts 22 TX ADC ? 280.1 (Purpose), 22 TX ADC ? 280.3 (Definitions),
and 22 TX ADC ? 280.5 (Grant Program Administration) to authorize the Texas Health and Human Services Commission (HHSC) to
establish a pediatric tele-connectivity resource program for rural Texas by awarding grants to support nonurban health care facilities in
establishing the capacity to provide pediatric telemedicine services. Adds related definitions. The regulations are effective March 15,
2021.

* 2021 TX REG TEXT 572608 (NS), filed May 7, 2021, adopts 26 TX ADC ? 306.45 (Definitions) to define 'telehealth service," 26 TX
ADC ? 306.53 (Pre-admission Screening and Assessment) providing that if a pre-admission screening indicates an individual requires
immediate assessment to determine risk of deterioration and immediate danger to self and others, the assessment must be conducted
with the individual, either in person or through the use of telemedicine medical services or telehealth services, and 26 TX ADC ? 306.67
(Additional Standards of Care for Children and Adolescents) allowing assessments to be administered in person or through telehealth
or telemedicine medical services. The regulation is effective May 27, 2021.

¢ 2021 TX REG TEXT 574189 (NS), filed December 29, 2020, amends 22 TX ADC ? 174.5 (Issuance of Prescriptions) providing

that treatment of chronic pain with scheduled drugs by telephone refill of an existing prescription is prohibited, unless a patient is an
established chronic pain patient of the physician and has been seen by the prescribing physician or health professional in the last 90
days either: (i) in-person; or (ii) via telemedicine using audio and video two-way communication. Also provides that treatment of acute
pain with scheduled drugs through use of telemedicine medical services is allowed, unless otherwise prohibited under federal and state
law. The rulemaking continues the previous emergency rulemaking in 2020 TX REG TEXT 570086 (NS) and is effective January 2,
2021 through March 2, 2021.

¢ 2021 TX REG TEXT 574689 (NS), filed December 30, 2020, a mends 22 TX ADC ? 217.24 (Telemedicine Medical Service
Prescriptions) adding requirements to allow APRNs to treat chronic pain with scheduled drugs through use of telemedicine medical
services if a patient is an established chronic pain patient of the APRN, is seeking a telephone refill of an existing prescription, and the

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APRN determines that the telemedicine treatment is needed due to the COVID-19 pandemic. This rulemaking continues the previous
emergency rulemaking in 2020 TX REG TEXT 570640 (NS). The rule is effective January 3, 2021 through March 3, 2021.

¢ 2021 TX REG TEXT 5754814 (NS), filed January 19, 2021, adopts 26 TX ADC ? 306.1351 (COVID-19 Flexibilities) to establish
flexibility of certain requirements in the provision of behavioral health services, to allow alternative methods other than face-to-face
contact or in-person interactions, such as the use of telehealth, telemedicine, video-conferencing, or telephonic methods. Also,

allows virtual platforms instead of a private physical space for certain in-person interactions, such as the use of a telephone or video-
conferencing. Also, allows a child or adolescent participating in the YES Waiver Program to reside with another responsible adult as the
child or adolescent may not be residing with his or her legally authorized representative due to COVID-19. This rulemaking extends the
previous July emergency rulemaking without any changes and is effective January 19, 2021 through May 18, 2021.

¢ 2021 TX REG TEXT 5754815 (NS), filed January 13, 2021, amends 40 TX ADC ? 30.14 (Certification of Terminal Illness and Record
Maintenance) providing that during a state of disaster declared by the Governor, a hospice physician or hospice advanced practice
registered nurse may determine an individual's continued eligibility for hospice care, for a period of care after the initial period, through
a telemedicine medical service. This rulemaking continues the previous emergency rulemaking (2020 TX REG TEXT 561243 (NS)) with
certain changes and is effective January 14, 2021 through May 13, 2021.

* 2021 TX REG TEXT 578680 (NS), filed August 10, 2021, amends 22 TX ADC ? 279.16 (Telehealth services) pertaining to
optometrists and updating definitions, adding requirements for a valid practitioner-patient relationship to exist, updating the fraud

and abuse prevention requirements, updating notice requirements, and updating security requirements. Establishes minimum
standards of care for an optometrist or therapeutic optometrist providing a telehealth service and adds requirements for the issuance of
prescriptions. The regulation is effective August 30, 2021.

¢ 2021 TX REG TEXT 579013 (NS), filed March 2, 2021, amends 22 TX ADC ? 174.5 (Issuance of Prescriptions) to allow physicians
to utilize telemedicine to issue refill prescriptions for scheduled medications to established chronic pain patients, if the physician

has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video communication. The
regulation was adopted via emergency and is effective March 3, 2021 through May 1, 2021.

¢ 2021 TX REG TEXT 579076 (NS), filed February 26, 2021, amends 22 TX ADC ? 217.24 (Telemedicine Medical Service
Prescriptions) adding requirements to allow APRNs to treat chronic pain with scheduled drugs through use of telemedicine medical
services if a patient is an established chronic pain patient of the APRN, is seeking a telephone refill of an existing prescription, and the
APRN determines that the telemedicine treatment is needed due to the COVID-19 pandemic. This rulemaking continues the previous
emergency rulemaking in 2020 TX REG TEXT 570640 (NS). The rule is effective January 3, 2021 through March 4, 2021.

* 2021 TX REG TEXT 582124 (NS), filed April 8, 2021, adopts 26 TX ADC ? 500.21 (ESRD Facility Requirements During the
COVID-19 Pandemic) allowing monthly visits for dialysis patients to be conducted using telemedicine medical services. The rulemaking
was via emergency and is effective April 11 and expires August 8, 2021.

* 2021 TX REG TEXT 584646 (NS), filed July 30, 2021, amends 1 TX ADC ? 353.1304 (Quality Metrics for the Quality Incentive
Payment Program for Nursing Facilities on or after September 1, 2019) removing requirements for nursing facilities to use telehealth
services to meet some or all of the RN staffing metric.

¢ 2021 TX REG TEXT 588307 (NS), filed June 30, 2021, amends, 22 TX ADC ? 174.5 (Issuance of Prescriptions) providing that
telemedicine treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way communication

is prohibited, unless: a patient is an established chronic pain patient of the physician, is receiving a prescription that is identical to a
prescription issued at the previous visit, and has been seen by the prescribing physician or health professional in the last 90 days either
in-person or via telemedicine using audio and video two-way communication. Provides that telemedicine medical services may be

used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law. Provides that this
emergency amendment effective July 1, 2021 at 12:01 A.M. shall be in effect for only 60 days or the duration of the time period that

the Governor's disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in effect, whichever is shorter. The
rulemaking continues a previous emergency rule.

¢ 2021 TX REG TEXT 588308 (NS), filed July 1, 2021, amends 22 TX ADC ? 217.24 (Telemedicine Medical Service Prescriptions)
providing that telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means other than via
audio and video two-way communication is prohibited, unless: (i) a patient is an established chronic pain patient of the APRN; (ii) is
receiving a prescription that is identical to a prescription issued at the previous visit; and (iii) has been seen by the prescribing APRN or
physician or health professional in the last 90 days, either in-person or via telemedicine using audio and video two-way communication.
Specifies the factors an APRN shall consider when determining whether to utilize telemedicine medical services for the treatment of
chronic pain with controlled substances; and provides that if a patient is treated, the medical records must document the exception and
the reason that a telemedicine visit was conducted instead of an in-person visit. Defines chronic pain and acute pain. Provides that
telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless otherwiseprohibited under
federal and state law. Provides that this emergency amendment of this rule effective July 2, 2021, shall be in effect for only 60 days or
the duration of the time period that the Governor's disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in
effect, whichever is shorter. The rulemaking continues a previous emergency rule.

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¢ 2021 TX REG TEXT 589121 (NS), filed July 12, 2021, amends 40 TX ADC ? 30.14 (Certification of Terminal Illness and Record
Maintenance) providing that during a state of disaster declared by the Governor, a hospice physician or hospice advanced practice
registered nurse may conduct the assessment to determine an individual's continued eligibility for hospice care through a telemedicine
medical service. This rulemaking continues the previous emergency rulemaking (2021 TX REG TEXT 575815 (NS)) with clarifying
changes and is effective July 13, 2021 and expires November 9, 2021.

«2021 TX REG TEXT 589480 (NS), filed July 16, 2021, adopts 26 TX ADC ? 306.1351 (COVID-19 Flexibilities) to allow the provision
of community mental health services through telehealth, telemedicine, video-conferencing, or telephonic methods to engage with the
individual to provide these services, to the extent this flexibility is permitted by and does not conflict with other law or obligation of the
provider. The rulemaking was adopted via emergency and is effective July 18, 2021 and expires November 14, 2021.

«2021 TX REG TEXT 589485 (NS), published November 5, 2021, adopts 26 TX ADC ? 306.1351 (Disaster Flexibilities) to establish
flexibility of certain requirements in the provision of behavioral health services and allow alternative methods other than face-to-face
contact or in-person interactions, such as the use of telehealth, telemedicine, video-conferencing, or telephonic methods. Allows a

child or adolescent participating in the YES Waiver Program to reside with another responsible adult. Provides that community mental
health providers may use the alternative interaction methods instead of a face-to-face contact to comply with certain listed training
requirements. Provides requirements for the Health and Human Services Commission (HHSC) to extend time frames for compliance
with staff training requirements based on training availability and feasibility. Adds additional requirements for community mental health
providers that avail themselves of the flexibilities allowed under this section. The rulemaking adopts a previous emergency regulation as
final and is effective November 15, 2021.

¢ 2021 TX REG TEXT 590837 (NS), filed July 30, 2021, amends by emergency, 22 TX ADC ? 174.5 (Issuance of Prescriptions)
providing that telemedicine treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way
communication is prohibited, unless: a patient is an established chronic pain patient of the physician, is receiving a prescription that

is identical to a prescription issued at the previous visit, and has been seen by the prescribing physician or health professional in the
last 90 days either in-person or via telemedicine using audio and video two-way communication. Provides that telemedicine medical
services may be used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law.
Provides that this emergency amendment effective July 31, 2021 at 12:01 A.M. shall be in effect for only 75 days or the duration of the
time period that the Governor's disaster declaration of March 13, 2020 in response to the COVID-19 pandemic is in effect, whichever
is shorter. The rulemaking continues, with changes, the previous emergency rulemaking (2021 TX REG TEXT 588307 (NS)) and is
effective July 31, 2021 and expires October 13, 2021.

¢ 2021 TX REG TEXT 590838 (NS), filed July 30, 2021, amends by emergency, 22 TX ADC ? 217.24 (Telemedicine Medical Service
Prescriptions) providing that telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means
other than via audio and video two-way communication is prohibited, unless: (i) a patient is an established chronic pain patient of

the APRN; (ii) is receiving a prescription that is identical to a prescription issued at the previous visit; and (iii) has been seen by the
prescribing APRN or physician or health professional in the last 90 days, either in-person or via telemedicine using audio and video
two-way communication. Specifies the factors an APRN shall consider when determining whether to utilize telemedicine medical
services for the treatment of chronic pain with controlled substances; and provides that if a patient is treated, the medical records must
document the exception and the reason that a telemedicine visit was conducted instead of an in-person visit. Defines chronic pain and
acute pain. Provides that telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless
otherwise prohibited under federal and state law. The rulemaking continues the previous emergency rulemaking (2021 TX REG TEXT
588308 (NS)) with changes and is effective August 1, 2021 and expires November 28, 2021.

¢ 2021 TX REG TEXT 590849 (NS), filed September 17, 2021, amends 22 TX ADC ? 174.5 (Issuance of Prescriptions) allowing
physicians to utilize telemedicine to continue issuing previous prescription(s) for scheduled medications to established chronic pain
patients, if the physician has, within the past 90 days, seen a patient in-person or via a telemedicine visit using two-way audio and video
communication. The rulemaking adopts a previous emergency rule (2021 TX REG TEXT 590849 (NS)) as final without changes and is
effective October 7, 2021.

¢ 2021 TX REG TEXT 590850 (NS), filed November 5, 2021, amends 22 TX ADC ? 217.24 (Telemedicine Medical Service
Prescriptions) providing that telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means
other than via audio and video two-way communication is prohibited, unless: (i) a patient is an established chronic pain patient of

the APRN; (ii) is receiving a prescription that is identical to a prescription issued at the previous visit; and (iii) has been seen by the
prescribing APRN or physician or health professional in the last 90 days, either in-person or via telemedicine using audio and video
two-way communication. Specifies the factors an APRN shall consider when determining whether to utilize telemedicine medical
services for the treatment of chronic pain with controlled substances; and provides that if a patient is treated for chronic pain through
the use of telemedicine, the medical records must document the exception and the reason that a telemedicine visit was conducted
instead of an in-person visit. Defines chronic pain and acute pain. Provides that telemedicine medical services may be used for the
treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law. This rulemaking was previously
adopted by emergency rule (2021 TX REG TEXT 590838 (NS)) and is effective November 25, 2021.

* 2021 TX REG TEXT 591773 (NS), filed August 16, 2021, amends 16 TX ADC ? 111.2 (Definitions), 16 TX ADC ? 111.51 (Assistant in
Speech-Language Pathology License--Supervision Requirements), 16 TX ADC ? 111.91 (Assistant in Audiology License--Supervision

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Requirements), 16 TX ADC ? 111.210 (Definitions Relating to Telehealth), 16 TX ADC ? 111.211 (Service Delivery Models for Speech-
Language Pathology), 16 TX ADC ? 111.212 (Requirements for the Use of Telehealth in Speech-Language Pathology), 16 TX ADC ?
111.215 (Requirements for Providing Telehealth Services in Audiology), 16 TX ADC ? 111.230 (purpose), and 16 TX ADC ? 111.232
(Requirements for Providing Telehealth Services for the Fitting and Dispensing of Hearing Instruments) allowing additional licensees to
provide telehealth services to clients, allow for direct and indirect supervision of certain licensees to be performed through telehealth,
remove in-person supervision requirements, removing caps and restrictions on the amount of supervision that can be conducted
through telehealth, updating the definition of 'telecommunications technology" to allow a smart phone, or any audio-visual, real-time,

or two-way interactive communication system, to qualify as telecommunications technology, removing the requirement that the initial
contact with a client must be in person, and replace that requirement with provisions stating that the initial contact may be in person

or through telehealth as determined appropriate by the provider and that the provider must consider certain factors in determining the
appropriateness of providing services via telehealth, and replacing references to 'telepractice" with the term 'telehealth." The regulations
were amended via emergency and are effective September 1, 2021 through December 29, 2021.

¢ 2021 TX REG TEXT 591774 (NS), filed August 16, 2021, amends 16 TX ADC ? 112.150 (Requirements Regarding the Fitting and
Dispensing of Hearing Instruments by Telehealth) updating the title and language to replace references to 'telepractice' with the term
'telehealth.' Updates the definition of 'telecommunications technology' to allow a smart phone, or any audio-visual, real-time, or two-way
interactive communication system, to qualify as telecommunications technology. Updates the provisions regarding facilitators to allow
for expanded use of facilitators. Removes the requirement that the initial contact with a client must be in person, and instead provides
that the initial contact may be in person or through telehealth as determined appropriate by the provider and that the provider shall
consider certain factors in determining the appropriateness of providing services via telehealth. Makes certain clarifying changes. The
regulation was amended via emergency and is effective September 1, 2021 through December 29, 2021.

* 2021 TX REG TEXT 597092 (NS), filed October 6, 2021, adopts 26 TX ADC ? 500.21 (ESRD Facility Requirements During the
COVID-19 Pandemic) allowing monthly visits for dialysis patients to be conducted using telemedicine medical services. The rulemaking
was via emergency and is effective October 8 and expires February 4, 2021.

* 2021 TX REG TEXT 597093 (NS), filed October 11, 2021, adopts 26 TX ADC ? 500.41 (Telemedicine or Telehealth During the
COVID-19 Pandemic) establishing the requirements for a licensed Chemical Dependency Treatment Facility (CDTF) to provide
telehealth and telemedicine treatment services to clients in order to reduce the risk of transmission of COVID-19. The rulemaking was
via emergency and is effective October 12 and expires February 8, 2021.

Utah

¢ 2021 UT H.B. 36 (NS), introduced January 19, 2021, would remove the sunset date from provisions requiring the Division of
Substance Abuse and Mental Health within the Department of Human Services to award a grant for a telehealth mental health pilot
program and provisions describing the program as a pilot program.

¢ 2021 UT H.B. 337 (NS), adopted March 15, 2021, amends UT ST ? 62A-15-1601 (Definitions) to define 'early childhood
psychotherapeutic telehealth consultation," and UT ST ? 62A-15-1602 (Psychiatric Consultation Program Account) to establish the
requirements for the early childhood psychotherapeutic telehealth consultation program. The bill is effective May 5, 2021.

¢ 2021 UT S.B. 28 (NS), adopted March 17, 2021, adopts UT ST ? 58-70a-501.2 (Scope of practice for a physician assistant
specializing in psychiatric mental health) to allow a physician assistant specializing in psychiatric mental health to providetelemedicine,
teletherapeutic, and telepsychiatric services through the use of electronic communication or information technology within the clinical
scope of services provided by the physician assistant. The bill is effective May 5, 2021.

¢ 2021 UT S.B. 41 (NS), adopted March 2, 2021, amends UT ST ? 31A-22-625 (Catastrophic coverage of mental health conditions) to
define 'telehealth services" and allow a diagnosis or treatment of a mental health condition to be rendered by a mental health therapist,
practicing within the scope of their license, through in-person services or telehealth services if the insurer determines that telehealth
services meet the appropriate standard of care for the diagnosis or treatment. The bill is effective March 2, 2021.

¢ 2021 UT S.B. 112 (NS), introduced January 20, 2021, would adopt the Occupational Therapy Practice Acts. One of the stated
purposes for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

¢ 2021 UT S.B. 161 (NS), adopted March 22, 2021, adopt UT ST ? 31A-22-649.6 (Insurance parity for behavioral telehealth services)
to define 'behavioral health treatment," 'behavioral telehealth services," and 'telehealth services" and to require a health benefit plan to
provide coverage for behavioral telehealth services and reimburse for the behavioral telehealth services at a rate that is at least 80% of
the rate that the state Medicaid program reimburses for behavioral health treatment that is provided in person. The bill is effective May
5, 2021.

¢ 2021 UT S.B. 170 (NS), adopted March 17, 2021, amends UT ST ? 26-61a-106 (Qualified medical provider registration--Continuing
Education--Treatment recommendation) to allow an individual to receive medical cannabis treatment from a limited medical provider if a
face-to-face visit for an initial recommendation or the renewal of recommendation for a patient for whom the limited medical provider did
not make the patient's original recommendation. The bill is effective March 17, 2021.

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¢ 2021 UT REG TEXT 571771 (NS), published February 1, 2021, adopts UT ADC R590-286-6 (Minimum Policy Standards) requiring
short-term limited duration health insurance that provides medical coverage to include coverage for medical services for diagnosis and
treatment of a covered condition including telehealth services and telemedicine services as appropriate. The regulation is effective
March 11, 2021.

¢ 2021 UT REG TEXT 577012 (NS), published February 15, 2021, amends UT ADC R156-1-602 (Telehealth - Definitions) to remove
definitions for 'Asynchronous store and forward transfer', 'Standards of Practice', 'Distant site' and 'Synchronous interaction' and to
make technical and clarifying changes. Amends UT ADC R156-1-603 (Telehealth - Scope of Telehealth Practice) to update the provider
requirements related to telehealth. The regulations are effective March 25, 2021.

Vermont

¢ 2021 VT H.B. 104 (NS), adopted May 12, 2021, would create the Facilitation of Interstate Practice Using Telehealth Working Group
to compile and evaluate methods for facilitating the practice of health care professionals throughout the United States using telehealth
modalities. The bill is effective May 12, 2021.

¢ 2021 VT H.B. 391 (NS), introduced March 9, 2021, would establish the Psychology Interjurisdictional Compact to regulate the day to
day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 VT H.B. 357 (NS), introduced February 26, 2021, would adopt new sections to deem an individual who is licensed, registered,
or certified to provide health care services in any other U.S. jurisdiction as being licensed, registered, or certified to provide health care
services in Vermont and to use telemedicine to provide health care services to patients located in Vermont.

¢ 2021 VT S.B. 87 (NS), engrossed February 23, 2021, would adopt new sections to allow, during a state of emergency, and in
consultation with the Commissioner of Health, the Director to authorize a health care professional or former healthcare professional
who practices or practiced a profession attached to the Office and who holds a valid license, certificate, or registration to provide those
health care services in any other U.S. jurisdiction to be deemed to be licensed, certified, or registered to provide health care services to
a patient located in Vermont using telehealth or as part of the staff of a licensed facility, wnen certain conditions are met.

Virginia

* 2020 VA H.B. 1987 (NS) and 2020 VA S.B. 1338 (NS),, adopted March 24, 2021, would amend VA ST ? 32.1-325 (Board to submit
plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of

plan; contracts with health care providers), VA ST ? 38.2-3418.16 (Coverage for telemedicine services), and VA ST ? 54.1-3303
(Prescriptions to be issued and drugs to be dispensed for medical or therapeutic purposes only) to clarify that nothing must preclude
coverage of telehealth services by an insurer proposing to issue individual or group accident and sickness insurance policies providing
hospital, medical and surgical, or major medical coverage on an expense-incurred basis and require the Board to amend the state plan
for medical assistance to provide for payment of medical assistance for remote patient monitoring services provided via telemedicine for
certain high-risk patients, and provides for the establishment of a practitioner-patient relationship via telemedicine for the prescribing of
Schedule II through VI controlled substances. The bill is effective July 1, 2021.

¢ 2020 VA H.B. 1988 (NS), adopted March 18, 20221, amends VA ST ? 54.1-3408.3 (Certification for use of cannabis oil for treatment)
to allow the practitioner to use his professional judgment to determine the manner, including through the use of telemedicine, and
frequency of patient care and evaluation provided that the use of telemedicine includes the delivery of patient care through real-time
interactive audio-visual technology. The bill is effective July 1, 2021.

* 2020 VA S.B. 1189 (NS), adopted March 18, 2021, adopts the Occupational Therapy Practice Acts. One of the stated purposes for the
Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services. The Compact
takes effect when it is enacted by a 10th member state.

¢ 2020 VA S.B. 1307 (NS), adopted March 18, 2021, amends VA ST ? 32.1-325 (Board to submit plan for medical assistance services
to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers)
to require health covered services include applied behavior analysis, preventive health care, behavioral health care, diagnostic care
including routine screenings, and acute care services and that services may be provided in person or through telemedicine. The bill is
effective July 1, 2021.

* 2020 VA S.B. 1338 (NS), adopted March 24, 2021, amends VA ST ? 32.1-325 (Board to submit plan for medical assistance services
to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers)
and VA ST ? 38.2-3418.16 (Coverage for telemedicine services) to define 'medically necessary" for the purposes of telemedicine
services and clarify the definitions of 'remote patient monitoring services" and 'telemedicine services." The bill also requires the Board
of Medical Assistance Services to include in the state plan for medical assistance services a provision for the payment of medical
assistance for medically necessary health care services provide through telemedicine services. The bill requires the Board to provide
payment for remote patient monitoring services provided through telemedicine services based on an annual publication by the Centers
for Medicare and Medicaid Services. The bill is effective July 1, 2021.

* 2021 VA REG TEXT 576099 (NS), filed January 1, 2021, amends 18 VAC 125-20-10 (Definitions), 18 VAC 125-20-150 (Standards of
practice), and 18 VAC 125-20-160 (Grounds for disciplinary action r denial of licensure) defining 'Compact," 'E.Passport," and 'IPC" and

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revising the standards of practice and the grounds for disciplinary action to cover persons practicing with an E.Passport or temporary
authorization to practice in Virginia through the Interjurisdictional Psychology Compact. The regulations were passed via emergency
and are effective January 3, 2021 through July 2, 2021.

¢ 2021 VA REG TEXT 589844 (NS), filed July 12, 2021, amends 18 VA ADC 110-60-30 (Requirements for practitioner issuing a
certification) to allow a practitioner to use telemedicine provided that the use of telemedicine includes the delivery of patient care
through real-time interactive audio-visual technology, conforms to the standard of care expected for in-person care, and transmits
information in a manner that protects patient confidentiality. The regulation is effective September 1, 2021.

Washington

¢ 2021 WAH.B. 1043 (NS), introduced January 11, 2021, would adopt the Audiology and Speech-Language Pathology Interstate
Compact and establish the requirements to practice audiology or speech-language pathology in any member state via telehealth under
a privilege to practice as provided in the Compact.

¢ 2021 WAH.B. 1196 (NS), adopted May 3, 2021, establishes the requirements for when insurers are required to reimburse a

provider for a health care service provided to a covered person through audio-only telemedicine. The bill also amend WA ST

41.05.700 (Reimbursement of health care services provided through telemedicine or store and forward technology),VWA ST 48.43.735
(Reimbursement of health care services provided through telemedicine or store and forward technology), VWA ST 70.41.020
(Definitions), WA ST 71.24.335 (Reimbursement for behavioral health services provided through telemedicine or store and forward
technology--Coverage requirements), and WA ST 74.09.325 (Reimbursement of a health care service provided through telemedicine or
store and forward technology--Report to the legislature) to define 'audio-only telemedicine" and 'established relationship" and to require
insurers to reimburse a provider for services provided via audio-only telemedicine if the covered person has an established relationship
with the provider. The bill is effective July 25, 2021.

¢ 2021 WAH.B. 1286 (NS), introduced January 19, 2021, would establish the Psychology Interjurisdictional Compact to regulate the
day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice.

¢ 2021 WAH.B. 1378 (NS), adopted April 14, 2021, amends WA ST 18.360.010 (Definitions) would update the definition for
'supervision' to provide that during a telemedicine visit, supervision over a medical assistant assisting a health care practitioner with the
telemedicine visit may be provided through interactive audio and video telemedicine technology. The bill is effective April 14, 2021.

* 2021 WA H.B. 1383 (NS), adopted April 21, 2021, amends WA ST 18.89.010 (Legislative findings--Insurance coverage not mandated)
to allow a respiratory care therapist to provide services through telemedicine to patients in health facilities licensed in this state, clinics,
home care, home health agencies, physicians' offices, and public or community health services. The bill is effective July 1, 2021.

«2021 WAH.B. 1462 (NS), introduced February 2, 2021, would amend WA ST 48.43.735 (Reimbursement of health care services
provided through telemedicine or store and forward technology) to clarify that an insurer must reimburse a provider for a health care
service provided to an insured through telemedicine at the same amount of total compensation as the insurer would pay if the health
care service was provided in person by the provider and to clarify that hospitals, hospital systems, telemedicine companies, and
provider groups consisting of 11 or more provider may elect a total compensation amount for telemedicine services that differs from the
total compensation amount for in-person services.

¢ 2021 WA S.B. 5304 (NS), adopted May 10, 2021, adopts a new section to require the Authority to convene a reentry services work
group to consider ways to improve reentry services for persons with an identified behavioral health services need and requiring the
work group to identify potential costs and savings for the state and local governments which could be realized through the use of
telehealth technology to provide mental and behavioral health services, expansion or replication of the reentry community services
program, or other reentry programs which are supported by evidence. The bill is effective July 25, 2021.

* 2021 WA S.B. 5325 (NS), amended/substituted February 12, 2021, would amend WA ST 71.24.335 (Reimbursement for behavioral
health services provided through telemedicine or store and forward technology--Coverage requirements) to clarify that upon initiation
or renewal of a contract with the authority, behavioral health administrative services organizations and managed care organizations
shall reimburse a provider for a behavioral health service provided to a covered person through telemedicine or store and forward
technology.

¢ 2021 WA S.B. 5423 (NS), adopted May 10, 2021, amends WA ST 18.71.030 (Exemptions) and WA ST 18.57.040 (Licensing
exemptions) to allow a consultation through telemedicine by a practitioner, licensed by another state or territory in which he or
she resides, with a practitioner licensed in Washington who has responsibility for the diagnosis and treatment of the patient within
Washington. The bill is effective July 25, 2021.

¢ 2021 WA REG TEXT 546052 (NS), filed August 11, 2021, adopts VWWA ADC 246-945-014 (Electronic prescribing mandate waiver)
to outline the electronic prescribing mandate, exceptions allowing a waiver, and related waiver process. The regulation is effective
September 11, 2021.

¢ 2021 WA REG TEXT 561686 (NS), filed March 5, 2021, amends WA ADC 246-930-010 (General definitions) updating the definition
for 'treatment' to remove 'face-to-face" from the definition of sex offender treatment enabling sex offenders to continue accessing

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telehealth treatment and enabling increased social distancing during the COVID-19 declared emergency. The regulation was amended
via emergency and is effective March 5, 2021.

¢ 2021 WA REG TEXT 561686 (NS), filed October 29, 2021, amends WA ADC 246-930-010 (General definitions) removing the words
'face-to-face' from the definition of sex offender treatment, enabling sex offenders to continue accessing telehealth treatment and
enabling increased social distancing during the coronavirus disease 2019 (COVID-19) declared emergency. The rulemaking was made
via emergency and is effective October 29, 2021.

* 2020 WA REG TEXT 562833 (NS), filed December 2, 2020, amends VWWA ADC 182-551-2040 (Face-to-face encounter requirements)
providing that during the current COVID-19 public health emergency, the face-to-face requirements of this section may be met using
telemedicine or telehealth services. The regulation was adopted via emergency and is effective December 2, 2020.

* 2021 WA REG TEXT 571418 (NS), filed March 4, 2021, amends WA ADC 182-507-0115 (Alien emergency medical program (AEM))
allowing the physician visit to be provided via telemedicine, online digital, or telephonic services.

¢ 2021 WA REG TEXT 571418 (NS), filed October 28, 2021, amends WA ADC 182-507-0115 (Alien emergency medical program
(AEM)) providing that for assessment and treatment of the COVID-19 virus, the agency covers 1 physician visits provided in any
outpatient setting, including the office or clinic setting, or via telemedicine, online digital or telephonic services to assess/evaluates and
test, if clinically indicated. The rulemaking was via emergency and is effective October 28, 2021.

¢ 2021 WA REG TEXT 591235 (NS), filed August 3, 2021, amends WA ADC 246-335-510 (Definitions-Home Health) and WA ADC
246-335-610 (Definitions-Hospice) updating the definition for 'telemedicine' and VWWA ADC 246-335-545 (Supervision of home health
services) and VWWA ADC 246-335-645 (Supervision of hospice services) allowing supervisory visits to be conducted on-site or via
telemedicine. The regulation was adopted via emergency and is effective August 3, 2021.

West Virginia

¢ 2021 WV H.B. 2007 (NS), engrossed February 18, 2021, would adopt WV ST ? 30-7F-3 (Occupational license or other authorization
to practice) to provide that a person offering telehealth services does not need to meet the residency requirements.

¢ 2021 WV H.B. 2024 (NS), adopted April 9, 2021, amends WV ST ? 30-3-13a (Coverage for telehealth services) providing definitions
and requiring plans to provide coverage of health services provided through telehealth services if those same services are covered
through face-to-face consultation. Adopts WV ST ? 9-5-28 (Reimbursement for telehealth rates) requiring a Medicaid plan to provide
reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for virtual telehealth
encounters. Amends WV ST ? 30-1-26 (Telehealth practice) defining 'interstate telehealth services" and 'registration" and update the
definition for 'telehealth services." Updates the licensing requirements for health care practitioners who practice telehealth. Permits a
fee for registration and place a cap on the fee. Permits physician-patient relationship to begin with an audio-only call or conversation
in real time. Requires a registration to report certain information to the Board and clarify that a registrant is subject to the laws of this
state. AmendsWV ST ? 30-3-13a (Telemedicine practice; requirements; exceptions; definitions; rule-making) and WV ST ? 30-14-12d
(Telemedicine practice; requirements; exceptions; definitions; rulemaking) defining terms, establishing the licensing and registration
requirements for a physician who practices telemedicine, providing for a standard of care, and establishing prescription limitations.
Amends WV ST ? 33-57-1 (Coverage of telehealth services) defining terms and requiring an insurer to provide coverage of health care
services provided through telehealth services if those same services are covered through face-to-face consultation by the policy. The
bill is effective March 30, 2021.

¢ 2021 WV H.B. 2173 (NS), introduced February 10, 2021, would adopt WV ST ? 33-15-4s (Additional mandatory policy provision) to
require an access plan to include the insurer's network, including how the use of telemedicine or telehealth or other technology may be
used to meet network access standards.

* 2021 WV H.B. 2226 (NS), introduced February 10, 2021, would amend WV ST ? 33-15-4 (Required policy provisions) to require an
access plan to include the insurer's network, including how the use of telemedicine or telehealth or other technology may be used to
meet network access standards.

¢ 2021 WV H.B. 2461 (NS), introduced February 13, 2021, and 2021 WV S.B. 197 (NS), introduced February 11, 2021, would amend
WV ST ? 64-9-1 (Board of Accountancy) to authorize the Board of Occupational Therapy to promulgate a legislative rule relating to
telehealth practice, requirements, and definitions.

¢ 2021 WV H.B. 2692 (NS), introduced February 23, 2021, would amend WV ST ? 30-3-13a (Telemedicine practice; requirements;
exceptions; definitions; rule-making) to change the section title from 'Telemedicine practice; requirements; exceptions; definitions; rule-
making; addiction telehealth services" and to allow telehealth services to be assigned to out-of-state providers in situations that involve
the treatment of addiction in the event of an emergency.

¢ 2021 WV H.B. 2880 (NS), introduced March 3, 2021, would amend WV ST ? 33-57-1 (Coverage of telehealth services) to require
telemedicine and telehealth systems to include accessible communication features to facilitate the use of telemedicine and telehealth
by individuals with a disability and individuals with a sensory impairment, including, but not limited to, individuals who are deaf, hard of
hearing, visually impaired, blind, or deaf-blind.

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¢ 2021 WV H.B. 2962 (NS), introduced March 8, 2021, would amend WV ST ? 30-4-3 (Definitions) to provide the definition for
'teledentistry" and adopt WV ST ? 30-4-25 (Teledentistry) to establish the requirements for the delivery of teledentistry services.

¢ 2021 WV H.B. 2968 (NS), introduced March 8, 2021, would amend WV ST ? 30-10-3 (Definitions) to provide the definition for
'telehealth" and 'telemedicine' and WV ST ? 30-10-9 (Scope of Practice for a Licensed Veterinarian) to authorize a veterinarian to
utilize telehealth or telemedicine technology.

¢ 2021 WV H.B. 3182 (NS), introduced March 16, 2021, would adopt WV ST ? 33-15-23 (Coverage for telemedicine service), WV

ST ? 33-16-19 (Coverage for telemedicine service), WV ST ? 33-24-46 (Coverage for telemedicine service), and WV ST ? 33-25-23
(Coverage for telemedicine service) to require insurers to provide benefits for telemedicine treatment and evaluation services service at
the same rate for the same in person medical services.

* 2021 WV S.B. 1 (NS), engrossed February 23, 2021, would amend WV ST ? 5-16-7b (Coverage for telehealth services) and

WV ST ? 33-57-1 (Coverage of telehealth services) to require a plan to provide reimbursement for a telehealth services on the

same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person
encounter rather than provided via telehealth. The bill would also readopt WV ST ? 30-1-26 (Telehealth practice) to define 'health care
practitioner" and 'telehealth services" and to regulate telehealth practice by a telehealth practitioner. The bill would amend WV ST ?
30-3-13a (Telemedicine practice; requirements; exceptions; definitions; rule-making) and WV ST ? 30-14-12d (Telemedicine practice;
requirements; exceptions; definitions; rule-making) to authorize a physician-patient relationship to be established through the use of
audio-only calls or conversations that occur in real time, prohibit a patient form having more than 3 telemedicine consultations without
an in-person primary care visit, and establish the standard of care.

¢ 2021 WV S.B. 273 (NS), introduced February 13, 2021, would amend WV ST ? 30-3-13a (Telemedicine practice; requirements;
exceptions; definitions; rule-making) to update the definition for 'telemedicine' and 'telemedicine technologies," to expand use of
telemedicine to all medical personnel, to allow four audio-only telemedicine encounters, to ensure parity for telemedicine to match in-
person coverage and fee, and to limit the ability of medical personnel professional licensure boards to restrict telemedicine.

¢ 2021 WV S.B. 668 (NS), adopted April 21, 2021, establishes the Interstate Psychology Interjurisdictional Compact to regulate the
day to day practice of telepsychology by psychologists across state boundaries in the performance of their psychological practice. The
Compact will come into effect on the date on which the Compact is enacted into law in the 7th Compact State.

«2021 WV REG TEXT 557867 (NS), filed April 5, 2021, adopts WV ADC ? 13-9-1 (General), WV ADC ? 13-9-2 (Definitions), WV
ADC ? 13-9-3 (Licensure), WV ADC ? 13-9-4 (Practitioner-patient relationship through telehealth), and WV ADC ? 13-9-5 (Telehealth
practice) establishing procedures for the practice of telehealth by an occupational therapist or occupational therapy assistant.

* 2021 WV REG TEXT 559732 (NS), passed April 6, 2021, adopts WV ADC ? 64-115-3 (Diabetes Self-Management Education)
allowing diabetes self-management programs to offer telehealth education when resources are limited, and otherwise communicate by
telephone when patients lack access to broadband intemet. The rulemaking is effective July 1, 2021.

¢ 2021 WV REG TEXT 565496 (NS), filed April 6, 2021, amends WV ADC ? 16-1-2 (Definitions) defining 'originating site" and
'telehealth services" and WV ADC ? 16-1-9 (Supervision of a Physical Therapist Assistant) to include telehealth sessions in the
requirements for supervision. Adopts WV ADC ? 16-1-12 (Telehealth) establishing the requirements for telehealth services to be used
to provide physical therapy services. The regulations are effective April 6, 2021.

¢ 2021 WV REG TEXT 565497 (NS), filed April 6, 2021, amends WV ADC ? 16-5-2 (Definitions) defining 'originating site" and
'telehealth services." Adopts WV ADC ? 16-5-13 (Telehealth) establishing the requirements for telehealth services to be used to provide
athletic training services. The regulations are effective April 6, 2021.

* 2021 WV REG TEXT 586079 (NS), filed July 26, 2021, adopts WV ADC ? 5-16 (Teledentistry) to establish the requirements for
teledentistry. New sections include: WV ADC ? 5-16-2 (Definitions), WV ADC ? 5-16-3 (Application for Registration and Annual
Renewal), WV ADC ? 5-16-4 (Delivery of Teledentistry) and WV ADC ? 5-16-5 (Complaints; investigations; due process procedure;
grounds for disciplinary action). The emergency rulemaking continues a previous emergency rulemaking with amendments and is
effective September 6, 2021.

¢ 2021 WV REG TEXT 590028 (NS), filed July 29, 2021, adopts WV ADC ? 19-16 (Telehealth Practice; Requirements; Definitions)

to establish the procedures for the practice of telenealth by a registered nurse or advanced practice registered nurse. New sections
include: WV ADC ? 19-16-2 (Definitions), WV ADC ? 19-16-3 (Telehealth Practice Requirements), WV ADC ? 19-16-4 (Interstate
Telehealth Registration Eligibility; Invalidation and Reinstatement), WV ADC ? 19-16-5 (Interstate Telehealth Registration Application,
Renewal and Expiration), WV ADC ? 19-16-6 (Establishment of the Practitioner-Patient Relationship), WV ADC ? 19-16-7 (Standard
of Care, Delivery of Telehealth Services and Medical Records), WV ADC ? 19-16-8 (APRN Prescribing Authority and Limitations), WV
ADC ? 19-16-9 (Complaint and Disciplinary Procedures for Interstate Telehealth Registrants). And WV ADC ? 19-16-10 (Registration
Denial, Professional Conduct, and Discipline). The rulemaking was adopted via emergency and is effective September 9, 2021.

Wisconsin

¢ 2021 WIA.B. 1 (NS), amended/substituted January 12, 2021, would adopt WI ST 609.719 (Telehealth services) providing that limited
service health organizations, preferred provider plans, and defined network plans are subject to WI ST 632.871 (Telehealth Services).

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The bill would also adopt WI ST 632.871 (Telehealth Services) to define 'disability insurance policy," 'self-insured health plan," and
'telehealth." It would also prohibit a disability insurance policy or self-insured health plan from denying coverage before January 1,
2022, for a treatment or service provided through telehealth if that treatment or service is covered by the policy or plan when provided in
person by a health care provider.

¢ 2021 WIA.B. 1 (NS), enrolled February 5, 2021, would adopt VV! ST 440.094 (Practice by health care providers from other states)
to allow a health care provider who practices within the scope of a temporary credential granted under this section to provide services
through telehealth to a patient located in this state.

¢ 2021 WI A.B. 68 (NS), amended/substituted June 30, 2021, would adopt WI ST 609.719 (Telehealth services) providing that limited
service health organizations, preferred provider plans, and defined network plans are subject to WI ST 632.871 (Telehealth Services).
The bill would also adopt WI ST 632.871 (Telehealth Services) to define 'disability insurance policy," 'self-insured health plan," and
'telehealth." It would also prohibit a disability insurance policy or self-insured health plan from denying coverage before January 1,
2022, for a treatment or service provided through telehealth if that treatment or service is covered by the policy or plan when provided in
person by a health care provider.

* 2021 WI A.B. 148 (NS), adopted March 26, 2021, adopts VV! ST 440.094 (Practice by health care providers from other states) to
allow a health care provider who practices within the scope of a temporary credential to provide services through telehealth to a patient
located in Wisconsin. The bill is effective March 27, 2021.

¢ 2021 WI S.B. 137 (NS), introduced February 24, 2021, would adopt VV! ST 440.094 (Practice by health care providers from other
states; necessity) to allow a health care provider who practices within the scope of a temporary credential to provide services through
telehealth to a patient located in Wisconsin.

¢ 2021 WI A.B. 259 (NS), introduced April 8, 2021, would adopt WI ST 632.872 (Telehealth services) to define 'self-insure health plan"
and 'telehealth." Prohibit an insurer or self-insured health plan from denying coverage or refusing to reimburse a health care provider for
a treatment or services provided through telehealth, including provided over audio-only telephone or interactive video, if that treatment
or service is covered and reimbursable by a plan or a policy offered by the plan or insurer when provided in person by the health care
provider.

* 2021 WI A.B. 296 (NS), introduced May 3, 2021, would amend WV! ST 440.01 (Definitions) to define 'asynchronous telehealth service,"
'interactive telehealth," 'remote patient monitoring," and 'telehealth. Adopt WI ST 440.17 (Telehealth) to define 'telehealth."

¢ 2021 WI A.B. 410 (NS), introduced June 25, 2021, would adopt the Occupational Therapy Practice Acts. One of the stated purposes
for the Act would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy services.

¢ 2021 WI A.B. 537 (NS), introduced September 10, 2021, and 2021 WI S.B. 534 (NS), introduced August 26, 2021, would establish the
Psychology Interjurisdictional Compact to regulate the day to day practice of telepsychology by psychologists across state boundaries
in the performance of their psychological practice.

¢ 2021 WI S.B. 306 (NS), introduced April 21, 2021, would adopt WI ST 609.713 (Telehealth services) to provide that limited service
health organizations, preferred provider plans, and defined network plans are subject to WI ST 632.872 (Telehealth services). Adopt
WI ST 632.872 (Telehealth services) to define 'self-insured health plan" and 'telehealth" and to prohibit an insurer or self-insured health
plan from denying coverage or refusing to reimburse a health care provider for a treatment or service provided through telehealth,
including provided over audio-only telephone or interactive video, if that treatment or service is covered and reimbursable by a plan or a
policy offered by the plan or insurer when provided in person by the health care provider.

¢ 2021 WI S.B. 309 (NS), introduced April 21, 2021, would amend VV! ST 440.01 (Definitions) to define 'asynchronous telehealth
service," 'interactive telehealth," 'remote patient monitoring," and 'telehealth. Adopt WI ST 440.17 (Telehealth) to define 'telehealth."

¢ 2021 WI S.B. 412 (NS), introduced June 10, 2021, would adopt the Occupational Therapy Interstate Compact. One of the stated
purposes for the Compact would be to facilitate the use of telehealth technology in order to increase access to Occupational Therapy
services.

Wyoming

¢ 2021 WY S.F. 74 (NS), adopted April 2, 2021, amends WY ST ? 33-45-106 (Board of athletic training; powers and duties; fees;
deposit in separate account to fund administration; separate account for enhancing practice of athletic training) requiring the Board to
promulgate rules and regulation including the provision of telehealth services. The bill is effective July 1, 2021.

* 2020 WY REG TEXT 562545 (NS), filed published December 16, 2020, adopts WY ADC 059.0001.13 ? 1 (Authority and Statement
of Purpose), WY ADC 059.0001.13 ? 2 (Definitions), and WY ADC 059.0001.13 ? 3 (Guidelines for Use of Telehealth) establishing the
guidelines for the use of telehealth for speech-language pathology and audiology services. The regulations are effective December 9,
2020.

* 2021 WY REG TEXT 567132 (NS), published January 13, 2021, adopts WY ADC 078.0001.20 ? 2 (Continuity of Care) allowing, for
the duration of a state of emergency declared by the Governor of the State of Wyoming, any mental health professional licensed or
certified by another state who has an existing provider-client relationship with a Wyoming citizen to continue to provide services to the

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individual through telehealth technology until 30 days after the state of emergency is lifted. This regulation adopts as final a previously
adopted emergency rule without change and is effective January 7, 2021.

¢ 2021 WY REG TEXT 585179 (NS), published September 22, 2021, adopts WY ADC 065.0001.10 ? 1 (Authority and Statements of
Purpose), WY ADC 065.0001.10 ? 2 (Definitions), and WY ADC 065.0001.10 ? 3 (Requirements for Use of Telehealth) establishing
standards governing the delivery of athletic training services via telehealth. The regulations are effective September 22, 2021.

V. E-Prescribing and E-Prescription Monitoring Programs

Proponents tout the usefulness and benefits of electronic prescribing technology in reducing drug prescribing errors, largely attributed
to illegible prescription orders, and increasing efficiencies in delivering prescription drugs to patients.

The use of electronic prescriptions has grown dramatically in recent years. In December 2008 only 7% of U.S. physicians were using e-

prescriptions. IFN113] That number rose to 48% by June 2012 with lowa, Minnesota, New Hampshire, and North Dakota experiencing
the greatest growth. During that same time the number of community pharmacies that can accept e-prescriptions rose from 76% to
94%. There was also during that time a ten-fold increase in the growth of new and renewal e-prescriptions. The states with the highest
volume of e-prescriptions are California, Texas, New York, and Florida.

In the fall of 2014, CMS released its 'User Guide:2013 Electronic Prescribing (eRx) Incentives Feedback Reports." [FN114] According

to the CMS the report is designed to assist eligible professionals, group practices and their authorized users in interpreting the 2013
eRx Incentives Feedback Reports. The report reflects data from the Medicare Part B Physician Fee Schedule claims received for the
dates of service January 1, 2013 ? December 31, 2013 that were processed into National Claims History (NCH) by February 28, 2014.
Additionally, quality data was received from qualified registries and EHR systems for purposes of the eRx Incentive Program. The 2013
eRx incentive payment is scheduled to be distributed in the fall of 2014. Participation in the 2013 eRx Incentive Program was defined as
individual EPs or group practices participating via eRx GPRO submitting at least one eRx quality-data code (QDC) via claims or quality
data via qualified registry, or qualified EHR submission methods.

Much like past years, security and the prevention of fraud and abuse related to prescriptions are important themes as lawmakers
propose strict prerequisites for issuing electronic prescription orders and the establishment or enhancement of electronic monitoring
programs to track controlled substances.

Beginning March 27, 2016, all prescriptions written in New York must be transmitted electronically from the prescriber directly to the
pharmacy. IFN115] This requirement is a component of New York's I-STOP Act.

I-STOP aims to reduce the number of deaths caused by opioid addiction and the over-prescription of painkillers by implementing
improved electronic monitoring methods. I-STOP was passed in 2012 as part of New York's continuing effort to lead the way in
programs to track, monitor and protect against drug abuse. The first process in the I-STOP Act went in to effect August 27, 2013
requiring all prescribers to consult the Prescription Monitoring Program (PMP) Registry when writing a prescription for a Schedule II,
Ill, and IV controlled substance. I-STOP is intended to help practitioners better evaluate their patients being treating with controlled
substance and prevent prescription drug abuse and overdose, prescription fraud, prescription errors, and double doctoring/doctor
shopping.

By moving to a 100% electronic prescription system, paper prescription pads can no longer be stolen, forged, or alter to illegally obtain
a prescription drug. There is limited exception to the I-STOP Act. I-STOP does not apply to veterinarians. All other prescribers of
controlled substances require the prescription to be transmitted electronically, regardless of the amount of supply. An exception to

this rule, is that a paper or oral prescription may be issued for a controlled substance that does not exceed a 5-day supply, only if the
practitioner determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely
manner, and such delay would adversely impact the patient's medical condition.

Recent Federal Activity

« 85 FR 86824-01, issued December 29, 2020, amends 42 CFR ? 423.160 (Standards for electronic prescribing) to adopt a new
standard for certain transactions concerning Part D-covered drugs prescribed to Part D-eligible individuals under the Part D e-
prescribing program. Provides that beginning January 1, 2021, Part D sponsors and prescribers may use the National Council

for Prescription Drug Programs SCRIPT standard, Implementation Guide Version 2017071 to provide for the communication of a
prescription or prescription-related information between prescribers and Part D sponsors for certain listed transactions. Provides that
beginning January 1, 2022, Part D sponsors and prescribers must use the new standard. The regulation is effective February 1, 2021.

¢ 86 FR 7813-01, issued February 2, 2021, delays the effective date of the final rule amending 42 CFR ? 423.160 (Standards for
electronic prescribing) published at 85 FR 86824-01 on December 31, 2020, from February 1, 2021, to March 30, 2021.

Recent State Activity
Arizona

2021 AZ S.B. 1088 (NS), adopted March 18, 20221, amends AZ ST ? 36-2525 (Prescription orders; labels; packaging; definition) to
clarify that a pharmacy may sell and dispense a schedule II controlled substance prescribed by a medical practitioner who is located

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in another state if the prescription was issued to the patient according to and in compliance with the applicable laws of the state of the
prescribing medical practitioner and federal law. The bill is effective July 24, 2021.

Arkansas

2021 AR H.B. 1107 (NS), adopted February 4, 2021, amends AR ST ? 20-7-607 (Providing prescription monitoring information) to
require prescribers or dispensers, or both, to provide physical copies of written or electronic prescriptions upon request to validate data
submitted to the program in order to evaluate the information reported by the program. The bill is effective August 2, 2021.

Colorado

¢ 2021 CO H.B. 1276 (NS), adopted June 28, 2021, amends CO ST ? 12-280-404 (Program operation--access--rules--definitions--
repeal) to allow the Board to, within existing funds available for operation of the Program, provide a means of sharing prescription
information and electronic health records through a Board-approved vendor and method with the health information organization
network in order to work collaboratively with the statewide health information exchanges designated by the Department of Health Care
Policy and Financing. The bill is effective July 1, 2021.

* 2021 CO S.B. 98 (NS), adopted June 22, 2021, would amend CO ST ? 24-34-104 (General assembly review of regulatory agencies
and functions for repeal, continuation, or reestablishment-legislative declaration-repeal) to extend the sunset provision of the
electronic prescription drug monitoring program to September 1, 2028. The bill is effective July 1, 2021.

Connecticut

2021 CT H.B. 5407 (NS), introduced January 22, 2021, would amend CT ST ? 21a-254 (Designation of restricted drugs or substances
by regulations. Records required by chapter. Electronic prescription drug monitoring program) to require the dispensing or administering
directly to a patient of an opioid agonist to be reported through the electronic prescription drug monitoring program.

Delaware

2021 DE REG TEXT 578327 (NS), issued June 1, 2021, adopts 24 DE ADC 1700-20.0 (Electronic Prescribing [Authority: 24 Del.C. ?
1764A)) clarifying the circumstances under which a prescriber can request a waiver from the Board of the electronic prescribing
requirements. The regulation is effective June 11, 2021.

Hawaii

* 2021 HI H.B. 1037 (NS), amended/substituted March 23, 2021, 2021 HI H.B. 1038 (NS), introduced January 27, 2021, and 2021 HI
S.B. 1191 (NS), amended/substituted February 18, 2021, would amend HI ST ? 329-104 (Confidentiality of information; disclosure

of information) to clarify that an advanced practice registered nurse or pharmacist may access information stored in the electronic
prescription accountability system (EPAS) and would adopt new sections to establish an information technology modernization program
management office to provide guidance and support to major public information technology projects.

¢ 2021 HI S.B. 1192 (NS), amended/substituted February 17, 2021, would amend HI ST ? 329-101 (Reporting of dispensation
of controlled substances; electronic prescription accountability system; requirements; penalty) to require that the dispensing of a
pharmacist-prescribed opioid antagonist be reported to the State's Electronic Prescription Accountability System.

¢ 2021 ME S.P. 71 (NS), adopted May 25, 2021, amends ME ST T. 32 ? 4878 (Requirements regarding prescribing and dispensing
benzodiazepine or opioid medication) to delay the implementation of the requirement that a veterinarian whose scope of practice
includes prescribing a benzodiazepine or an opioid medication prescribe all benzodiazepine or opioid medication electronically to July
1, 2025. The bill is effective June 29, 2021.

¢ 2021 ME S.P. 207 (NS), adopted May 25, 2021, amends ME ST T. 24-A ? 4304 (Electronic transmission of prior authorization
requests) to require insurers to make available to a provider in real time at the point of prescribing one or more electronic benefit tools
that are capable of integrating with at least one electronic prescribing system or electronic medical record system to provide complete,
accurate, timely, clinically appropriate formulary and benefit information specific to an enrollee, including, but not limited to, enrollee
cost-sharing information, information on any available formulary alternatives that are clinically appropriate and information about the
formulary status and the utilization review and prior authorization requirements of each drug presented. The bill is effective January 1,
2022.

Massachusetts

2020 MA REG TEXT 549897 (NS), published August 6, 2021, amends 130 MA ADC 409.416 (Requirements for Prescriptions or
Letters of Medical Necessity Completed by the Ordering Practitioner) providing the MassHealth agency accepts electronic prescriptions
(escripts) that comply with state and federal requirements. The regulation is effective August 6, 2021.

Michigan

2021 MI REG TEXT 535640 (NS), filed December 22, 2020, adopts | ADC R 338.584 (Noncontrolled prescriptions) establishing the
requirements for an electronic prescription. Repeals !il ADC 338.479b (Noncontrolled prescriptions). The rules are effective December
22, 2020.

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Minnesota

¢ 2021 MN H.F. 58 (NS), engrossed March 10, 2021, would amend MN ST ? 62J.497 (Electronic prescription drug program) to require
a group purchasers and pharmacy benefit managers to use a real-time prescription benefit tool that complies with the NCPDP Real-
Time Prescription Benefit Standard and that, at a minimum, notifies a prescriber if a prescribed drug is covered by the patient's

group purchaser or pharmacy benefit manager, if a prescribed drug is included on the formulary or preferred drug list of the patient's
group purchaser or pharmacy or pharmacy benefit manager, of any patient cost-sharing for the prescribed drug, if prior authorization
is required for the prescribed drug, and of a list of any available alternative drugs that are in the same class as the drug originally
prescribed and for which prior authorization is not required.

¢ 2021 MN H.F. 2121 (NS), introduced March 11, 2021, would amend MN ST ? 62J.497 (Electronic prescription drug program) to
update the standards for electronic prescribing.
Missouri

2021 MO REG TEXT 574491 (NS), published May 3, 2021, adopts 19 MMO ADC 30-1.080 (Electronic Prescribing Waiver) establishing
the process for practitioners to obtain waivers to the electronic prescribing requirements established by MO ST 195.550 (Electronic
prescriptions required, when, exceptions--violations). The regulation is effective June 30, 2021.

Nebraska

2021 NE L.B. 583 (NS), adopted May 5, 2021, adopts new section to require electronic issuance of prescriptions for controlled
substances and update related sections. The bill is effective January 1, 202.

Nevada

2021 NV S.B. 214 (NS), introduced March 11, 2021, would extend the maximum length of exemptions from certain requirements
governing electronic prescriptions.

New Hampshire

2021 NH H.B. 143 (NS), amended/substituted May 27, 2021, would amend NH ST ? 318:47-c (Prescriptions) to provide that a patient
must be entitled to receive a paper prescription instead of an oral or electronically transmitted prescription, except prescriptions for
controlled drugs as defined in NH ST ? 318-B:1 (Definitions).

New Mexico

2021 NM TEXT 578948 (NS), published May 25, 2021, adopts NM ADC 16.19.26.14 (Prescribing Dangerous Drugs in Conjunction with
Point-of-Care Testing) requiring the prescribing pharmacist to generate a written or electronic prescription for any medication dispensed
under the protocol. The regulation is effective May 31, 2021.

New York

¢ 2021 NY A.B. 5411 (NS), amended/substituted April 23, 2021, would adopt NY INS ? 341-a (Patient prescription pricing transparency)
to define 'interoperability element," 'electronic health record," 'electronic prescribing system," 'electronic prescription," and 'real-time
benefit tool" or 'RTBT" and require health plans to furnish the cost, benefit, and coverage data for prescriptions.

¢ 2021 NY A.B. 8227 (NS), amended/substituted September 16, 2021, would amend NY PENAL ? 220.00 (Controlled substances;
definitions) to updated the definition for 'prescription for a controlled substance" to include an electronic prescription.

¢ 2021 NY S.B. 101 (NS), introduced January 6, 2021, would amend NY PENAL ? 220.00 (Controlled substances; definitions) to
updated the definition for 'prescription for a controlled substance" to include an electronic prescription.

¢ 2021 NY S.B. 1017 (NS), amended/substituted August 6, 2021, would amend NY PENAL ? 220.00 (Controlled substances;
definitions) to include an electronic prescription within the definition for 'prescription for a controlled substance."

¢ 2021 NY S.B. 4620 (NS), amended/substituted April 28, 2021, would adopt the 'Patient Rx Information and Choice Expansion Act" or
the 'PRICE Act" to define 'electronic health record," 'electronic prescribing system," and 'electronic prescription" and to require health
plans operating in the state to furnish the cost, benefit, and coverage data as required to the insured, his or her health care provider, or
the third-party of their his or her choosing.

* 2021 NY S.B. 6838 (NS), introduced May 19, 2021, would amend NY PUB HEALTH ? 281 (Official New York state prescription forms)
and NY EDUC ? 6810 (Prescriptions) removing exceptions to the requirement to prescribe medications electronically.

Ohio

2021 OH H.B. 193 (NS), engrossed June 23, 2021, would amend OH ST ? 3719.05 (Rules for pharmacists) to require a schedule
Il controlled substance to be dispensed on upon an electronic prescription, with an exception for oral prescriptions in an emergency
situation as provided in the federal drug abuse control laws.

Oklahoma

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¢ 2021 OK H.B. 2676 (NS), adopted April 28, 2021, amends OK ST T. 63 ? 2-309 (Prescriptions) to exempt certain practitioners from
electronic prescription requirements for controlled dangerous substances, allow for the utilization of electronic prescriptions under
certain circumstances, and expand the definition to allow for the inclusion of certain information on electronic prescriptions. The bill is
effective November 1, 2021.

¢ 2021 OK S.B. 4 (NS), adopted April 22, 2021, adopts OK ST T. 59 ? 355.4 to require a pharmacist who dispenses a biological
product to communicate to the prescriber the name and manufacturer of the drug within 5 business days following the dispensing of
the biological product. The communication shall occur via an entry in an interoperable electronic medical records system, an electronic
prescribing technology, a pharmacy benefit management system or a pharmacy record that can be accessed electronically by the
prescriber. The bill is effective November 1, 2021.

¢ 2021 OK S.B. 58 (NS), adopted April 27, 2021, amends OK ST T. 63 ? 2-309 (Prescriptions) to provide that the electronic prescription
requirement does not apply to prescriptions for controlled dangerous substances issued by a practitioner who orders a controlled
dangerous substance to be administered through a hospice program as defined in OK ST T. 63 ? 1-860.2 (Definitions). The bill
declared that an emergency exists and is effective immediately.

Oregon

2021 OR REG TEXT 582536 (NS), filed June 24, 2021, adopts OR ADC 851-055-0070 (Standards for Prescriptive -Privilege) requiring
an electronically transmitted prescription to include the name and immediate contract information of the prescriber and be electronically
encrypted or in some manner protected by up-to-date technology from unauthorized access, alteration or use. Adopts OR ADC
851-055-0076 (Drug Delivery and Dispensing) requiring a person granted dispensing authority to have available at the dispensing

site a hard copy or electronic version of prescription drug reference works commonly used by professionals authorized to dispense
prescription medications. The regulations are effective July 1, 2021.

Tennessee

2021 TN REG TEXT 568814 (NS), filed July 8, 2021, adopts TN ADC 1200-10-04 (Waiver from Electronic Prescription Mandate)
establishing the requirements for a waiver from electronic prescription mandate. New sections include TN ADC 1200-10-04-.01 (Petition
for Waiver), TN ADC 1200-10-04-.02 (Petition for Waiver Information), TN ADC 1200-10-04-.03 (Duration of Waiver or Renewal of a
Waiver), TN ADC 1200-10-04-.04 (Circumstances Where Electronic Prescribing is Not Available due to Temporary Technological or
Electrical Failure), and TN ADC 1200-10-04-.05 (Prescriptions to be Dispensed Out-of-State). The regulation is effective October 6,
2021.

Texas

¢ 2021 TX H.B. 2056 (NS), adopted June 16, 2021, amends TX OCC ? 111.001 (Definitions), TX OCC ? 111.002 (Informed Consent),
TX OCC ? 111.004 (Rules), TX OCC ? 111.005 (Practitioner-Patient Relationship for Telemedicine Medical Services or Teledentistry
Dental Services), TX OCC ? 111.006 (Coordination to Adopt Rules That Determine Valid Prescription), TX OCC ? 111.007 (Standard
of Care for Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services), TX OCC ? 251.003 (Practice

of Dentistry), TX OCC ? 258.001 (Impermissible Delegations), TX OCC ? 262.152 (Performance of Delegated Duties), TX OCC ?
562.056 (Practitioner-Patient Relationship Required), TX GOVT ? 531.001 (Definitions), TX GOVT ? 531.0216 (Participation and
Reimbursement of Telemedicine Medical Service Providers, Teledentistry Dental Service Providers, Teledentistry Dental Services,
and Telehealth Service Providers Under Medicaid), TX GOVT ? 531.02162 (Medicaid Services Provided Through Telemedicine
Medical Services and Telehealth Services to Children With Special Health Care Needs), TX HEALTH & S 762.157 (Telemedicine
Medical Services and Telehealth Services for Children With Special Health Care Needs), TX HEALTH & S ? 62.1571 (Telemedicine
Medical Services and Teledentistry Dental Services), TX INS ? 1455.001 (Definitions), TX INS ? 1455.004 (Coverage for Telemedicine
Medical Services, Teledentistry Dental Services, and Telehealth Services), and TX INS ? 1455.006 (Telemedicine Medical Services,
Teledentistry Dental Services, and Telehealth Services Statement), and adopt TX OCC ? 111.0075 (Licensing for Teledentistry
Dental Services), TX OCC ? 111.009 (Limitation on Certain Prescriptions), TX GOVT ? 531.02172 (Reimbursement for Teledentistry
Dental Services) to update the requirements for the practice of dentistry and the provision of teledentistry dental services and to
require Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in Texas. The

bill is effective September 1, 2021, except the amendments to TX INS ? 1455.004 (Coverage for Telemedicine Medical Services,
Teledentistry Dental Services, and Telehealth Services) and TX INS ? 1455.006 (Telemedicine Medical Services, Teledentistry Dental
Services, and Telehealth Services Statement) which take effect January 1, 2022.

¢ 2020 TX REG TEXT 569594 (NS), filed December 11, 2020, adopts 22 TX ADC ? 111.5 (Electronic Prescribing Waivers) allowing
for prescriber waivers which may be renewed annually, if the prescriber is experiencing: 1) economic hardship; 2) technological
limitations not reasonably within the control of the prescriber; or 3) other exceptional circumstances demonstrated by the prescriber.
The regulation is effective December 31, 2020.

¢ 2020 TX REG TEXT 570093 (NS), filed December 11, 2020, adopts 22 TX ADC ? 170.10 (Electronic Prescribing of Controlled
Substances) establishing the requirements and exceptions related to electronic prescribing of controlled substances, and the process
and circumstances in which a physician may obtain a waiver from such requirements. The regulation is effective December 31, 2020.

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¢ 2020 TX REG TEXT 572598 (NS), filed January 12, 2021, amends 22 TX ADC ? 222.4 (Minimum Standards for Prescribing or
Ordering Drugs and Devices) requiring licensee prescribers to issue their prescriptions electronically beginning January 1, 2021, unless
one of the specified circumstances in TX HEALTH & S ? 481.0755 (Written, Oral, and Telephonically Communicated Prescriptions)
applies. Also provides circumstances that will allow a licensee prescriber to request a waiver from the electronic prescribing
requirements. The rule is effective February 16, 2021.

¢ 2020 TX REG TEXT 573091 (NS), filed March 12, 2021, amends 16 TX ADC ? 130.59 (Opioid Prescription Limits and Required
Electronic Prescribing) establishing the waiver of electronic prescribing request. The regulation is effective April 1, 2021.

Utah

¢ 2021 UT H.B. 265 (NS), adopted March 16, 2021, amends UT ST ? 58-37-6 (License to manufacture, produce, distribute, dispense,
administer, or conduct research--Issuance by division--Denial, suspension, or revocation--Records required--Prescriptions) to remove
requirement that each prescription issued for a controlled substance be transmitted electronically. The bill adopts UT ST ? 58-37-22
(Electronic prescriptions for controlled substances) to require that each prescription issued for a controlled substance be transmitted
electronically unless certain conditions are met and to require a pharmacy software system that receives electronic prescriptions for a
controlled substance to allow an unfilled prescription to be transferred to a different pharmacy. The bill is effective May 5, 2021.

¢ 2021 UT REG TEXT 570344 (NS), published November 15, 2020, repeals UT ADC R156-82 (Electronic Prescribing Act Rule)
including sections UT ADC R156-82-101 (Title), UT ADC R156-82-103 (Authority ? Purpose), UT ADC R156-82-201 (Security), UT
ADC R156-82-202 (Informing Patients), and UT ADC R156-82-203 (Waiver). The regulations are repealed effective December 24,
2020.

Virginia

2021 VA REG TEXT 535196 (NS), filed April 12, 2021, amends 18 VA ADC 85-21-21 (Electronic prescribing) to require a prescription
for a controlled substance that contains an opioid to be issued as an electronic prescription unless the prescriber qualifies for an
exemption set out in the law and provide a one-time waiver of this requirement for a maximum of one year if a practitioner can

demonstrate economic hardship, technological limitations, or other exceptional circumstances beyond the practitioner's control. The
rulemaking is effective June 9, 2021.

Washington

2021 WA REG TEXT 553783 (NS), filed October 25, 2021, amends WA ADC 246-945-010 (Prescription and chart order-Minimum
requirements) providing that a singed prescription is either a paper prescription, an electronic prescription, a copy of the paper
prescription sent via facsimile to the pharmacy, or a photograph or scanned copy of the paper prescription sent to the pharmacy. The
rulemaking was via emergency and is effective October 25, 2021.

West Virginia

2021 WV H.B. 2311 (NS), introduced February 12, 2021, would adopt WV ST ? 30-5-12d (Mandatory e-prescribing; exceptions)
requiring prescriptions to be made by electronic means with exceptions.

Wisconsin

2020 WI REG TEXT 331246 (NS), published December 28, 2020, repeals and reenacts WI ADC ? Phar 7 (Pharmacy Practice). The
rulemaking allows a pharmacist to dispense pursuant to an electronic prescription, if the prescription is sent to the patient's choice
of pharmacy, contains the elements of a prescription and may be signed with the prescriber's electronic signature and requires
pharmacies providing centralized prescription filling to share a common electronic file to allow access to sufficient information
necessary to fill or refill a prescription order. The rules are effective January 1, 2021.

Vi. Conclusion

Both patients and health care professionals have become comfortable with and more dependent on the use of healthcare technology.
Funds from the American Recovery and Reinvestment Act for health IT helped the states to begin the process of achieving the
important national objective of having comprehensive digital medical information systems. In addition, federal funds have enabled many
healthcare providers to adopt the use of health IT. An increasing number of state legislatures are requiring that insurance companies
recognize the importance of health IT and cover treatments appropriately done by telemedicine. As American healthcare systems

strive toward implementing digital technology, lawmakers and policymakers will continue to address cost and security concerns to
encourage more widespread adoption of health IT by healthcare providers and facilities. In addition, professional organizations are
issuing guidelines for healthcare providers in their use of social media.

© Copyright Thomson/West - NETSCAN's Health Policy Tracking Service

 

[FN2]

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. Executive Order 13410, "Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care
Programs," 71 FR 51089, 2006 WL 2463679 (Aug. 22, 2006).

[FN3]

. 'Top 12 Legislative Issues of 2012', NCSL News, National Conference of State Legislatures, Jan. 3, 2012, available at:http://
www.ncsl.org/?tabid=24021.

[FN4]

. Erin McCann, 'Former UConn Employee Breached Health Records,' Government Health IT, Privacy and Security, March 14, 2013,
available at:http://www.govhealthit.com/news/former-uconn-employee-breaches-health-records.

[FN5]

. Erin McCann, 'HIPAA Breach for 34K After Staff Slipup,' HealthcarelTNews, June 13, 2014, available at:http://
www.healthcareitnews.com/news/HIPAA-breach-34K-after-staff-slipup.

[FN6]

. '6th Annual HIMSS Security Survey,' HIMSS, February 19, 2014, available at: http://himss.files.cms-
plus.com/2013_HIMSS_Security_Survey.pdf.

[FN7]

. Pamela Lewis Dolan, 'Passwords Make Doctors Vulnerable, But Solutions Are Easy,' Amednews.com, American Medical News, Nov.
12, 2012, available at:http:/Awww.ama-assn.org/amednews/201 2/1 1/12/bil21112.htm.

[FN8]

. '2012 Data Breach Investigations Report,' a study conducted by the Verizon RISK Team with cooperation from the Australian Federal
Police, Dutch National High Tech Crime Unit, Irish Reporting, and Information Security Services, Police Central e-Crime Unit, and
United States Secret Service, October 2012, available at:http:/Avww.verizonbusiness.com/about/events/201 2dbir/.

[FN9]

. Healthcare Vendors Identified as the 'Unlocked Backdoor to Healthcare Data,' CORL Technologies Press Release, June 27, 2014,
available at:http://www.prweb.com/releases/201 4/06/prweb1 1977024.htm.

[FN10]

. Mary Mosquera, "HHS:Patients Should Receive Easily Understood HIE Privacy Notices," Government

Health IT, Oct. 18, 2010, available at:http:/Awww.govhealthit.com/newsitem.aspx?nid=74873. For

more information on the recommendations of the panel accesshttp://healthit.hhs.gov/portal/server.pt?
open=512&objID=1814&parentname=CommunityPage&parentid=18&mode=2&in_hi_userid=11673&cached=true#102010.

[FN11]

. Personal Health Record (PHR) Model Privacy Notice, The Office of the National Coordinator for Health Technology, September 2011
available at:http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__phr_model_privacy_notice/1176.

[FN12]

. "New Tools to Help providers Protect Patient Data on Mobile Devices," Department of Health and Human Services Press Release,
December 12, 2012, available at:http:/Awww.hhs.gov/news/press/2012pres/12/20121212a.html.

[FN13]

. 'HHS Releases Security Risk Assessment Tool to Help Providers with HIPAA Compliance,' Department of Health & Human Services
Press Release, March 28, 2014, available at:http://www.hhs.gov/news/press/2014pres/03/20140328a.html.

[FN14]

. Pamela Lewis Dolan, 'Data Breach Insurance Goes Mainstream in Health Care,' Amednews.com, Aug. 19, 2013, available at: http://
www.amednews.com/article/2013081 9/business/130819963/2/.

[FN15]

. 'Medicare Information Technology:Centers for Medicare and Medicaid Services Needs to Pursue a Solution for Removing Social
Security Numbers from Medicare Cards,' United States Government Accountability Office, Sept 10, 2013, GAO-13-761, available
at:http:/Awww.gao.gov/products/GAO- 13-761.

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[FN16]

. 'Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology,' Office of Inspector General of
the Department of Health & Human Services, Report (OEI-01-11-00570), Dec. 9, 2013, available at:http://oig.hhs.gov/oei/reports/
oei-01-11-00570.asp

[FN17]

. 'CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs,' Office of Inspector
General of the Department of Health & Human Services, Report (OEI-01-11-00571), Jan. 8, 2014, available at:https://oig.nhs.gov/oei/
reports/oei-01-11-0057 1.pdf.

[FN18]

- 'Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology,' Office of Inspector General of
the Department of Health & Human Services, Report (OEI-01-11-00570), Dec. 9, 2013, available at:http://oig.hhs.gov/oei/reports/
oei-01-11-00570.asp. This report is discussed in the HPTS Healthcare Information Technology Issue Brief published December 30,
2013 (HPTS Issue Brief 12-30-13.7).

[FN19]

. Transcript of Podcast 'Fraud Safeguards in Electronic Health Records,' Office of Inspector General of the Department of Health &
Human Services, January 8, 2014, available at:https://oig.hhs.gov/newsroom/podcasts/reports.asp#ehr14.

[FN20]

. 'States Prepare for Seamless Exchange of Health Records After Disasters," Department of Health & Human Services Press Release,
July 11, 2013, available at http:/Awww.hhs.gov/news/press/2013pres/07/201 3071 1a.html.

[FN21]

. Anne Brynolf, et al., 'Virtual Colleagues, Virtually Colleagues-- Physicians' Use of Twitter:A Population Observational Study, British
Medical Journal Open, Col 3, Issue 7, BMJ Open 2013;3:e002988 doi:10.1136/bmjopen-2013-002988.

[FN22]

. 'Physicians on Twitter,' JAMA, Feb. 9, 2011, JAMA. 2011;305(6):566-568. doi:10.1001/jama.2011.68, available at:http://
jama.jamanetwork.com/article.aspx?articleid=893850.

[FN23]

. Jeanne M. Farnan MD., MHPE, et al., 'Online Medical Professionalism:Patient and Public Relationships:Policy Statement From the
American College of Physicians and the Federation of State Medical Boards,' Ann Intern Med. 16 April 2013;158(8):620-627, available
at:http://annals.org/article.aspx?articleid=1675927.

[FN24]

. 'Rhode Island Board of Medical Licensure and Discipline Policy Guidelines for the Appropriate Use of Social Media and Social
Networking in Medical Practice,' Rhode Island Department of Health, September 2013, available at:http:/Awww.health.ri.gov/
publications/guidelines/AppropriateUseOfSocialMediaAndSocialNetw

[FN25]
. In the Matter of LabMD, Inc., a corporation, 2014 WL 253518 (F.T.C., Jan. 16, 2014).

[FN26]

. 'Actions Needed to Address Weaknesses in Information Security and Privacy Controls,' U.S. Government Accountability Office
Report, Sept. 16, 2014, available at:http:/Awww.gao.gov/products/GAO-14-730.

[FN27]

. Eric D. Fader, "GAO Report Critical of HHS Cybersecurity Guidance and Oversight," Monday (September 28, 2016), available at 2016
WLNR 29615508.

[FN28]

. Joe Davidson, "Cyberattacks on personal health records growing 'exponentially'," The Washington Post (September 28, 2016),
available at 2016 WLNR 29622964.

[FN29]

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. Greg Slabodkin, "HHS Security, Privacy Guidance Said to Fall Short of Fed Guidelines," Information Management (September 28,
2016), available at 2016 WLNR 29619013.

[FN30]

. "ELECTRONIC HEALTH INFORMATION: HHS Needs to Strengthen Security and Privacy Guidance and Oversight," GAO report
number GAO-16-771 (U.S. Government Accountability Office, September 26, 2016), available at http:/Awww.gao.gov/products/
GAO-16-771.

[FN31]

. David Blumenthal MD and David Squires, "2014 The Health Care Year in Review," The Commonwealth Fund, Dec. 23, 2014,
available at:http:/Awww.commonwealthfund.org/publications/blog/2014/dec/2014-health-care-year.

[FN32]

. Data and Program Reports, EHR Incentive Programs, U.S. Department of Health and Human Services, last updated Sept. 3, 2014,
available at:http://(www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html.

[FN33]

. 'Doctors and Hospitals' Use of Health IT More Than Doubles Since 2012,'Department of Health & Human Services Press Release,
May 22, 2013, available at:http:/Awww.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/201 3-Press-Releases-
Items/2013-05-22.html.

[FN34]

. 'Healthgrades Partners With Athenahealth to Provide Easier Access to Online Appointment Scheduling," Healthgrades' Press
Release, July 25, 2014, available at:http:/Avww.healthgrades.com/about/press/healthgrades-partners-with-athenahealth-to-provide-
easier-access-to-online-appointment-scheduling.

[FN35]

. 'Booking a Trip to the ER on Your Smartphone?7It's a Breeze,' The Associated Press, Jan 15, 2015, available at:http://
www.nytimes.com/aponline/2015/01/15/us/ap-us-er-reservations. html.

[FN36]

. Martijn van der Eijk, MSc et al., 'Using Online Health Communities to Deliver Patient-Centered Care to People with Chronic
Conditions,' Journal of Medical Internet Research, June 25, 2013, Vol. 15, No. 6, (J Med Internet Res 2013;15(6):e115J Med Internet
Res 2013;15(6):e115) doi:10.2196/jmir.2476, available at:http:/Awww jmir.org/2013/6/e115/.

[FN37]

. 'Allscripts Introduced iPad Application for EHRs,' Allscripts News Release, April 5, 2012, available at:http://investor.allscripts.com/
phoenix.zhtml?c=1 12727&p=irol-newsArticle&ID=1680565&highlight=.

[FN38]

. Gaylin, Daniel S., Moiduddin, Adil, Mohamoud, Shamis, Lundeen, Katie, Kelly, Jennifer A., 'Public attitudes about health information
technology, and its relationship to health care quality, costs, and privacy,' Health Services Research, Volume 46, Issue 3, June 1, 2011,
2011 WLNR 10475008.

[FN39]

. 'More Than Forty Percent of U.S. Consumers Willing to Switch Physicians to Gain Online Access to Electronic Medical Records,
According to Accenture Survey,' Accenture Press Release, Sept. 16, 2013, available at:http://newsroom.accenture.com/news/more-
than-40-percent-of-us-consumers-willing-to-switch-physicians-to-gain-online-access-to-electronic-medical-records-according-to-
accenture-survey.htm.

[FN40]

. Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD, 'Physician Capability
to Electronically Exchange Clinical Information, 2011', American Journal of Managed Care, Oct. 23, 2013, available at:http://
www.ajmc.com/publications/issue/2013/2013-1-vol19-n10/Physician-Capability-to-Electronically-Exchange-Clinical-Information-201 1.

[FN41]

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. "Governance Framework for Trusted Electronic Health Information Exchange," The Office of the National
Coordinator for Health Information Technology, May 2013, available at:http:/Avww.healthit.gov/sites/default/files/
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[FN42]

. 'Accreditor for ONC Health IT Certification Program Approved for Second Term,' Department of Health & Human Services Press
Release, May 13, 2014, available at:http:/Avww.hhs.gov/news/press/201 4pres/05/20140513c.htm

[FN43]

. Alicia Chang, "Study: Few US Hospitals Use Digital Records," AP Online, March 25, 2009. 3/25/09 Associated Press (AP) Newswires
22:49:33.

[FN44]

. Ashish K. Jha, M.D., M.P.H., et al., "Use of Electronic Health Records in U.S. Hospitals," New England Journal of Medicine, March 25,
2009, available at: http://content.nejm.org/cgi/content/full/NEJMsa0900592.

[FN45]

. Russ Mitchell, 'Farzad Mostarshari:Man on a Digital Mission,' Kaiser Health News in partnership with FORTUNE, Mar. 9, 2012,
available at:http://www.kaiserhealthnews.org/Stories/2012/March/09/Farzad-Mostashari-health-information-technology.aspx.

[FN46]

. 'Secretary Sebelius Announces Next Stage for Providers Adopting Electronic Health Records, U.S. Department of Health and Humans
Services Press Release, Feb. 24, 2012, available at:http:/Awww.hhs.gov/news/press/201 2pres/02/20120224a.html.

[FN47]
. 77 FR 13832-01, 2012 WL 706844 (F.R.).

[FN48]

. 'AHA to CMS:Too Soon to Finalize Stage 3 EHR Requirements,' AHA News Now, May 27, 2015, available at:http://news.aha.org/
article/aha-to-cms-too-soon-to-finalize-stage-3-ehr-requirements.

[FN49]

. 'HHS issues rules to advance electronic health records with added simplicity and flexibility', Department of Health and Human
Services Press Release, Oct .6, 2015, available at:http:/Avww.hhs.gov/news/press/2015pres/10/20151006a.html.

[FN50]

. 'CMS FACT SHEET: EHR Incentive Programs in 2015 and Beyond,' Oct. 6, 2015, available at:https:/Avww.cms.gov/Newsroom/
MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-06-2.htm

[FN51]

- 'More than 100,000 Health Care Providers Paid for Using Electronic Health Record,' a Centers for Medicare &

Medicaid Services Press Release, June 19, 2012, available at: http:/Avww.cms.gov/apps/media/press/release.asp?
Counter=4383&intNumPerPage=10&checkDate=&chckKey=&srchT ype=1 &numDays=3500&srchOpt=0&srchData=&keywordT ype=All&chkNews
+2#+3#+4#+58&intPage=&showAll=&pY ear=&year=&desc=&cboOrder=date.

[FN52]

. Federal Health IT Strategic Plan:2015-2020, Office of the National Coordinator for Health Information Technology, December 8, 2012,
Letter from the National Coordinator, p. 2, http:/Awww.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf.

[FN53]

. Eric Whitney, 'Rural Hospitals Face Tough Choices on Computerized Records,' Kaiser Health News, April 24, 2014, available at:http://
www.kaiserhealthnews.org/Stories/201 4/April/24/rural-hospitals-face-tough-choices-on-computerized-records.aspx.

[FN54]

. 'Oklahoma Made Incorrect Medical Electronic Health Record Incentive Payments to Health Care Professionals,' Office of the Inspector
General of the Department of Health and Human Services, Sept. 23, 2015, available at: http://oig.hhs.gov/newsroom/whats-new/
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[FN55]

. Provision of Electronic Health Record (EHR) 'Navigators' during Hospital and Critical Access Hospital (CAH) Surveys,' Memorandum
to State Agency Directors by Centers for Medicare & Medicaid Services May 16, 2014, available at:http://nr.cch.com/hid/Survey-and-
Cert-Letter-14-31 pdf.

[FN56]

. Chitra Mohla, Director of Community College Workforce Program, "Health IT:Coming Soon to a Class Near You."Health IT Buzz,
Office of the National Coordinator for Health IT. Available at:http://healthit.hhs.gov/blog/onc/index.php/2010/08/25/health-it-coming-
soon-to-a-class-near-you/#more-316.

[FN57]

. http://healthit.hhs.gov/portal/server.pt?
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. Genevra Pittman, 'Are E-Visits as Good as Office Appointments?' Reuters Health, Jan. 15, 2013, available at: http:/Avww.reuters.com/
article/2013/01/15/us-evisits-appointments-idJSBRE90E0ZM20130115.

[FN59]

. 'HHS Proposes Path To Improve Health Technology and Transform Care,' a Department of Health and Human Services Press
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[FN60]

. News Release, 'Final Federal Health IT Strategic Plan 2015-2020 Released,' HHS, Sept. 21, 2015, available at: http://www.hhs.gov/
news/press/2015pres/09/20150921b.html.

[FN61]

. Final Federal Health IT Strategic Plan 2015-2020,' ONC and HHS, available at: https://www.healthit.gov/sites/default/files/9-5-
federalhealthitstratplanfinal_0O.pdf.

[FN62]

. Final Federal Health IT Strategic Plan 2015-2020,' ONC and HHS, available at: https://www.healthit.gov/sites/default/files/9-5-
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[FN63]

. 'Computers Reading Doctors' Notes?', United States Department of Veteran's Affairs Press Release, September 20, 2011, available
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[FN64]

. Electronic Health Records No Cure-All,' The Chart, January 24, 2011, available at: http://thechart.blogs.cnn.com/2011/01/24/
electronic-health-records-no-cure-all/?hpt=T2/.

[FN65]

. Arthur L. Kellermann and Spencer S. Jones, 'What It Will Take To Achieve The As-Yet Unfulfilled Promises of Health Information
Technology,' Health Affairs, January 2013, vol. 32 no. 63-68, dpi:10.1377/hithaff.2012.0683, available at:http://content.healthaffairs.org/
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[FN66]

. Eric Whitney of Colorado Public Radio, 'Despite Incentives, Doctor's Offices Lag on Digital Records,' Kaiser Health News in a
reporting partnership with NPR and Colorado Public Radio, Jan. 22, 2013, available at:http:/Awww.kaiserhealthnews.org/Stories/2013/
January/22/colorado-health-information-technology.aspx/

[FN67]

. Amy Standen, 'Veterans To Create World's Largest Medical Database,' National Public Radio, Nov. 17, 2011, available at:http://
www.npr.org/201 1/11/14/142184307/veterans-to-create-worlds-largest-medical-database.

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. 'LongView Intemational Technology Solutions Awarded $300 Million Military Health IT Contract,' Healthcare Global Press Release,
May 30, 2012, available at:http:/Avww.healthcareglobal.com/press_releases/healthcare/longview-international-technology-solutions-
awarded-300-million-military-health-it-contract.

[FN69]

. Mike Millard, 'Ohio State University Wexner Medical Center Achieves Stage 7,' Healthcare News, May 29, 2012, available at:http://
www.healthcareitnews.com/news/ohio-state-university-wexner-medical-center-achieves-stage-7.

[FN70]

. 'HIMSS Analytics Honors Atrius Health and its Affiliate, Reliant Medical Group with Stage 7 Ambulatory Award.'HIMISS Analytics
Press Release, Nov. 7, 2013, available at: http:/Avww.himssanalytics.org/about/NewsDetail.aspx?nid=821 17.

[FN71]

. 'HIMSS Analytics Honors Truman Medical Centers Ambulatory Clinics with Stage 7 Ambulatory Award.'HIMISS Analytics Press
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[FN72]

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[FN73]

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[FN74]

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[FN76]

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Q1 with $1.8 Billion in Q2 2014.'Mercom Capital Group, LLC Press Release, July 2014, available at:http:/Awww.mercomcapital.com/
mercom-capital-group-reports-first-billion-dollar-quarter-for-healthcare-information-technology-sector-vc-funding-doubled-over-q1-with-
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[FN82]

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[FN97]

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. 'HHS Awards $5.3 Million to Boost Health IT for Rural Areas,' U.S. Department of Health & Human Services Press Release, Sept. 11,
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health emergency," last reviewed March 17, 2020, available at: https:/Avww.hhs.gov/hipaa/for-professionals/special-topics/emergency-
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Delaware, October 1, 2020, available at https://bluntrochester.house.gov/news/documentsingle.aspx?DocumentID=2563.

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[FN111]

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in the United States,' ONC Data Brief, No. 4, November 2012, available at:http:/Avww.healthit.gov/sites/default/files/us_e-
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Produced by Thomson Reuters Accelus Regulatory Intelligence 24-Jan-2022

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