REGULATORY INTELLIGENCE

YEAR-END REPORT - 2022

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

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

12/19/2022
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 1affecting 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 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 State Activity

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Colorado

2022 CO H.B. 1157 (NS), engrossed April 26, 2022, would require the state board of health to promulgate rules, which apply to all
public health agencies, health officers, and other persons required to collect and report data, concerning the requirements for collecting
data, and the manner and time frame for reporting and disaggregating data in compliance with health data privacy laws.

New Jersey

2022 NJ S.B. 1046 (NS), introduced January 31, 2022, would require vendors of electronic health records systems to provide to the
Department of Health de-identified patient data, which the department is to use to evaluate trends concerning disease, injury, illness,
and other measures of public health in the State, and develop programs and resources appropriate to those trends.

Pennsylvania

¢ 2021 PA H.B. 1561 (NS), adopted July 7, 2022, amends PA ST 50 P.S. ? 7111 (Confidentiality of records) providing that all
documents concerning persons in treatment must be kept confidential and, without the person's written consent, may not be released
or their contents disclosed to anyone except a covered entity or a covered entity's business associate that makes the use, disclosure or
request for disclosure in accordance with 45 CFR Pt. 164, Subpt. E (Privacy of Individually Identifiable Health Information). The bill is
effective July 7, 2022.

¢ 2021 PA H.B. 1563 (NS), adopted July 7, 2022, amends PA ST 71 P.S. ? 1690.108 (Confidentiality of records) allows patient records
to be disclosed without the patient's consent to a covered entity or a covered entity's business associate that makes the use, disclosure
or request for disclosure in accordance with 45 CFR Pt. 164, Subpt. E (Privacy of Individually Identifiable Health Information). The bill is
adopted July 7, 2022.

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] Wist 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.

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

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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. [FN38] 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. [FNS®] 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. '84° 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
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

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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." IFN44] 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 government 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. IFN47] 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 Stage 3 EHR requirements 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 requirements has 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.

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;

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¢ 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. IFN52]

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. IFNS4] 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. [FN55] in the memorandum CMS advised hospitals and Critical Access Hospitals (CAHs) that State Survey Agency
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 of qualified trained individuals. [FNS6] 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

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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. IFN58] An
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. IFNS8] 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. [FN60] While 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;

* 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. "NS!

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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] Stich 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. [FNE8] 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
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. [FN6S] 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

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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, IFN71] 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 demonstrate 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. [FN76] 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.

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

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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

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

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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. [FN86] 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
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,

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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.

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 | think replacing doctors at the bedside with technology is
insane.'

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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.

'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.'

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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

¢ 2021 CONG US HR 7427, introduced in House April 6, 2022, would amend 42 USCA ? 1315a (Center for Medicare and Medicaid
Innovation) to require CMI testing of incentive payments for behavioral health providers and certain other providers for adoption and
use of certified electronic health record technology.

«2021 CONG US S 3904, reported in Senate October 18, 2022, would require the Sectary to update the Healthcare and Public Health
Sector Specific Plan with an evaluation of the challenges Healthcare and Public Health Sector assets face in securing sensitive patient
health information an electronic health records.

Recent State Activity
Arizona

2022 AZ H.B. 2100 (NS), introduced January 13, 2022, and 2022 AZ S.B. 1167 (NS), engrossed March 10, 2022, would amend AZ

ST ? 36-135 (Child immunization reporting system; requirements; access; confidentiality; immunity; violation; classification; definitions)
a nonprofit health information organization that is designated by the department as this state's official health information exchange
organization may receive, use and redisclose the confidential information received pursuant to this section for any purpose allowed by
the health insurance portability and accountability act privacy standards regardless of whether the information is being maintained by or
for a covered entity or business associate.

California

* 2021 CAA.B. 2473 (NS), adopted September 27, 2022, amends CA HLTH & S ? 11833 (qualifications of personnel) to require
registered and certified counselor curriculum to include elements utilizing electronic health records systems. The bill is effective January
1, 2023.

¢ 2021 CA A.B. 2526 (NS), adopted September 30, 2022, adopts CA PENAL ? 5073 to require The Department of Corrections and
Rehabilitation, the State Department of State Hospitals, county agencies caring for inmates to disclose, by electronic transmission when
possible, mental health records for any transferred inmate who received mental health services while in the custody of the transferring
facility. The bill is effective January 1, 2023.

Colorado

2022 CO H.B. 1302 (NS), adopted May 18, 2022, adopts CO ST ? 25.5-5-332 (Primary care and behavioral health statewide integration
grant program ? creation ? report ? definition ? repeal) prohibiting any money received through the grant program to be used for
ongoing or existing electronic health records costs, require grant applications to demonstrate a commitment to maintaining models

and programs that maintain a plan for how technology will be leverage for whole-person care, which may include plans for data
security, electronic health records reforms, and telehealth implementation or expansion, and requiring the state department to prioritize
applicants that utilize telenealth. The bill is effective May 18, 2022.

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Florida

2022 FL S.B. 998 (NS), introduced January 11, 2022, would amend FL ST ? 381.0406 (Rural health networks) to require rural health
networks to use health information exchange systems for specified purposes, FL ST ? 395.1052 (Patient access to primary care and
specialty providers; notification) to require hospitals to use health information exchange systems to provide certain notification to

a patient's primary care provider, if any, FL ST ? 408.051 (Florida Electronic Health Records Exchange Act) to 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 minimum requirements for such records, prohibit vendors of 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, FL ST ? 408.0611 (Electronic prescribing clearing house) to require the Agency for Health Care
Administration to provide health information exchange systems with access to the electronic prescribing clearing house for a specified
purpose, and FL ST ? 456.057 (Ownership and control of patient records; report or copies of records to be furnished; disclosure of
information) to require certain records owners to use a health information exchange system to provide patient records to health care
practitioners and providers.

Illinois

2021 IL H.B. 4640 (NS), introduced January 21, 2022, and 2021 IL S.B. 3131 (NS), filed January 11, 2022, would amend IL ST CH 20 ?
2305/2 (Powers) to require that emergency access to medical or health information, records, or data must include access to electronic
health records, provided that the local public health authority must be unable to alter the electronic health records.

Louisiana

2022 LA H.B. 728 (NS), introduced March 14, 2022, would amend LA R.S. 15:574.20 (Medical release program; eligibility; revocation)
to require the referral system to be incorporated into a correctional health electronic records system that is compatible with major
hospitals and health providers outside the correctional institutions and other electronic health records systems, and hospital staff and
requiring hospital staff to be trained on the eligibility and application procedure for medical release no later than January 1, 2023.

Maryland

2022 MD H.B. 213 (NS), adopted May 29, 2022, amends MD HEALTH GEN ? 4-301 (Definitions) to update the definition for 'health
information exchange" and MD HEALTH GEN ? 4-302.2 (Regulations relating to privacy and security of health information) and

to prohibit the regulations adopted under this section from prohibiting the sharing or disclosing of information that is required to be
exchanged under federal law or MD HEALTH GEN T. 21, Subt. 2 (Maryland Food, Drug, and Cosmetic Act), or for the purposes of
payment or prohibit the use of the electronic health information for purposes that are important to public health functions or health
planning activities of the Department, the Maryland Health Care Commission, or the Health Services Cost Review Commission. The bill
is effective October 1, 2022.

Massachusetts

2022 MA REG TEXT 610068 (NS), filed May 11, 2022, amends 105 MA ADC 300.191 (Access to Medical Records and Other
Information) authorizing the Department or local boards of health to have access to electronic health records and authorizing the
Department to require health care providers to report specified information from medical records, including electronic health records.
The regulation is effective May 27, 2022.

New Jersey

2022 NJ A.B. 4114 (NS), introduced June 2, 2022, would amend NJ ST 24:6E-7 (Prescriptions; dispensation of lowest cost
interchangeable drug product; exceptions; notice of substitution) to require that every prescription for a controlled dangerous substance,
prescription legend drug, or other prescription item be transmitted electronically using an electronic health records system.

New York

¢ 2021 NY A.B. 5411 (NS), amended/substituted May 4, 2022, and 2021 NY S.B. 4620 (NS), amended/substituted May 17, 2022,
would adopt NY INS ? 341-a. (Patient prescription pricing transparency) to define 'interoperability element," 'electronic health record,"
'electronic prescribing system, 'electron prescription," and 'real-time benefit tool."

¢ 2021 NY A.B. 10302 (NS), introduced May 13, 2022, would amend NY PUB HEALTH ? 2803 (Commissioner and council; powers
and duties), NY PUB HEALTH ? 4902 (Utilization review program standards), and NY PUB HEALTH ? 4905 (Required and prohibited
practices) requiring providers to share electronic health records with plans for purposes of improving patient care and reducing
administrative delays.

¢ 2021 NY S.B. 9103 (NS), introduced May 9, 2022, would amend NY PUB HEALTH ? 2803 (Commissioner and council; powers and
duties) to require the Commissioner to require every general hospital subject to this article to timely share electronic medical records to
utilization review agents for purposes of article forty-nine of this chapter and article forty-nine of the insurance law. Prohibit health plans
utilizing electronic medical records from seeking information that they are not already permitted to receive. Amend NY PUB HEALTH ?
4902 (Utilization review program standards) to require medical records requested by utilization review agents to be made available
electronically by health care providers.

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¢ 2021 NY S.B. 9599 (NS), introduced November 21, 2022, would adopt NY GEN BUS Ch. 20, Art. 42 (Electronic Health Products and
Services) to create privacy standards for electronic health products and services and permissible data brokering and require consent to
be given for the collection and/or sharing of personal health information or personal data.

Ohio

2022 OH REG TEXT 612225 (NS), filed June 21, 2022, adopts OH ADC 5160-59-01 (OhioRISE: definitions) providing the definitions
for 'electronic health record (EHR)" and 'telehealth" Adopts OH ADC 5160-59-03.2 (OhioRISE: care coordination) providing that care
coordination activities may be provided via telehealth. Adopts OH ADC 5160-59-03.3 (OhioRISE: intensive home-based treatment
service) allowing payment to be made for IHBT services rendered via telehealth. The rulemaking is effective July 1, 2022.

Oklahoma

¢ 2021 OK S.B. 1337 (NS), adopted May 26, 2022, amends OK ST T. 56 ? 4002.5 (Managed care organizations and dental benefit
managers--Duties) requiring each contracted entity and each participating provider to submit data through the state-designated entity
for health information exchange to ensure effective systems and connectivity to support clinical coordination of care, the exchange of
information, and the availability of data to the Authority to manage the state Medicaid program. The bill is effective July 1, 2022.

* 2021 OK S.B. 1369 (NS), adopted May 11, 2022, creates the Oklahoma Healthcare Transparency Initiative Act of 2022 to establish
the Oklahoma State Health Information Network and Exchange Authority. Amends OK ST T. 63 ? 1-133 (Oklahoma Statewide Health
Information Exchange (OKHIE)--Certification-- Oklahoma State Health Information Network and Exchange (OKSHINE)) updating the
definition for 'health information exchange organization" and removing the definition for 'Oklahoma State Health Information Network
and Exchange" or 'OKSHINE." Requires the State of Oklahoma to designate a health information exchange organization as the state-
designated entity for health information exchange, establish a transition plan to ensure continued operation of the health information
exchange, and may temporarily serve as the state-designated entity as part of the transition plan. Requires beginning July 1, 2023, all
health care providers as defined by the rules promulgated by the Oklahoma Health Care Authority Board and who are licensed by and
located in this state shall report data to and utilize the state-designated entity. The bill is effective July 1, 2022.

Oregon

2022 OR H.B. 4150 (NS), adopted March 2, 2022, adopts new section to define 'community information exchange' and require the
Health Information Technology Oversight Council to explore options to accelerate, support and improve secure, statewide community
information exchanges that would allow the seamless coordination of health care and social services across all delivery systems,
prioritizing health equity, confidentiality and the security of information.

Pennsylvania

2021 PA H.B. 2686 (NS), introduced June 20, 2022, would adopt the Collaborative Care Model Implementation Program to require an
entity that receives a grant to provide technical assistance to primary care physicians and primary care practices within that region that
will assist primary care physicians and primary care practices with providing information technology expertise to assist with building
the model requirements into electronic health records, including assistance with care manager tools, patient registry, ongoing patient
monitoring and patient records.

Rhode Island

¢ 2021 RI H.B. 7669 (NS), amended/substituted September 14, 2022, would amend RI ST ? 40.1-5-26 (Disclosure of confidential
information and records) to clarify that information and records may be disclosed to any vendor, agent, contractor, or designee who
operates an electronic health record, health information exchange, or clinical management system for the purpose of sharing data with
qualified medical or mental health professionals or designees. Amend RI ST ? 40.1-5-29 (Record of disclosure) to require disclosures
occurring through automated electronic exchanges such as those facilitated by electronic health records or health information
exchanges must be recorded and made available to the patient by the applicable system operator upon the patient's request.

¢ 2022 RI REG TEXT 614073 (NS), published November 20, 2022, amends 216 R! ADC 10-10-6.3 (General Provisions) updating

the requirements to reflect the change of the health information exchange model from an opt-in to an opt-out. Amends 216 RI ADC
10-10-6.5 (Confidentiality Protections) updating the requirements to reflect the change of the health information exchange model from
an opt-in to an opt-out. Also strikes language regarding the participant authorization form and adds requirements regarding a health
care provider's temporary access of a patient participant's protected health information via emergency procedures. The regulation is
effective December 8, 2022.

¢ 2021 RI REG TEXT 616782 (NS), filed June 10, 2022, would amend 212 R! ADC 10-10-1.3 (Definitions, General Requirements, and
Procedures) providing the definition for 'health information exchange" or 'HIE." The regulation was adopted via emergency rulemaking
and is effective June 10, 2022.

Texas

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2022 TX REG TEXT 616649 (NS), filed September 9, 2022, adopts 26 TX ADC ? 306.107 (Certification Eligibility) requiring the T-
CCBHC to have a health information technology system that includes an electronic health record and must have a plan in place
focusing on ways to improve care coordination using health information technology. The regulation is effective September 29, 2022.

Washington

2021 WA S.B. 5827 (NS), amended/substituted February 7, 2022, would adopt new section in WA ST T. 72, Ch. 72.09 (Department
of Corrections) to requirement the Department to implement a comprehensive electronic health records system at the Department
and to require the comprehensive electronic health records system implemented by the Department to be able to communicate with
information and data systems used by managed care organizations for purposes of care coordination activities.

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. IFN90] 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. [FN91] 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. [FN82]
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. IFNS3] 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.

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. IFN9S] 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

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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. IFNS7] 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. [FN98]

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. IFNSS] 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

* 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]

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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. [FN103]

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

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:

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¢ 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
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.

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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 appointmenis.,' 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.

'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.

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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

* 2021 CONG US HR 1620, referred in Senate May 24, 2022, would require the Attorney General and Secretary of the Department
of Health and Human Services to issue and disseminate guidance and best practices to improve sexual assault forensic nurse exam
training and program sustainability. The guidance must 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 2471, engrossed in the House of Representatives March 11, 2022, would amend 42 USCA ? 254c-14 (Telehealth
network and telehealth resource centers grant programs) to include providers of prenatal, labor care, birthing, and postpartum care
services, including hospitals obstetric care units on the list of network providers. The bill would also amend 42 USCA ? 1395m (Special
payment rules for particular items and services) to remove geographic requirements and expand originating sites for telehealth
services, to expand practitioners eligible to furnish telehealth services, to extend telehealth services for federally qualified health centers
and rural health clinics, to delay the in-person requirements under Medicare for mental health services furnished through telehealth and
telecommunications technology, and to allow for the furnishing of audio-only telehealth services. The bill would also allow for the use of
telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period, and extend
the exemption for telehealth services, and require reports on telehealth utilization.

¢ 2021 CONG US §S 2533, enrolled Bill May 20, 2022, would require the Secretary to ensure that veterans with breast cancer who
reside in rural areas or States without a cancer center that has entered into such a partnership with the Secretary are able to receive
care through such a partnership via telehealth. Require the Secretary to submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a report assessing how the partnerships entered have impacted
access by veterans to cancer centers of the National Cancer Institute, including an assessment of the telehealth options made available
and used pursuant to the partnership.

* 2021 CONG US HR 4040, engrossed in House July 27, 2022, would adopt the Advancing Telehealth Beyond COVID-19 Act of 2022
to amend 42 USCA ? 1395m (Special payment rules for particular items and services) requiring the Secretary to continue to provide

coverage and payment for telehealth services that are furnished via an audio-only communications system during the period beginning
on the first day after the end of such emergency period and ending on December 31, 2024.

* 2021 CONG US HR 7053, introduced in House March 9, 2022, to amend 42 USCA ? 1395d (Scope of benefits) to allow telehealth
services to be furnished by an Acute Hospital Care at Home Program.

¢ 2021 CONG US HR 7097, introduced in House March 16, 2022, to facilitate the provision of telehealth services through interstate
recognition of health care professionals' licensees.

¢ 2021 CONG US HR 7353, introduced in House, March 31, 2022, would amend 42 USCA ? 300gg-91 (Definitions) to treat benefits for
telehealth services offered under a group health plan or group health insurance coverage as excepted benefits.

* 2021 CONG US HR 7233, reported in House June 16, 2022, would require the Secretary to update guidance issued by CMS to
States, the State Medicaid & CHIP Telehealth Toolkit, to clarify strategies to overcome existing barriers and increased access to
telehealth services under the Medicaid program and CHIP.

* 2021 CONG US HR 7666, engrossed in the House June 23, 2022, would amend 42 USCA ? 254c-19 (Pediatric mental health care
access grants) allowing a pediatric mental health care telehealth access program to be provide support to schools and emergency
departments and requiring the Secretary to give priority, in awarding grants, to applicants proposing to establish a pediatric mental
health care telehealth access program in the jurisdiction of a State, Territory, Indian Tribe, or Tribal organization that does not yet have
such a program or expand a pediatric mental health care telehealth access program to include one or more new sites of care, such as a
school or emergency department.

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«2021 CONG US HR 7667, engrossed in House June 7, 2022, would require the Secretary of Health and Human Services to

create guidance that addresses recommendations for how digital health technology or other remote assessment options, such as
telehealth, could support decentralized clinical trials, including guidance on considerations for selecting technological platforms and
mediums, data collection and use, data integrity and security, and communication to study participants through digital technology and
recommendations for subject recruitment and retention, including considerations for sponsors to minimize or reduce burdens for clinical
trial participants through the use of digital health technology, telehealth, local health care providers and laboratories, or other means.

¢ 2021 CONG US HR 7900, engrossed in House August 3, 2022, would adopt new sections requiring the Secretary to submit a plan

to address any shortfall of the behavioral health workforce including a plan to expand access to behavioral health care under the
military health system using telehealth. Require the Director of the Defense Health Agency to carry out a 5-year telehealth pilot program
on sexual health. Require the Direct to ensure that any data collected pursuant to such pilot program to be included in an electronic
health record for the member. Expand readjustment counselor expectations at Vet Centers, including the availability, advisability, and
willingness of veterans to use telehealth or group counseling.

* 2021 CONG US HR 8017, introduced in the House June 9, 2022, would amend 38 USCA ? 1730C (Licensure of health care
professionals providing treatment via telemedicine) to allow a covered health care professional who is authorized to dispense
controlled substances in the State which the health care professional is licensed to prescribe controlled substances through the use of
telemedicine.

* 2021 CONG US HR 8023, introduced in House June 9, 2022, and 2021 CONG US S 4375, introduced in Senate June 9, 2022,
to require the Secretary to submit to the Congressional Defense Committee a plan to address any shortfall of the behavioral health
workforce, including a plan to expand access to behavioral health care under the military health system using telehealth.

¢ 2021 CONG US HR 8296, engrossed in House July 15, 2022, would adopt new section proving that a health care provider has a
statutory right to provide abortion services, and may provide abortion services, and that provider's patient has a corresponding right to
receive such 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 8405, introduced in House July 18, 2022, would require the Secretary of Health and Human Services to
modify the risk evaluation and mitigation strategy under 21 USCA ? 355-1 (Risk evaluation and mitigation strategies) that applies to
mifepristone so that the in-person dispensing requirements is removed from such risk evaluation and mitigation strategy, patients
may access prescription for such drug via telehealth, and all pharmacies that are certified to dispense such drug are permitted to, at
minimum, dispense and mail such drug to patients.

* 2021 CONG US HR 9233, introduced in House October 25, 2022, would require the Secretary of Labor to update existing rules

and policies, consistent with applicable law and to the extent practicable, to allow individuals entitled to medical treatment under any
Federal workers' compensation program to conduct their routine medical treatment appointments using telehealth platforms. Require
the Secretary of Health and Human Services to develop guidance for covered entities and business associates of such entities as such
terms are defined in Section 160.103 of title 45, Code of Federal Regulations, on providing telehealth in compliance with HIPAA privacy
regulation (as defined in section 1180(b)(3) of the Social Security Act) to improve patient experience and convenience following the end
of the COVID-19 public health emergency and test methods to automate patient access to electronic prenatal, birth, and postpartum
health records (including laboratory results, genetic tests, ultrasound images, and clinical notes) to improve patient experiences in
maternity care and health outcomes.

¢ 2021 CONG US SRES 518, introduced in Senate February 17, 2022, would require the Federal Government to create a
comprehensive approach to improving the health care system that incorporates mental health and substance use disorder and includes
system reform that provides a process by which States can work with other States to reconcile licensure and certification for an
reimbursement to mental health and substance use disorder providers across State lines for the purpose of telemedicine.

¢ 2021 CONG US S 1605, enrolled December 21, 2021, would amend 10 USCA ? 1079 (Contracts for medical care form spouses and
children; plans) would allow for treatment for eating disorders to include outpatient services for in-person or telehealth care.

¢ 2021 CONG US §S 2938, enrolled in the Senate June 25, 2022, would adopt guidance to states on furnishing services through
telehealth under Medicaid and CHIP.

* 2021 CONG US §S 3593, introduced in Senate February 3, 2022, would amend titles XI and XVIII of the Social Security Act to extend
certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries.

* 2021 CONG US S 3623, placed on Senate calendar February 10, 2022, would adopt the Supporting Access to Nurse Exams Act or
SANE Act to give preference to grants that establish or sustain sexual assault mobile teams or units or otherwise enhance SANE and
SAFE access through telehealth.

¢ 2021 CONG US §S 3793, introduced in Senate March 7, 2022, would amend 42 USCA ? 1315a (Center for Medicare and Medicaid
Innovation) to test the effect of technology-enabled care interventions in the home to coordinate care over time and across settings,
improve quality, and lower costs for certain Medicare Advantage beneficiaries.

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«2021 CONG US §S 3937, introduced in Senate March 28, 2022, would establish the Home-Based Telemental Health Care Act of
2022 to increase mental health services in rural medically underserved populations and for individuals in farming, fishing, and forestry
occupations.

¢ 2021 CONG US S 4132, placed on Calendar Senate May 4, 2022, would establish a health care provider's statutory right 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 S 4428, reported in Senate, would create the United States-Taiwan Public Health Protection Act to require the
Secretary, in consultation with the Secretary of Health and Human Services and the heads of other relevant Federal departments and
agencies, to submit to the relevant congressional committees a study that includes a description of ongoing cooperation between the
Unites States Government and Taiwan related to public hearing, including disease surveillance, information sharing, and telehealth.

* 2021 CONG US S 4543, reported in Senate July 18, 2022, would require an annual report that describes the conduct of the
Accountable Care Organization demonstration that includes a description of the telehealth utilization outcomes. Require the Plan to
Address Shortfalls in Behavioral Health Workforce to include a plan to expand access to behavioral health services under the military
health systems through the use of telehealth.

¢ PL 117-135, adopted June 7, 2022, adopts the Making Advances in mammography and Medical Options for Veterans Act to establish
a telescreening mammography pilot program for veterans in areas where VA does not offer in-house mammography, and expand
veterans' access to clinical trials through partnerships with the National Cancer Institute.. The bill is effective January 1, 2023.

¢ 87 FR 33001-01, dated May 12, 2022, amends 32 C.F.R. ? 199.4 (Basic program benefits) providing that health care services
covered by TRICARE and provided through the use of telehealth modalities including telephone services for: telephonic office visits;
telephonic consultations; electronic transmission of data or biotelemetry or remote physiologic monitoring services and supplies, are
covered services to the same extent as if provided in person at the location of the patient if those services are medically necessary and
appropriate for such modalities. The regulation is effective July 1, 2022.

Recent State Activity
Alabama

¢ 2022 AL H.B. 219 (NS), introduced February 2, 2022, would establish the Interstate 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.

¢ 2022 AL H.B. 222 (NS), introduced February 2, 2022, would establish the interstate 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.

* 2022 AL H.B. 423 (NS), introduced March 1, 2022, would allow licensed physicians, including osteopathic physicians, to practice
telemedicine in the state, proscribe the duties and responsibilities of a physician practicing telemedicine, provide that licensed practicing
telemedicine may prescribe medications without meeting a patient in person, and authorize the Board of Medical Examiners and the
Medical Licensure Commission to adopt rules related to telehealth and telemedicine.

* 2022 AL S.B. 99 (NS), adopted March 8, 2022, 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 statute is enacted into law in the 10th member state. The bill is effective July 1,
2022.

¢ 2022 AL S.B. 167 (NS), adopted March 8, 2022, 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 statute is enacted into law in the 10th member state. The
bill is effective July 1, 2022.

¢ 2022 AL S.B. 180 (NS), introduced February 2, 2022, would provide for community health clinics that include birthing centers in
certain counties, provide for a home visitation program to provide prenatal and perinatal care to mothers and infants in underserved
areas, including for telehealth services.

* 2022 AL S.B. 272 (NS), adopted April 12, 2022, 2022, adopts AL ST ? 34-24-7071 to define 'telehealth," 'telehealth medical services,"
and 'telemedicine." Adopts AL ST ? 34-24-702, AL ST ? 34-24-703, AL ST ? 34-24-704, AL ST ? 34-24-705, AL ST ? 34-24-706, and
AL ST ? 34-24-707 to allow licensed physicians, including osteopathic physicians, to practice telemedicine in the state, to proscribe

the duties and responsibilities of a physician practicing telemedicine, provide that licensed physicians practicing telemedicine may
prescribe certain medications without meeting a patient in person, authorize the Board of Medical Examiners and the Medical Licensure
Commission to adopt rules related to telehealth and telemedicine, and repeal existing law relating to the practice of medicine and
osteopathy across state lines. The bill is effective April 13, 2022.

* 2022 AL REG TEXT 600622 (NS), filed January 19, 2022, amends AL ADC 536-X-8-.09 (Technology-Assisted Training/Education
Requirements of Profession) decreasing the amount of hours required for initial teletherapy training and allowing for the LMFT to begin
training and telephone simultaneously. The regulation is effective May 1, 2022.

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¢ 2022 AL REG TEXT 613467 (NS), filed April 22, 2022, adopts AL ADC 560-X-45-.01 (ER Nurse-Family Partnership ? General)
providing that NFP nurse visiting services are delivered in the home setting, via telehealth, or in an alternative community setting as
indicated by client need. Adopts AL ADC 560-X-45-.06 (ER NFP Visits) providing that a qualified NFP visit is a contact with the recipient
in-person either at their home or other location of the recipient's choosing or via telehealth when appropriate. The regulation is effective
April 22, 2022.

¢ 2022 AL REG TEXT 615944 (NS), published September 30, 2022, adopts AL ADC 610-X-6-.16 (Telehealth Nursing) requiring the
licensed nurse to hold an active Alabama license or multistate license issued by a party state other than Alabama in order to practice
telenursing in the State of Alabama. Provides that telenursing practice can take place in varied practice settings and establishes the
responsibilities for the individual nurse. The regulation is effective November 15, 2022.

Alaska

* 2021 AK H.B. 265 (NS), adopted July 13, 2022, adopts AK ST ? 08.01.085 (Telehealth) and AK ST ? 08.08.100 (Telehealth) to allow
a health care provider may provide health care services within the health care provider's authorized scope of practice to a patient in this
state through telehealth without first conducting an in-person examination if the health care provider holds a license in good standing.
The bill would also require a fee for a service provided through telehealth to be reasonable and consistent with the ordinary fee typically
charged for that service and may not exceed the fee typically charged for that service and define telehealth. Adopt AK ST ? 47.07.069
(Payment for telehealth) to establish the payment provisions for services provided through telehealth. The bill is effective July 13, 2022.

¢ 2021 AK S.B. 175 (NS), amended/substituted April 15, 2022, would adopt AK ST ? 08.01.085 (Telehealth) to allow a health care
provider may provide health care services within the health care provider's authorized scope of practice to a patient in this state through
telehealth without first conducting an in-person examination if the health care provider holds a license in good standing. The bill would
also require a fee for a service provided through telehealth to be reasonable and consistent with the ordinary fee typically charged

for that service and may not exceed the fee typically charged for that service and define telehealth. The bill would adopt AK ST ?
47.07.069 (Payment for telehealth) to establish the payment provisions for services provided through telehealth.

Arizona

* 2022 AZ H.B. 2093 (NS), introduced June 23, 2022, would amend AZ ST ? 36-449.03 (Abortion clinics; rules; civil penalties) to require
the Director to require an ultrasound evaluation for all patients who are expected to be at least 11 weeks' gestation by medical history
and last menstrual period, except in the case of a patient using a telehealth encounter for a medication abortion or a determination of
last menstrual period. Amend AZ ST ? 36-2156 (Informed consent; ultrasound required; violation; civil relief; statute of limitations) to
add a telehealth encounter for a medication abortion to the informed consent requirements. AZ ST ? 36-2301 .02 (Review of ultrasound
results) to exempt telehealth encounters for a medical abortion from the review of ultrasound result requirements.

¢ 2022 AZ S.B. 1468 (NS), adopted April 6, 2022, enacts the interstate 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 is effective on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective July 23, 2022.

* 2022 AZ REG TEXT 610778 (NS), published March 25, 2022, amends AZ ADC R4-22-104 (Fees and Charges) adding a $300 fee for
an out-of-state health care provider to register to provide services in Arizona. The regulation is effective March 1, 2022.

¢ 2022 AZ REG TEXT 613002 (NS), published April 22, 2022, adopts AZ ADC R9-10-2203 (Administration) to require an administrator
to ensure that policies and procedures for physical health services, habilitation services, and behavioral care are established,
documented, and implemented to protect the health and safety of a resident that cover telemedicine. The regulation is effective April 15,
2022.

California

* 2023 CA A.B. 48 (NS), introduced December 5, 2022, would adopt CA HLTH & S ? 1599.15 to provide that for purposes of obtaining
informed written consent, the use of remote technology, including, but not limited to, telehealth, to allow a prescriber to examine and
obtain informed consent, and for the prescriber, the resident or the resident's representative to use electronic signatures, must be
permitted.

¢ 2021 CA A.B. 686 (NS), introduced February 15, 2022, would adopt CA WEL & INST ? 5920 to provide that the best practices

for replication and for system improvement may include, but are not limited to, community-defined evidence practices that reduce
disparities, the use of telehealth or other technology to serve geographically isolated populations, and effective supplemental services,
including housing supports that assist vulnerable populations with behavioral health needs.

¢ 2021 CA S.B. 1438 (NS), adopted September 23, 2022, amends CA BUS & PROF ? 2620.1 (Direct physical therapy treatment
services) authorizing a physician and surgeon or podiatrist to conduct either an in-person or telehealth patient examination and
evaluation of the patient's condition in connection with their approval of the physical therapist's plan of care. The bill is effective January
1, 2023.

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¢ 2021 CA A.B. 1758 (NS), amended/substituted August 23, 2022, would require a supervisor within 60 days of the commencement of
supervision to conduct a meeting with the supervisee during which the supervisor is required to assess the appropriateness allowing
the supervisee to gain experience hours via telehealth and to receive supervision via 2-way, real-time videoconferencing.

¢ 2021 CAA.B. 1759 (NS), adopted September 25, 2022, adopts CA BUS & PROF ? 4989.23.1 to require an applicant for licensure
as an educational psychologist to show, as part of the application, that they have completed a minimum of 3 hours of training or
coursework in the provision of mental health services via telehealth, which must include law and ethics related to telehealth and to
require a license issued prior to this requirement to meet this requirement upon renewal, reactivation, or reinstatement. Amends CA
BUS & PROF ? 4996.23.2 (Associate clinical social worker or applicant for licensure to perform services as employee or volunteer;
setting for supervised experience; counseling or psychotherapy for applicants) to allow an associate to provide services via telehealth
that are in the scope of practice. Adopts CA BUS & PROF ? 4996.27.1 to require an applicant for licensure as a clinical social worker
to show, as part of the application, that they have completed a minimum of 3 hours of training or coursework in the provision of mental
health services via telehealth, which must include law and ethics related to telehealth and to require a license issued prior to this
requirement to meet this requirement upon renewal, reactivation, or reinstatement. Amends CA BUS & PROF ? 4999.46.3 (Trainee,
associate, or applicant for licensure to perform services as employee or volunteer; setting for supervised experience; counseling or
psychotherapy for applicants) to require a clinical counselor trainee or associate to provide services via telehealth that are in the scope
of practice. Adopts CA BUS & PROF ? 4999.67 to require an applicant for licensure as professional clinical counselor to show, as part
of the application, that they have completed a minimum of 3 hours of training or coursework in the provision of mental health services
via telehealth, which must include law and ethics related to telehealth and to require a license issued prior to this requirement to meet
this requirement upon renewal, reactivation, or reinstatement. The bill is effective January 1, 2023.

* 2021 CAA.B. 1982 (NS), adopted September 25, 2022, adopts CA HLTH & S ? 1374.142 and CA INS ? 10123.857 to require a
health care service plan or health insurer covering dental services that offers a service via telehealth through a third-party corporate
telehealth provider, as defined, to disclose to the enrollee or insured the impact of third-party telehealth visits on the patient's benefit
limitations, including frequency limitations and the patient's annual maximum. Require those plans and insurers to submit specified
information for each product type. The bill is effective January 1, 2023.

* 2021 CAA.B. 2117 (NS), adopted September 29, 2022, adopt CA HLTH & S ? 1797.95 to provide that 'mobile store unit" means a
multijurisdictional mobile facility that serves as an emergency response critical care ambulance under the direction and approval of a
local emergency medical services (EMS) agency, and as a diagnostic, evaluation, and treatment unit, providing radiographic imaging,
laboratory testing, and medical treatment under the supervision of a physician in person or by telehealth, for patients with symptoms of
a stroke, to the extent consistent with any federal definition of a mobile stroke unit as set forth in 42 USCA ? 1395m (Special payment
rules for particular items and services), 42 CFR ? 410.78 (Telehealth services), and any other federal law. The bill is effective January
1, 2023.

¢ 2021 CA A.B. 2320 (NS), enrolled August 29, 2022, would adopt CA HLTH & S ? 12435.1 to require a participating primary care clinic
to improve health care delivery for marginalized patients, including expanding telemedicine services.

¢ 2021 CA S.B. 1475 (NS), adopted September 28, 2022, amends CA HLTH & S ? 1607 (Skin puncture and venipuncture; predonation
screening; personnel; supervision; displacement) to authorize the registered nurse placed in charge to be physically present or
available via telehealth, so long as the method of telehealth used is synchronous. The bill is effective January 1, 2023.

* 2022 CA REG TEXT 557590 (NS), filed March 16, 2022, amends 28 CA ADC ? 1300.67.2.2 (Timely Access to Non-Emergency
Health Care Services and Annual Timely Access and Network Reporting Requirements) providing that a description of the
implementation and use of triage, telemedicine, including the applicable telehealth modalities, and health information technology used
by the plan and its network providers to provide timely access to care. Requires plan to annually submit the Telehealth Report Form
(Form No. 40-271) (April 1, 2022). The regulation is effective April 1, 2022.

¢ 2022 CA REG TEXT 605941 (NS), filed January 18, 2022, adopts emergency regulations 8 CA ADC 46.3 (Emergency Regulation
Regarding Medical-Legal Evaluations in Response to COVID-19), allowing Qualified Medical Evaluators (QME), Agreed Medical
Evaluators (AME), or other medical-legal evaluations to be performed via telehealth. The regulation is effective January 18, 2022.

¢ 2022 CA REG TEXT 626175 (NS), filed October 18, 2022, adopts emergency regulations 8 CA ADC 46.3 (Emergency Regulation
Regarding Medical-Legal Evaluations in Response to COVID-19), allowing Qualified Medical Evaluators (QME), Agreed Medical
Evaluators (AME), or other medical-legal evaluations to be performed via telehealth. The regulation is effective October 18, 2022.
Colorado

* 2022 CO H.B. 1076 (NS), adopted April 4, 2022, amends CO ST ? 12-230-104 (Scope of practice) to authorize a hearing aid provider
to perform services through the use of telehealth. The bill is effective August 9, 2022.

* 2022 CO H.B. 1263 (NS), adopted May 26, 2022, amends CO ST ? 12-200-103 (Definitions) to include the provision of acupuncture
services through telehealth in the definition for 'practice of acupuncture.' Amends CO ST ? 12-200-114 (Director--powers and duties--
rules) to require the Board to adopt rules establishing the appropriate use of telehealth to provide acupuncture services. The bill is
effective September 1, 2022.

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¢ 2022 CO H.B. 1302 (NS), adopted May 18, 2022, adopts CO ST ? 25.5-5-332 (Primary care and behavioral health statewide
integration grant program ? creation ? report ? definition ? repeal) prohibiting any money received through the grant program to be
used for ongoing or existing electronic health records costs, require grant applications to demonstrate a commitment to maintaining
models and programs that maintain a plan for how technology will be leverage for whole-person care, which may include plans for data
security, electronic health records reforms, and telehealth implementation or expansion, and requiring the state department to prioritize
applicants that utilize telenealth. The bill is effective May 18, 2022.

¢ 2022 CO S.B. 77 (NS), adopted June 8, 2022, enacts 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 statute is enacted into law in the 10th member state. The
bill is effective August 10, 2022.

¢ 2022 CO S.B. 173 (NS), adopted June 8, 2022, amends CO ST ? 12-280-103 (Definitions--rules) updating the definition for
'telepharmacy outlet" and CO ST ? 12-280-107 (Rules) to allow the Board to adopt rules as necessary to specify additional criteria for a
telepharmacy outlet. The bill is effective August 10, 2022.

¢ 2022 CO S.B. 181 (NS), adopted June 8, 2022, amends CO ST ? 12-20-103 (Division of professions and occupations--creation--
duties of division and department head--office space--per diem for board or commission members--review of functions) to require the
Division to make recommendations to expand the portability of existing credentialing requirements through statutory changes, including
the adoption of interstate compacts in order to facilitate for mental health and behavioral health-care providers the use of telehealth to
practice in multiple jurisdictions. The bill is effective July 1, 2022.

¢ 2022 CO S.B. 200 (NS), adopted June 1, 2022, adopts CO ST ? 25.5-1-207 (Rural provider access and affordability stimulus grant
program - advisory committee - fund ? reporting - rules - definitions ? repeal) to provide the definition for 'telemedicine' and to require
that grant money be used to expand access to telemedicine in rural communities, including remote monitoring support. The bill is
effective June 1, 2022.

¢ 2022 CO S.B. 219 (NS), adopted June 7, 2022, amends CO ST ? 12-220-104 (Definitions--rules) to update the definition for
'telehealth supervision." The bill is effective January 1, 2023.

Connecticut

¢ 2022 CT H.B. 5001 (NS), adopted May 23, 2022, amends CT ST ? 17a-20a (Behavioral health consultation and care coordination
program. Plan. Regulations) to require the regional behavioral health consultation and care coordination program to provide to the
pediatric patient of a primary care provider who serves children not more than 3 follow-up telehealth appointments, if determined

to be medically necessary by the primary care provider, with a mental health care provider after the primary care provider has

utilized the program on behalf of such patient. Amends CT ST ? 19a-906 (Telehealth services) to update the definition for 'telehealth
provider." The bill also allows certain out-of-state telehealth providers to provide telehealth services in Connecticut, temporarily expand
telehealth requirements for the delivery of telehealth services by one year to June 30, 2024, to temporarily expand insurance coverage
requirements and prohibitions for telehealth services by one year to June 30, 2024, and apply the coverage requirements to high
deductible health plans to the extent permitted by federal law, and to require, beginning July 1, 2024, insurance policies to cover
services provided through telehealth to the same extent that they cover them when provided in person by a Connecticut-licensed
provider, rather than by any provider. The bill is effective October 1, 2022.

¢ 2022 CT H.B. 5046 (NS), amended/substituted March 28, 2022, and 2022 CT H.B. 5395 (NS), amended/substituted March 29, 2022,
would enact 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.

¢ 2022 CT H.B. 5450 (NS), introduced March 10, 2022, would amend CT ST ? 19a-906 (Telehealth services) to add dental hygienists
to the list of telehealth providers and to require mental health care providers who practice in multiple states and provide telehealth to
have a physical presence in Connecticut, charge rates pursuant to Connecticut law, and regularly see patients in Connecticut and
amend CT ST ? 38a-499a (Coverage for telehealth services) and CT ST ? 38a-526a (Coverage for telehealth services) to require
insurance coverage for telehealth services provided to residents who are temporarily outside of the state. The bill would also enact 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.

* 2022 CT H.B. 5480 (NS), amended/substituted April 4, 2022, would amend CT ST ? 19a-906 (Telehealth services) to update the
definition for 'telehealth provider" and CT ST ? 20-187a (License required. Practice defined) to permit students enrolled in a doctorate
degree program in psychology at an institution of higher education in the state to provide professional psychological services in person
and through the use of telehealth while under the supervision of a licensed psychologist to improve the accessibility of mental health
services in the state.

¢ 2022 CT S.B. 2 (NS), adopted May 24, 2022, amends CT ST ? 19a-906 (Telehealth services) to update the definition for 'telehealth
provider" and prohibit a telehealth provider or hospital from charging a facility fee for telenealth services. Enacts the Psychology
Interjurisdictional Compact to regulate the day to day practice of telepsychology by psychologists across state boundaries in the

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performance of their psychological practice. The Compact will come into effect on the date on which the compact statute is enacted into
law in the 10th member state. The bill is effective October 1, 2022.

¢ 2022 CT S.B. 15 (NS), amended/substituted March 21, 2022, amends CT ST ? 38a-477kk (Proof of coverage to disclose whether
coverage is fully insured or self-insured. Regulations) requiring the carrier or TPA to include on the ID card a telephone number the
insured may call to access telehealth or a list of local in-network PCPs accepting new patients if the insured did not designate a PCP.

¢ 2022 CT S.B. 412 (NS), amended/substituted April 6, 2022, would amend CT ST ? 19a-906 (Telehealth services) to prohibit a
telehealth provider or hospital from charging a facility fee for telenealth services and provide that such prohibition applies to hospital
telehealth services whether provided on-campus or otherwise.

Delaware

¢ 2021 DE H.B. 295 (NS), adopted February 16, 2022, 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" and 'telemedicine.' The bill is effective February 16,
2022.

¢ 2021 DE H.B. 334 (NS), adopted October 21, 2022, amends DE ST TI 24 ? 6002 (Authorization to practice by telehealth and
telemedicine) to clarify that health-care providers licensed in a state that has not adopted an interstate compact applicable to the health-
care provider may only provide telehealth under this chapter if the health-care provider obtains an interstate telehealth registration from
the Division of Professional Regulation. Establishing the requirements for an interstate telehealth registration. Provides the conditions
that are applicable to a health-care provider who obtains an interstate telehealth registration. The bill is effective October 21, 2022.

¢ 2021 DE H.B. 415 (NS), introduced May 10, 2022, would adopt DE ST ? 6103 (Authorization to practice by telehealth and
telemedicine) to allow a health care provider who practices within the scope of a temporary license to deliver health care services by
telehealth and telemedicine.

¢ 2021 DE H.B. 455 (NS), adopted June 29, 2022, adopts DE ST TI 18 ? 2535 (Adverse actions on policies relating to provision of
medical care for termination of pregnancy) to prohibit an insurer from increasing the premium or taking any adverse action against a
health-care professional or health care organization for performing or providing reproductive health care services that are lawful in this
State and covers any medical professional who prescribes medication for the termination of human pregnancy to an out-of-state patient
by means of telehealth. The bill is effective June 29, 2022.

¢ 2021 DE S.B. 247 (NS), adopted August 4, 2022, enacts the Interstate 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 must come into effect on the date on which the Compact statute is enacted into law in the 10th Member State.
The bill is effective August 4, 2022.

¢ 2021 DE S.B. 257 (NS), adopted August 4, 2022, enacts the Multistate Professional Counselor 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. The Compact must come into effect on the date on which the Compact statute is enacted into law in the 10th Member State.
The bill is effective August 4, 2022.

¢ 2021 DE S.B. 272 (NS), adopted August 4, 2022, enacts 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 must come into effect on the date on which the Compact statute is enacted into law
in the 10th member state. The bill is effective August 4, 2022.

¢ 2022 DE REG TEXT 589824 (NS), published November 1, 2022, repeals 24 DE ADC 1700-19.0 (Telemedicine). The rulemaking is
effective November 11, 2022.

¢ 2022 DE REG TEXT 615996 (NS), published October 1, 2022, amends 24 DE ADC 1900-8.0 (Rules and Regulations Governing the
Practice of Nursing as an Advanced Practice Registered Nurse in the State of Delaware) establishing the requirements for electronic
prescribing and providing exceptions for the requirements. The regulation is effective October 11, 2022.

District of Columbia

* 2021 DC L.B. 484 (NS), adopted December 13, 2021, amends DC CODE ? 7-771.07a (Grant authority) to allow the Director to award
competitive grants in an amount up to $200,000 to study the barriers to telehealth services, award a competitive grants in an amount
up to $250,000 to assist FQHCs in educating their patients in Wards 7 and 8 on how to properly access telehealth services, and award
competitive grants in an amount up to $100,000 to a District-based organization to deploy non-physician health care practitioners to
facilitate and improve care coordination for pregnant mothers receiving health benefits through Medicaid or the DC HealthCare Alliance,
provided the awardee has experience providing prenatal and postpartum maternal care to Medicaid beneficiaries by way of digital
health or telehealth with a focus on early detection of pregnancy-related illness, such as gestational hypertension or preeclampsia. The
bill is effective October 1, 2021.

* 2021 DC L.B. 550 (NS), adopted December 24, 2021, amends DC CODE ? 3-1205.02 (Exemptions) allowing 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

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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. The bill was adopted via emergency and is effective
December 24, 2021 and expires March 24, 2022.

¢ 2022 DC REG TEXT 456605 (NS), filed September 20, 2022, amends 29 DC ADC ? 997 (Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies) clarifying that a telehealth visit will satisfy the requirement for a face-to-face encounter for purpose of payment
for DMEPOS requirements. The regulation is effective September 30, 2022.

* 2022 DC REG TEXT 617028 (NS), adopted March 2, 2022, adopts 29 DC ADC ? 7406 (Individual Enrollment into HSS for Persons
Matched to PSH Program After HSS Benefit Implementation) requiring the Department to conduct face-to-face assessments in a range
of settings, including locations where people who are experience homelessness are staying or accessing services, or they may conduct
assessments using telehealth (e.g., telephone or video meeting) to ensure this process can be completed as safely and quickly as
possible, and to minimize disruption for the individual. Adopts 29 DC ADC ? 7407 (Individual Enrollment into HSS for Persons Matched
to PSH Program Before HSS Benefit Implementation) allowing the Department to use telehealth (e.g., telephone or video meeting) to
meet with the PSH consumer, and with the PSH consumer's consent, this may include their current service provider or a trusted support
person. The regulations were adopted via emergency rulemaking are effective March 2, 2022 through June 30, 2022.

* 2022 DC REG TEXT 619318 (NS), adopted June 30, 2022, amends 22-A DC ADC ? 3708 (Authorization of and Referrals to Mental
Health Supported Employment Services) and 22-A DC ADC ? 3708 (Authorization of and Referrals to SUD Supported Employment
Services) requiring the Department to complete the independent and needs-based assessments face-to-face or through telehealth as
permitted by Title 29 DCMR Chapter 910 using the Department-specified approved independent and needs-based assessment tools.
The rulemaking was adopted via emergency and is effective June 30, 2022 and remains in effect for 120 calendar days.

¢ 2022 DC REG TEXT 625960 (NS), adopted October 7, 2022, amends 7 DC ADC ? 3599 (Definitions) to define 'in-person treatment"
which includes all medical visits attended by a health care provider and the patient in the same physical space and telehealth services
that meet the requirements for reimbursement under the Telehealth Reimbursement Act of 2013, approved July 23, 2013. The
rulemaking was adopted via emergency and is effective October 7, 2022 and will remain in effect for 120 days, until February 4, 2023,
unless superseded by a Notice of Final Rulemaking published in the District of Columbia Register.

¢ 2022 DC REG TEXT 625966 (NS), adopted September 28, 2022, adopts 29 DC ADC ? 11201 (Scope of Services) allowing doula
services to be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth (when appropriate). The
regulation is effective October 7, 2022.

* 2022 DC REG TEXT 625966 (NS), adopted November 21, 2022, adopts 29 DC ADC ? 11201 (Scope of Services) allowing doula
services to be provided in a clinic, physician's office, freestanding birth center, or the home, or via telehealth (when appropriate). The
regulation is effective December 2, 2022.

Florida

¢ 2022 FL H.B. 953 (NS), amended/substituted March 18, 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.

¢ 2022 FL H.B. 1521 (NS), adopted April 6, 2022, enacts 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 becomes effective on the date on which the Compact is enacted into law in the 10th member state.

* 2022 FL H.B. 1585 (NS), filed January 11, 2022, 2022 FL S.B. 164 (NS) and 2022 FL S.B. 326 (NS), introduced January 11, 2022,
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.

¢ 2023 FL S.B. 56 (NS), filed December 9, 2022, would enact 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.

¢ 2022 FL S.B. 312 (NS), adopted April 6, 2022, amends FL ST ? 456.47 (Use of telehealth to provide services) to update the definition
for 'telehealth." The bill is effective July 1, 2022.

¢ 2022 FL S.B. 630 (NS), introduced January 11, 2022, 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), introduced January 11, 2022, would amend FL ST ? 409.967 (Managed care plan accountability) to prohibit

a plan from using providers who exclusively provide services through telehealth to meet the network access standards, adopt new

FL ST ? 627.42396 ( Requirements for Reimbursement by health insurers for telehealth services) to establish the reimbursement
requirements for telehealth services, FL ST ? 641.31 (Health maintenance contracts) to prohibit a health maintenance organization
issuing major medical individual or group coverage from requiring a subscriber to consult with, seek approval from, or obtain any

type of referral or authorization by way of telehealth from a telehealth provider, and adopt FL ST ? 641.31093 (Requirements for
reimbursement by health maintenance organizations for telehealth services) to establish the reimbursement requirements for telehealth
services.

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* 2022 FL S.B. 768 (NS), adopted April 20, 2022, amends 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. The bill is effective July 1, 2022.

¢ 2022 FL S.B. 1262 (NS), adopted April 6, 2022, amends FL ST ? 394.455 (Definitions) to define 'telehealth" and FL ST ? 394.463
(Involuntary examination) to allow the release to be approved through telehealth. The bill is effective July 1, 2022.

¢ 2022 FL S.B. 1268 (NS), introduced January 11, 2022, 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 S.B. 1370 (NS), introduced January 18, 2022, 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.

¢ 2022 FL S.B. 1506 (NS), introduced January 18, 2022, would amend FL ST ? 383.2163 (Telehealth minority maternity care pilot
programs) to require the pilot program to adopt the use of telehealth to provide education to eligible pregnant women on pediatric
cardiopulmonary resuscitation, including provision of the educational materials developed by the Department.

¢ 2022 FL S.B. 1510 (NS), introduced January 18, 2022, would adopt the Telehealth Pilot Program within the Department of Children
and Families to require certain persons transporting minors to receiving facilities to first obtain specific advice through telehealth
services and prohibiting the telehealth services from being provided by an entity that provides involuntary examination services.

¢ 2022 FL REG TEXT 582212 (NS), published November 8, 2022, amends 64 FL ADC 64B8-55.001 (Disciplinary Guidelines)
substantially rewriting the disciplinary guidelines used to notify applicants, licensees, and telehealth registrants of the ranges of
penalties which will routinely be imposed unless the Board finds it necessary to deviate from the guidelines for the stated reasons given
within this rule. The rulemaking is effective November 22, 2022.

* 2022 FL REG TEXT 591884 (NS), published May 3, 2022, adopts 59 FL ADC-3.249 (Neonatal Intensive Care Units (NICU)) providing
the definition for 'telemedicine" and establishing the pediatric medical subspecialities that must be available onsite or via telemedicine
each Level Il and Level III NICU. The regulation is effective May 19, 2022.

¢ 2022 FL REG TEXT 593540 (NS), published October 25, 2022, amends 64 FL ADC 6485-13.005 (Disciplinary Guidelines) updating
disciplinary guidelines for the Board of Dentistry. Amendments include adding penalty ranges for telehealth registrants. Provides that for
telehealth registrants, a suspension may be accompanied by a corrective action plan that addressees the conduct which resulted in the
underlying disciplinary violations. The regulation is November 9, 2022.

¢ 2022 FL REG TEXT 603710 (NS), published May 3, 2022, adopts 65 FL ADC 65D-30.0142 (Clinical and Operational Standards
for Medication-Assisted Treatment for Opioid Use Disorder) allowing subsequent assessment for methadone medication-assisted
treatment to be conducted via telehealth. The regulation is effective May 19, 2022.

* 2022 FL REG TEXT 607029 (NS), published March 29, 2022, adopts 64B FL ADC 64B13-15.0065 (Disciplinary Action; Telehealth
Registrants) providing disciplinary action for telehealth registrants. The regulation is effective April 13, 2022.

¢ 2022 FL REG TEXT 608203 (NS), published February 24, 2022, amends FL ADC 65DER22-2 (Clinical and Operational Standards for
Medication-Assisted Treatment for Opioid Use Disorders) to allow an assessments to be conducted either face-to-face or via telehealth,
except for the initial assessment for methadone medication-assisted treatment which must be conducted face-to-face. The rulemaking
was amended via emergency and is effective February 24, 2022.

Georgia

¢ 2021 GA S.B. 351 (NS), introduced January 25, 2022, would adopt GA ST ? 31-9C-2 to provide that it is unlawful for any
manufacturer, supplier, physician, qualified physician, or any other person to provide any abortion-inducing drug via courier, delivery,
telemedicine, or mail service.

¢ 2021 GA S.B. 540 (NS), introduced February 24, 2022, would require coverage of dental care provided by means of teledentistry,

to provide that dental care delivered through teledentistry services must be reimbursed on the same basis and at least at the rate that
the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact, and to authorize
licensed dentists to provide oral healthcare by means of teledentistry.

Hawaii

¢ 2021 HI H.B. 1406 (NS), amended/substituted February 10, 2022, would amend HI ST ? 346-59.1 (Coverage for telehealth) to
require coverage for psychiatric services provided by a patient by a collaborative care team consisting of a primary care provider and
behavioral health care manager, who must be present in the primary care provider's office, in conjunction with a psychiatric consultant
whose services may be delivered remotely through telehealth.

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¢ 2021 HI H.B. 1634 (NS), introduced January 21, 2022, 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 health insurers, mutual benefit
societies, and health maintenance organizations from excluding coverage of a service solely because the service is provided through
telehealth and not through face-to-face contact and require parity between telehealth services and face-to-face services for purposes of
deductibles, copayments, coinsurance, benefit limits, and utilization reviews.

¢ 2021 HI H.B. 1823 (NS), amended/substituted April 8, 2022, would amend HI ST ? 327L-4 (Attending provider; duties) to allow an
initial determination of a patient's terminal disease to be made in-person or via telehealth.

* 2021 HI H.B. 1980 (NS), amended/substituted April 29, 2022, 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) allowing Medicaid, insurers, mutual benefit societies, and health maintenance organizations to cover telephonic behavioral
health services under certain circumstances and updates telehealth coverage requirements. Amend HI ST ? 453-1.3 (Practice of
telehealth) to clarify that telephonic services do not constitute telehealth.

¢ 2021 HI S.B. 2073 (NS), amended/substituted March 3, 2022, would amend HI ST ? 346-59.1 (Coverage for telehealth), HI ST ?
432:1-601.5 (Coverage for telehealth), and HI ST ? 432D-23.5 (Coverage for telehealth) suspending the exclusion of the use of
standard telephone contacts from the definition of 'telehealth" to enable doctors and patients to minimize in-person meetings while
ensuring access to medical care.

¢ 2021 HI S.B. 2624 (NS), adopted June 27, 2022, requires the Department of Health to implement a telehealth pilot project and publish
an evaluation report on the telehealth pilot project outcomes. The telehealth pilot project exempts from the Hawall Public Procurement
Code for a period of 12 months. Clarify that the period of performance of all procurements made during this temporary exemption must
not exceed the term of the telehealth pilot project. Requires the Department of Health to implement and administer a rural healthcare
pilot project to provide physicians serving selected rural areas with an availability fee and reimbursements for certain expenses. The bill
is effective July 1, 202.

¢ 2021 HI S.B. 2645 (NS), amended/substituted March 3, 2022, 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." The bill would also amend HI ST ? 453-1.3 (Practice of telehealth) to require
reimbursement for behavioral health services provided through telehealth, including standard telephone contacts, to be equivalent to
reimbursement for the same services provided via face-to-face contact between a health care provider and a patient.

Idaho

* 2022 ID H.B. 602 (NS), introduced February 10, 2022, 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.

¢ 2022 ID H.B. 664 (NS), adopted March 23, 2022, 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. The bill is effective July 1, 2022.

¢ 2022 ID H.B. 760 (NS), introduced March 10, 2022, would adopt ID ST ? 54-5714 (Interstate Telehealth -- Mental and Behavioral
Health) establishing the requirements for a mental or behavioral health provider, excluding a physician, licensed or registered in another
state, district, or territory of the United States to practice mental or behavioral health care, including through telehealth.

¢ 2022 ID S.B. 1305 (NS), adopted March 22, 2022, 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
must come into effect on the date on which the compact is enacted into law in the 7th compact state. The bill is effective July 1, 2022.

Illinois

¢ 2021 IL H.B. 4501 (NS), adopted May 27, 2022, amends IL ST CH 225 ? 25/18 (Acts constituting the practice of dental hygiene;
limitations) to clarify that a dentist must either personally examine and diagnose the patient or utilize approved teledentistry
communication methods and determine which services are necessary to be performed, which must be contained in an order to the
hygienist and a notation in the patient's record. The bill is effective January 1, 2023.

¢ 2021 IL H.B. 4665 (NS), adopted May 27, 2022, amends IL ST CH 225 ? 30/10 (Definitions) to update the definition for 'telehealth" or
'telepractice." The bill is effective January 1, 2023.

¢ 2021 IL H.B. 4700 (NS), adopted April 19, 2022, adopts IL ST CH 305 ? 5/12-4.56 (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, that may include clinical personal health care consultants for telehealth (health information and advice) and wellness
initiatives. The bill is effective April 19, 2022.

¢ 2021 IL H.B. 4703 (NS), adopted May 26, 2022, adopts IL ST CH 215 ? 356z.3a (Billing; emergency services; nonparticipating
providers) to include telehealth in the definition of 'visit."

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¢ 2021 IL H.B. 4797 (NS), adopted May 13, 2022, amends IL ST CH 225 ? 20/4 (Exemptions) to provide that this Act does not prohibit
a person, who is not a resident of this State, from performing social work via telehealth in this State for a nonresident of this State

for not more than 5 days in any one month or more than 15 days in any one calendar year, had a previous established therapeutic
relationship with the nonresident, and the person is authorized to perform such services under the laws of the state or country in which
the person resides. Also provide that this Act does not prohibit a person, who is not a resident of this State, from performing social
work via telehealth in this State for a nonresident of this State currently attending a university or college in this State, had a previous
established therapeutic relationship with the nonresident, and the person is authorized to perform such services under the laws of the
state or country in which the person resides. The bill is effective January 1, 2023.

¢ 2021 IL H.B. 5278 (NS), introduced January 31, 2022, 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 IL H.B. 5501 (NS), adopted May 13, 2022, renumbers IL ST CH 20 ? 2205/2205-30 (Health care telementoring) as IL ST CH
20 ? 2205/2205-31 (Health care telementoring). The bill is effective May 13, 2022.

¢ 2021 IL H.B. 5710 (NS), introduced March 1, 2022, would adopt IL ST CH 410 ? 705/75-35 (Certifying health care professional
requirements) prohibiting a certifying health care professional who certifies a debilitating medical condition for a qualifying patient from
performing the required physical examination via remote means, including telemedicine.

¢ 2021 IL S.B. 3190 (NS), introduced January 13, 2022, would amend IL ST CH 225 ? 25/4 (Definitions) to update the definition for
'teledentistry."

¢ 2022 IL REG TEXT 603531 (NS), published September 16, 2022, amends 77 |L ADC 250.310 (Organization) requiring hospitals
without a licensed pediatric unit or board certified or board eligible pediatrician in the hospital 24 hours a day, 7 days a week that
provide limited inpatient or observation services to pediatric patients (14 years old and younger) must have a written agreement with
a children's hospital or hospital with a licensed pediatric unit, including consultations that meet the telemedicine requirement. The
regulation is effective September 1, 2022.

Indiana

* 2022 IN H.B. 1141 (NS), amended/substituted January 20, 2022, would amend IN ST 25-1-9.5-3.5 ('Practitioner') to expand the
application of the telehealth statute to additional practitioners.

¢ 2022 IN H.B. 1202 (NS), engrossed April 13, 2022, 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 IN H.B. 1230 (NS), introduced January 6, 2022, would amend IN ST 25-1-9.5-3.5 ('Practitioner') to expand the application of the
telehealth statute to additional practitioners.

¢ 2022 IN H.B. 1359 (NS), adopted March 11, 2022, adopts IN ST 31-37-19-11.7 allowing a juvenile court to recommend telehealth
services as an alternative to a child receiving a diagnostic assessment. The bill is effective July 1, 2022.

* 2022 IN S.B. 5 (NS), adopted March 18, 2022, 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. The bill is effective July 1, 2022.

¢ 2022 IN S.B. 36 (NS), amended/substituted March 25, 2022, 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.

¢ 2022 IN S.B. 284 (NS), adopted March 14, 2022, adds specified health care providers and students to the definition of 'practitioner' for
purposes of practicing telehealth, allow behavior health analysts to temporarily perform telehealth during the time when the professional
licensing agency is preparing to implement licensure for the profession, and exempt certain actions from the definition of 'telehealth."
The bill is effective July 1, 2022.

¢ 2022 IN S.B. 365 (NS), adopted March 9, 2022, 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. The bill is effective July 1, 2022.

lowa

¢ 2021 IA H.F. 2179 (NS), introduced February 1, 2022, would adopt the Licensed Professional Counselors 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.

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¢ 2021 IA H.F. 2363 (NS), introduced February 10, 2022, would amend IA ST ? 124E.9 (Medical cannabidiol dispensaries) to allow a
medical dispensary to send medical cannabis to a patient or a patient's primary caregiver following an initial telehealth consultation with
the patient and receipt of proof that the patient or patient's primary caregiver possesses a valid medical cannabis registration card.

¢ 2021 IA H.F. 2578 (NS), adopted June 14, 2022, amends IA ST ? 514C.34 (Health care services delivered by telehealth--coverage) to
prohibit a health carrier from excluding a health care professional who provides services for mental health conditions, illnesses, injuries,
or disease and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract
offered by the health carrier in the state if all of the following requirements are met: the health care professional is licensed in this

state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses,
injuries, or diseases via telehealth in compliance with paragraph 'a'; and the health care professional is able to satisfy the same criteria
that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-
of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the
state. The bill is effective July 1, 2022.

* 2021 IA S.F. 463 (NS), adopted May 24, 2022, establishes the Occupational Therapy Licensure Compact and the Audiology and
Speech-Language Pathology Interstate Compact. Establishes the requirements to practice occupational therapy in any member state
via telehealth under a privilege to practice as provided in the Compact. Establishes 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. The bill is effective July 1,
2022.

* 2021 IA S.F. 2006 (NS), introduced January 11, 2022, would adopt a new section Medicaid Reimbursement for Maternal Health

-- Related Services to require the same reimbursement for maternal-fetal medical services and comprehensive maternity care,
including both facility and professional fees, whether provided in person or through the use of telehealth. 2022 IA REG TEXT 601484
(NS), filed March 23, 2022, amends |A ADC 657-13.2(155A) (Definitions) providing the definition for 'telepharmacy personnel" and
updating the definition for 'telepharmacy site." Amends |A ADC 657-13.3(124,155A) (Written agreement) updating terminology

to use 'telepharmacy personnel" instead of 'telepharmacy technician" and updating the time frame for written agreements to 45

days from 90 days. Amends !A ADC 657-13.8(124,155A) (General requirements for telepharmacy site) updating the requirements
for telepharmacy sites. Amends IA ADC 657-13.10 (155A) (General requirements for verifying pharmacist) updating terminology

to use 'telepharmacy personnel" instead of 'telepharmacy technician." Amends |A ADC 657-13.11 (155A) (General requirements

for telepharmacy technician) updating the requirements for telepharmacy technicians. Adopts |A ADC 657-13.12(155A) (General
requirements for telepharmacy support person) establishing the registration and training requirements for telepharmacy support
persons. Amends !A ADC 657-13.16(124,155A) (Telepharmacy site-initial application) updating the requirements for the telepharmacy
site-initial application. The regulations are effective April 27, 2022.

¢ 2022 IA REG TEXT 608121 (NS), filed April 20, 2022, amends !A ADC 655-6.1(152) adding the definitions for 'asynchronous store-
and-forward transmission,' 'license,' and 'telehealth.' Adopts [A ADC 655-6.4(152) (Telehealth) establishing the licensing requirements
and minimum standards of practice for registered nurses (RNs) and licensed practical nurses (LPNs) who provide health care services
through telehealth. The regulations are effective June 22, 2022.

¢ 2022 IA REG TEXT 608122 (NS), filed April 20, 2022, amends IA ADC 655-7.1(17A,124,147,152) (Definitions) adding the definitions
for 'asynchronous store-and-forward transmission,' 'cross-coverage,' 'license,' 'on call,' and 'telehealth.' Adopts |A ADC 655-7.9(152)
(Standards of practice for telehealth) establishing the licensing requirements and standards of practice for advanced registered nurse
practitioners (ARNPs) who provide health care services through telehealth. The regulations are effective June 22, 2022.

Kansas

* 2021 KS H.B. 2552 (NS), introduced January 25, 2022, would establish the Kansas telehealth advisory committee to make
recommendations regarding telemedicine quality care practices. The bill would also amend KS ST 40-2,211 (Same; definitions) to
define 'in-state practitioner' and 'interstate telehealth practitioner' and update the definition for 'distant site" and 'telemedicine." Amend
KS ST 40-2, 212 (Same; confidentiality) to allow telemedicine to be used by an in-state practitioner to refer a patient to a specialty
service healthcare provider to the extent that such services are consistent with the standard of care for an in-state practitioner, establish
the requirements for an in-state practitioner to use audio-only commination with a patient who has an existing relationship with an in-
state practitioner, and allowing a healthcare provider to refuse to provide healthcare services using telemedicine at their sole discretion.
Amend KS ST 40-2,213 (Same; application of; coverage parity established) to require an individual or group health insurance policy,
medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit
society or health maintenance organization that provides coverage for accident and health services and the Kansas medical assistance
program must provide payment and reimbursement for telemedicine service provided by an in-state practitioner under the same criteria
that the policy provides for payment and reimbursement for the same or similar healthcare services delivered in person by an in-state
practitioner.

¢ 2021 KS H.B. 2652 (NS), introduced February 9, 2022, 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
extend the section expiration date to January 20, 2023, from March 31, 2022.

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¢ 2021 KS S.B. 286 (NS), enrolled April 8, 2022, 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 extend the sections
sunset date to January 20, 2023 from March 31, 2022.

¢ 2022 KS REG TEXT 606703 (NS), published May 5, 2022, amends KS ADC 28-51-100 (Definitions) providing the definition for
'telehealth." The regulation is effective May 20, 2022.

Kentucky

* 2022 KY H.B. 3 (NS), adopted April 14, 2022, amends KY ST ? 213.101 (Abortion required to be reported to Vital Statistics Branch;
public report; administrative regulations) requiring the report to include the method of obtaining the abortion-inducing drug if not provide
by a qualified physician, including mail order, internet order, or by a telehealth provider in which case identifying information for the
pharmacy, Web site address, or the telemedicine provider must be included. The bill is effective April 14, 2022.

¢ 2022 KY H.B. 65 (NS), adopted April 8, 2022, enacts the Licensed Professional 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.
The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective July 14, 2022.

¢ 2022 KY H.B. 188 (NS), adopted March 31, 2022, amends KY ST ? 211.336 (Duties of agency promulgating administrative
regulations relating to telehealth; restrictions) to provide that the state agency must not prohibit the delivery of telehealth services to

a person who is a permanent resident of Kentucky who is temporarily located outside of Kentucky by a provider who is credentialed
by a Kentucky professional licensure board, prohibit the delivery of telehealth services to a person who is not a permanent resident of
Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person's
state of permanent residence, or require a health care provider to be physically located in the state that he or she is credentialed in by
a professional licensure board in order to provide telehealth services to a person who is a permanent resident of the state. The bill is
effective July 14, 2022.

* 2022 KY H.B. 213 (NS), adopted April 8, 2022, enacts the interstate 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.
The bill is effective July 14, 2022.

* 2022 KY H.B. 512 (NS), adopted April 8, 2022, adopts new section to require a coordinating heart attack care agreement to be in
writing and include communication criteria and protocols that include but are not limited to telemedicine systems.

¢ 2022 KY H.B. 541 (NS), introduced February 22, 2022, would adopt new sections to require comprehensive location counseling,
lactation consultation, and breastfeeding equipment, including the delivery of counseling or consultation via telehealth, of the
beneficiary requests telehealth counseling or consultation in lieu of in-person, one-on-one counseling or consultations.

¢ 2022 KY H.B. 582 (NS), introduced February 24, 2022, would adopt a new section to allow a bona fide practitioner-patient relationship
to be established following a referral from the patient's primary care provider and be maintained via telehealth, but prohibits a bona fide
practitioner-patient relationship from being established via telehealth. Defines 'telehealth."

* 2022 KY S.B. 90 (NS), adopted April 20, 2022, to allow clinical assessments to be conducted through telehealth or in person and
amends KY ST ? 197.020 (Administrative regulations to be promulgated by Department of Corrections; fee for use of medical facilities;
reimbursement of telehealth consultations; use of jail medical facilities by state prisoner governed by KRS 441.045) to require telehealth
services in county jails. The bill is effective July 13, 2022.

* 2022 KY S.B. 133 (NS), adopted April 20, 2022, amends KY ST ? 194A.030 (Major organizational units of cabinet) to require the
Office of Inspector General to be responsible for the oversight of the operations of the Kentucky Health Information Exchange and
for the support and guidance to health care providers related to telehealth services including the development of policy, standards,
resources, and education to expand telehealth services across the Commonwealth. The bill is effective July 13, 2022.

* 2022 KY REG TEXT 587148 (NS), published February 1, 2022, amends 806 KY ADC 17:270 (Telehealth claim forms and records)
updating the requirements for telehealth claim forms and records. The regulation is effective January 4, 2022.

¢ 2022 KY REG TEXT 598025 (NS), published July 1, 2022, amends 907 KY ADC 3:170 (Telehealth service coverage and
reimbursement) updating coverage and reimbursement requirements for telehealth services. Updates definitions and cross-references.
The regulation is effective June 2, 2022.

* 2022 KY REG TEXT 600904 (NS), published July 1, 2022, amends 201 KY ADC 26:310 (Telehealth and telepsychology) updating the
definition for 'telehealth" and 'telepsychology." Requires a credential holder to document within the client's medical record that a service
was provided by telehealth within 48 hours of the telehealth service and to follow all documentation requirements of the practice. The
regulation is effective June 2, 2022.

* 2022 KY REG TEXT 609076 (NS), published August 1, 2022, amends 201 KY ADC 17:110 (Telehealth and telepractice) allowing
a practitioner-patient relationship to commence via telehealth. Provides that an in-person initial meeting is not required unless the
provider determines it is medically necessary to perform those services in person as set for in KY ST ? 211.336(2)(a) (Duties of

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agency promulgating administrative regulations relating to telehealth; restrictions). Requires a licensee to obtained informed consent
of the client at the initial meeting. Requires the licensee to maintain patient privacy and security. Allows for a provider who is a
participant in the audiology and speech-language pathology interstate compact to deliver telehealth services to a person in Kentucky.
Requires a licensee using telehealth to deliver services or who telepractices to conform to the statutes and regulations governing the
provision of speech-language pathology and audiology services in Kentucky. Prohibits a licensee using telehealth to deliver services
or who telepractices from engaging in false, misleading, or deceptive advertising of telepractice or fee splitting in violation of KY ST ?
334A.200(2)(a) and (b) (Duty of treating speech-language pathologist or audiologist utilizing telenealth to ensure patient's informed
consent and maintain confidentiality; board to promulgate administrative regulations; definition of 'telehealth"). The regulation is
effective July 20, 2022.

¢ 2022 KY REG TEXT 623043 (NS), filed August 8, 2022, amends 900 KY ADC 12:005E (Telehealth terminology and requirements)
removing the definition for 'Department" and updating 'Telehealth Terminology Glossary," August 2022, which is incorporated by
reference. The rulemaking continues a previous emergency rule and is effective August 8, 2022.

Louisiana

* 2022 LA H.B. 304 (NS), adopted May 25, 2022, adopts LA R.S. 22:1845.1 (Telehealth coverage and reimbursement; prohibitions

and limitations; exceptions; rulemaking) to require a health coverage plan to pay for covered services provided via telehealth to an
insured person, require equivalency for telehealth coverage and payment for the same service provided in person, unless the telehealth
provider and plan contractually agree to an alternative payment rate, provide that services via telehealth may be subject to a deductible,
copayment, or coinsurance not in excess of the deductible, copayment, or coinsurance required by the plan for in-person services,
prohibit a plan from imposing an annual dollar maximum on coverage for healthcare services provided as telehealth, other than an
annual dollar maximum that applies to the same services when provided in person by the same provider, require a plan to provide
payment for telehealth services to healthcare professionals licensed or otherwise permitted to practice physical therapy in this state,
and require telehealth payments to be consistent with any provider network arrangements that have been established for the plan. The
bill prohibits a plan from requiring prior authorization for telehealth. Define telehealth. The bill is effective January 1, 2023.

¢ 2022 LA H.B. 582 (NS), adopted June 10, 2022, enacts 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 Compat will come into effect on the date on which the compact statute is enacted into law in the 10th member state. The
bill is effective August 1, 2022.

¢ 2022 LA H.B. 697 (NS), adopted June 16 2022, amends LA R.S. 40:1046 (Recommendation and dispensing of marijuana for
therapeutic use; rules and regulations of the Louisiana Board of Pharmacy; production facility licensing; permitting by the Louisiana
Department of Health) to clarify that nothing in this Part must be construed or enforced in any manner that prevents a physician
authorized by Subsection A to recommend therapeutic marijuana from either recommending therapeutic marijuana or practicing
telemedicine. The bill is August 1, 2022.

* 2022 LA H.B. 826 (NS), adopted May 26, 2022, amends LA R.S. 37:3386.3 (Powers and duties of the Addictive Disorder Regulatory
Authority) to allow for the Board to promulgate rules for the provision of telehealth services by licensed, certified, or registered addiction
counselors; licensed, certified, or registered prevention professionals; and certified compulsive gambling counselors that, at a minimum,
comply with the applicable requirements and standards of the Louisiana Telehealth Access Act (LA R.S. T. 40, Ch. 5-D, Subch. D, Pt.
Vil).

¢ 2022 LA S.B. 296 (NS), engrossed April 28, 2022, would adopt LA R.S. 46:460.37 (Pharmacist clinical services in Louisiana medical
assistance program) to define 'telehealth" and to require a pharmacist to furnish services via telehealth or in-person in the pharmacy,
office, home, walk-in retail health clinic, federally qualified health center, rural health clinic, skilled nursing facility, assisted living facility,
or other place of service in order to be eligible to receive Medicaid reimbursement.

¢ 2022 LA S.B. 439 (NS), adopted June 18, 2022, amends LA R.S. 37:1271 (License to practice medicine or telemedicine required) to
update the requirements to practice telemedicine. The bill is effective August 1, 2022.

¢ 2022 LA REG TEXT 549477 (NS), published April 20, 2022, amends 50 LA ADC Pt I, ? 505 (Emergency Provisions) changing the
section title from 'Telemedicine in the Event of an Emergency" and allowing the Medicaid Program, in the event that the federal or state
government declares an emergency, to temporarily cover services provided through the use of an interactive audio telecommunications
system, without the requirement of video, if such action is deemed necessary to ensure sufficient services are available to meet
beneficiaries' needs. The rulemaking continues a previous emergency rules with changes noted above and is effective April 20, 2022.

* 2022 LA REG TEXT 550005 (NS), field April 11, 2022, amends 50 LA ADC Pt XXI, Subpt. 7 (Community Choices Waiver) to
allow monitored in-home caregiving (MIHC) providers to monitor participants via frequent telephone contacts and/or telehealth. The
rulemaking was adopted via emergency and is effective May 14, 2022.

¢ 2022 LA REG TEXT 550005 (NS), published October 10, 2022, amends 50 LA ADC Pt XXI, Subpt. 7 (Community Choices Waiver)
to allow monitored in-home caregiving (MIHC) providers to monitor participants via frequent telephone contacts and/or telehealth.
Amends 50 LA ADC Pt XXXiIll, Subpt. 9 (Home and Community-Based Services Waiver) to allow services to be provided telephonically

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or through videoconferencing means in accordance with LDH-issued guidance. The rulemaking was adopted via emergency and is
effective November 11, 2022.

¢ 2022 LA REG TEXT 558112 (NS), published March 10, 2022, amends 50 LA ADC Pt XV, ? 3503 (Waiver of Payment for Other
Services) allowing telemedicine visits to be used to meet requirements for daily visits by the hospice provider. The rulemaking
continues previous emergency rules and is effective April 19, 2022.

¢ 2022 LA REG TEXT 558112 (NS), published September 13, 2022, amends 50 LA ADC Pt XV, ? 3503 (Waiver of Payment for
Other Services) allowing telemedicine visits to be used to meet requirements for daily visits by the hospice provider. The rulemaking
continues previous emergency rules and is effective October 17, 2022.

« 2021 LA REG TEXT 594091 (NS), published February 20, 2022, adopts 46 LA ADC Pt LI, ? 509 (Optometric Telemedicine)
establishing criteria for licensed optometrists to practice telemedicine within the bounds of the scope of the practice of optometry. The
rule is effective February 20, 2022.

¢ 2022 LA REG TEXT 608058 (NS), filed May 20, 2022, amends 48 LA ADC Pt I, ? 5605 (General Provisions) providing that the
geographic service area is the geographic area that a BHS provider's license allows services, including all telehealth services, to
be provided to clients and prohibiting a BHS provider from providing telehealth services outside of its geographic service area. The
regulation is effective May 20, 2022.

¢ 2022 LA REG TEXT 612670 (NS), published July 20, 2022, amends 50 LA ADC Pt 1, ? 503 (Claim Submissions) clarifying that
Medicaid covered services provided via telemedicine/telehealth must be identified on claim submissions by appending the appropriate
place of service or modifier to the appropriate procedure code, in line with current policy. Adopts 50 LA ADC Pt I, ? 505 (Emergency
Provisions) allowing the Medicaid Program, in the event that the federal or state government declares an emergency, to temporarily
cover services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such
action is deemed necessary to ensure sufficient services are available to meet beneficiaries' needs. This rulemaking adopts previous
emergency rule 50 LA ADC Pt |, ? 505 (Emergency Provisions) as final and is effective July 20, 2022.

¢ 2022 LA REG TEXT 614901 (NS), published November 20, 2022, amends 46 LA ADC Pt LXXV, ? 111 (Application for Telehealth
Registration) requiring criminal history record information to be submitted with the application form. Requires telehealth registrants to
report any previous or pending disciplinary actions in any state. Removes provision allowing the Board to offer a consent agreement
and order to grant an individual registration when there is probable cause to believe that an applicant practiced illegally in Louisiana

as an audiologist and/or speech-language pathologist. Amends 46 LA ADC Pt LXXV, ? 135 (Telehealth) updating the section title from
'Telehealth (Formerly ? 130)." Amends 46 LA ADC Pt LXXV, ? 701 (Preamble) providing that speech-language pathology assistants
must not interpret tests or assessment results, guarantee results, make referrals, discharge patients/clients, nor provide patient/client or
family counseling. Clarifying that provisional speech-language pathology assistant licensees must not provide services via telepractice,
interpret test or assessment results, guarantee results, make referrals, discharge patients/clients, or provide patient/client or family
counseling. Makes technical changes. The regulation is effective November 20, 2022.

¢ 2022 LA REG TEXT 617338 (NS), published September 20, 2022, amends 50 LA ADC Pt XV, ? 3503 (Waiver of Payment for Other
Services) allowing, during a state or federal declared emergency or disaster, the Medicaid Program to waive the provision requiring
daily visits by the hospice provider to clients under the age of 21 to facilitate continued care while maintaining the safety of staff and
beneficiaries. Requires the visits to be completed based on clinic need and allows the use of telemedicine visits. The regulation is
effective September 20, 2022.

¢ 2022 LA REG TEXT 620135 (NS), published October 20, 2022, to require Obstetrical Level II Unit (Specialty Care) to have a lactation
consultant or counselor to be certified by a nationally recognized board on breastfeeding and providing that if individuals are not of staff,
the services may be obtained from certified providers through the use of telehealth. The regulation is effective October 20, 2022.

¢ 2022 LA REG TEXT 622373 (NS), published November 20, 2022, amends 48 LA ADC Pt I, ? 5605 (General Provisions) clarifying that
a BHS provider that is not a licensed mental health professional or a provisionally licensed mental health professional acting within his/
her scope of practice may not provide telehealth services outside of its geographic service area. The regulation is effective November
20, 2022.

¢ 2021 ME H.P. 1427 (NS), adopted March 31, 2022, enacts the Interstate 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.
The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective July 19, 2022.

¢ 2021 ME H.P. 1435 (NS), adopted April 26, 2022, amends ME ST T. 22 ? 2422 (Definitions) to define 'telehealth services,"
'asynchronous encounter," 'store and forward transfer," 'synchronous encounter," and 'telemonitoring." Amends ME ST T. 22 ?
2423-B (Authorized conduct by a medical provider) allowing a medical provider who provides written certifications for the medical
use of marijuana may use telehealth services to consult with a patient subject to the following conditions: a. a medical provider
using telehealth services to consult with a patient seeking a written certification for the medical use of marijuana must engage in a
synchronous encounter with a patient before providing a written certification or renewal of a written certification; and (b) a medical

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provider who provides written certifications for the medical use of marijuana and uses telehealth services to consult with patients must
operate within the standards of practice determined by the licensing board for that medical provider. The bill is effective April 26, 2022.

Maryland

* 2022 MD H.B. 669 (NS) and 2022 MD S.B. 166 (NS), adopted May 29, 2022, adopts MD HEALTH GEN ? 15-141.3 requiring the
Program to cover doula services that are medically indicated, are provided during the prenatal, labor and delivery, or postpartum period
of a birthing parent, and if provided remotely, comply with the telehealth requirements in MD ADC T. 10, Subt. 09, Ch. 49 (Telehealth
Services) and other relevant state and federal law. The bill is effective October 1, 2022.

* 2022 MD H.B. 670 (NS), introduced January 31, 2022, would require the Maryland Health Care Commission, in consultation with
certain State agencies and stakeholders, to study ways that interstate telehealth can be expanded.

¢ 2922 MD H.B. 765 (NS), introduced February 3, 2022, would adopt MD HEALTH GEN ? 15-141.3 to cover doula services that if
provided remotely, comply with the telehealth requirements, to prohibit doula services from being provided during labor and delivery,
and to prohibit a professional services provided by telehealth when the service is indicated as an exclusion.

* 2022 MD H.B. 912 (NS) and 2022 MD S.B. 707 (NS), adopted May 12, 2022, amends MD INSURANCE ? 15-830 (Referrals to
specialists) to require on request for a telehealth visits, if the carrier's provider panel has an insufficient number or type of participating
specialists or nonphysician specialists with the expertise to provide the covered mental health or substance use disorder services
required to a member within the appointment waiting time or travel distance standards established in regulations, the carrier must cover
the services provided by a nonparticipating provider at no greater cost to the member than if the service were provided by a provider on
the carrier's provider panel. The bills are effective July 1, 2022.

* 2022 MD H.B. 1139 (NS), introduced February 11, 2022, would adopt new section to prohibit a facility operated on public school
property or operated by a public school district, and an employee or contractor of any facility acting within the scope of employment or
the contract from providing telehealth services for purposes of obtaining an abortion.

* 2022 MD S.B. 344 (NS), introduced January 21, 2022, would adopt MD INS ? 15-856 to require that an entity may not impose any
cost-sharing requirements, including copayments, coinsurance, or deductibles, for medically necessary and appropriate services
related to the use of postexposure prophylaxis or preexposure prophylaxis, including, including provider office and telehealth visits for
prescribing and medication management.

* 2022 MD S.B. 398 (NS), introduced January 24, 2022, would amend MD HEALTH OCCUP ? 1-1005 (Licensure, certification, or
authorization to provide health care services) to allow a health care practitioner who is not licensed in the state to provide behavioral
health services via telehealth to a patient located in the state in accordance with the requirements and limitations of this subsection
and establish the requirements for the provision of behavioral health services via telehealth to a patient located in the state by a
health care practitioner who is not licensed in the state. Provide that an out-of-state health care practitioner who provides behavioral
health services via telehealth to a patient located in the state must be held to the same standards of practice that are applicable to in-
person health care settings in the state. Providing for a venue for a civil or administrative action initiated against an out-of-state health
care practitioner by the Department, a health occupation board in the state, or a patient who receives behavioral health services via
telehealth from a health care practitioner.

¢ 2022 MD S.B. 821 (NS), introduced February 7, 2022, would enact the Medical Excellence Zone Compact for the purpose authorizing
licensed physicians to practice through telehealth in other compact states.

Massachusetts

«2021 MA H.B. 4879 (NS), introduced June 17, 2022, and 2021 MA H.B. 4891 (NS), introduced June 21, 2022, would adopt MA GEN
111 ? 51? to all the regulations to permit evaluation via telemedicine, electronic or telephonic consultation, as deemed appropriate by
the Department.

¢ 2021 MA S.B. 2774 (NS), introduced March 17, 2022, would define 'telehealth" and allow a physician to provide healthcare services to
a patient via telehealth from any location provided the following conditions are met: (i) the patient is physically located in Massachusetts
at the time the healthcare services are provided; (ii) the location from which the physician provides the services does not compromise
patient confidentiality and privacy; and (iii) the location from which the physician provides the services does not exceed restrictions
placed on the physician's specific license, including but not limited to, restrictions set by the hospital, institution, clinic or program in
which a physician licensed pursuant to section 9 of this chapter has been appointed.

¢ 2021 MA S.B. 3003 (NS), introduced July 14, 2022, would adopt a new section to require the Department of public health to utilize
money in the fund to provide a grant to each health center to pay for the cost of direct and indirect medication abortion readiness;
provided, however, that, the department shall prioritize applications from the University of Massachusetts and state university segments
and create a simple application process for community colleges to apply for funding; and provided further, that allowable expenses
under these grants shall include, but not be limited to costs associated with enabling the health center to deliver telehealth services.

¢ 2021 MA S.B. 3097 (NS), adopted August 10, 2022, adopts MA ST 111 ? 51 3/4 would require the Department to promulgate
regulations requiring all acute-care hospitals licensed under MA ST 111 ? 51G (Acute-care hospitals; original licensure process;
determination of suitability and responsibility; factors) to provide, or arrange for, licensed mental health professionals during all

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operating hours of an emergency department or a satellite emergency facility as defined in section 51 1/2 (Substance use disorder
evaluation and treatment for acute-care hospital or satellite emergency facility patient experiencing opioid-related overdose) to
evaluate and stabilize a person admitted with a mental health presentation to the emergency department or satellite facility and to
refer such person for appropriate treatment or inpatient admission. The regulations must permit evaluation via telemedicine electronic,
or telephonic consultation, as deemed appropriate by the Department. The section is effective January 1, 2023, provided that the
Department of Public Health promulgates regulations to implement the section within 90 days of the effective date of the Act. The bill is
effective November 8, 2022.

Michigan

¢ 2021 MI H.B. 5488 (NS), amended/substituted December 8, 2022, would amend Mi ST 333.18201 (Definitions; principles of
construction) to provide that 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 is authorized to
engage in the practice of psychology under this article. Provide that for purposes of this article, including the obligations of an individual
who is licensed as a psychologist under this part, 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
is considered a psychologist who is licensed under this part.

¢ 2021 MI H.B. 5489 (NS), engrossed December 7, 2022, would enact 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 H.B. 5651 (NS), introduced December 16, 2021, would amend | ST 500.3476 (Telemedicine services) to prohibit an
insurer from excluding a service for coverage solely because the service is provided through telemedicine, imposing any annual or
lifetime dollar maximum on coverage for telemedicine services other than that is equally imposed on in-person services, impose prior
authorization requirements that are not equally imposed on in-person services, require demonstration that it is necessary to provide
services to a patient through telemedicine, restrict or deny coverage of telemedicine based solely on the community technology or
application used to deliver the telemedicine services, require a provider to be part of a telemedicine network.

¢ 2021 MI H.B. 5751 (NS), introduced February 15, 2022, would adopt the Emotional Support Animal Act would allow a provider-patient
relationship to be established via telehealth and provides the definition for 'telehealth."

¢ 2021 MI H.B. 6355 (NS), introduced August 17, 2022, would amend | ST 330.1409 (Preadmission screening units; establishment;
assessment and screening services; operation of crisis stabilization unit; referrals and treatment) allowing telehealth services to be
used to complete the assessment.

* 2021 MI H.B. 6446 (NS), introduced October 11, 2022, would establish the interstate 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 MI S.B. 637 (NS), adopted December 23, 2021, adopts M! ST 330.1207e defining 'telehealth" and M! ST 330.1207f to include
metrics on the number of calls transferred to telehealth with physical response follow-up and the number of calls transferred to
telehealth without physical response follow-up. The bill is effective December 23, 2021.

¢ 2021 MI S.B. 1135 (NS), introduced June 30, 2022, would amend MI! ST 400.105h (Telemedicine services) providing that beginning
October 1, 2022, telemedicine services are also covered under the medical assistance program and Health Michigan program if those
services are provided at, or contracted through, a distant site allowed in the Medicaid provider manual. Requiring telemedicine services
to be reimbursed by the medical assistance program and the Health Michigan program in, at least, the same amount as would be
reimbursed if the service was provide in person. Defines 'distant site."

¢ 2022 MI REG TEXT 592290 (NS), filed February 22, 2022, adopts | ADC R 338.7127 (Telehealth) to require a licensee to obtain
consent for treatment before providing a telehealth service, require a licensee to keep proof of consent for telehealth treatment in the
patient's up-to-date medical records, and require a licensee providing any telehealth service to act within the scope of the licensee's
practice and exercise the same standard of care applicable to traditional, in-person health care services. The regulation is effective
February 22, 2022.

* 2022 MI REG TEXT 592291 (NS), field December 7, 2021, adopts Mi! ADC R 338.1832 (Telehealth) requiring a licensee to obtain
consent for treatment before providing a telehealth service, requiring a licensee to keep proof of consent in the patient's up-to-date
medical record, and requiring a licensee providing any telehealth service to act within the scope of the licensee's practice and exercise
the same standard of care applicable to a transitional, in-person health care service. The rulemaking is effective December 7, 2021.

¢ 2021 MI REG TEXT 592301 (NS), filed December 7, 2021, adopts !Vil ADC R 338.2526 (Telehealth) requiring a licensee to obtain
consent for treatment before providing a telehealth service, requiring a licensee to keep proof of consent in the patient's up-to-date
medical record, and requiring a licensee providing any telehealth service to act within the scope of the licensee's practice and exercise
the same standard of care applicable to a transitional, in-person health care service. The rulemaking is effective December 7, 2021.

¢ 2022 MI REG TEXT 593764 (NS), filed December 16, 2021, adopts Mi] ADC R 338.7204 (Telehealth) requiring a licensee to obtain
consent for treatment before providing a telehealth service and requiring a licensee to keep proof of consent for telehealth treatment

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in the patient's up-to-date medical record. Requires a licensee providing any telehealth service to act within the scope of the licensee's
practice and exercise the same standard of care applicable to a traditional, in-person health care service. The regulation is effective
January 16, 2021.

¢ 2022 MI REG TEXT 596530 (NS), filed March 16, 2022, adopts | ADC R 338.13 (Telehealth) to require a licensee to obtain consent
from the patient for treatment before providing a telehealth service, require a licensee to keep proof of consent for telehealth treatment
in the patient's up-to-date medical record, and require a licensee providing telehealth services to act within the scope of the licensee's
practice and exercise the same standard of care applicable to a traditional, in-person health care service. The regulation is effective
March 16, 2022.

Minnesota

¢ 2021 MN H.F. 3114 (NS), introduced February 3, 2022, would adopt MN ST ? 144.595 (Support and Grants for Comprehensive
School-Based Health Centers) to allow services provided by a school-based health center to include emerging services such as mobile
health and telehealth.

¢ 2021 MN H.F. 3153 (NS), introduced February 3, 2022, would amend MN ST ? 256B.0625 (Covered services) to allow tobacco and
nicotine cessation services to be provided by telemedicine.

¢ 20221 MN H.F. 3240 (NS), introduced February 10, 2022, would amend MN ST ? 148.706 (Physical therapist assistants, aides,

and students) to require that when a physical therapist directs components of a patient's treatment to a physical therapist assistant, a
physical therapist must have a real-time, collaborative treatment session, that takes place in person or remotely via telehealth, with the
physical therapist assistant and document the continued appropriateness of the plan of care at least every 6 treatment sessions.

¢ 2021 MN H.F. 3319 (NS), introduced February 10, 2022, would amend MN ST ? 256B.0625 (Covered Services) would update the
definition for 'telehealth."

¢ 2021 MN H.F. 3510 (NS), introduced February 17, 2022, would enact 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.

¢ 2021 MN H.F. 3537 (NS), introduced February 17, 2022, 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 MN H.F. 3636 (NS), engrossed April 4, 2022, would amend MN ST ? 256B.0625 (Covered services) updating the definition for
'telehealth."

¢ 2021 MN H.F. 4005 (NS), introduced March 3, 2022, and 2021 MN S.F. 3380 (NS), engrossed March 7, 2022, would amend MN
ST ? 126C.44 (Safe schools levy) to allow safe schools revenue to be used for school-linked mental health services delivered by
telemedicine.

* 2021 MN H.F. 4065 (NS), adopted June 2, 2022, adopts temporary telephone-only telehealth authorization for face-to-face
requirements for reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic,
Indian health services, 638 Tribal clinic, and certified community behavioral health clinic during the COVID-19 federal public health
emergency. The bill is effective July 1, 2022.

¢ 2021 MN H.F. 4398 (NS), introduced March 17, 2022, would adopt MN ST ? 145.988 (Minnesota School Health Initiative) to allow for
emergency services such as mobile health and telehealth to be provided by a school-based health center.

¢ 2021 MN H.F. 4501 (NS), introduced March 21, 2022, would adopt MN ST ? 152.283 (Distribution of Medical Cannabis) to allow
a consultation between a distributor of medical cannabis to be conducted remotely by secure videoconference, telephone, or other
remote means, so long as the employee providing the consultation is able to confirm the identity of the patient and the consultation
adheres to patient privacy requirements that apply to health care services delivered through telehealth.

¢ 2021 MN H.F. 4579 (NS), engrossed April 19, 2022, would amend MN ST ? 256B.0625 (Covered services) to allow for telehealth
visits to be provided through accessible video-based platforms and removing documentation requirements for consent for mental health
services or assessments delivered through telehealth.

¢ 2021 MN H.F. 4705 (NS), introduced March 30, 2022, would amend MN ST ? 256B.0625 (Covered services) to require that services
delivered through telemedicine be paid at 90% of the reimbursement rate paid for the same service delivered through in-person contact.

¢ 2021 MN S.F. 2806 (NS), introduced February 3, 2022, would adopt the Temporary Youth Mental Health Services Program, provide
the definition for 'telehealth," to require the portal to allow providers to register and share telehealth appointment availability and

allow a youth, regardless of whether the youth has health insurance coverage or another payment source available, to schedule a
telehealth appointment with a provider, and to require a provider, to be eligible for reimbursement, to be available to provide at least 3
mental health sessions to each eligible youth the provider accepts as a client, either through telehealth or in person, and to require the
Commissioner to report how many sessions were provide through telehealth.

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¢ 2021 MN S.F. 3165 (NS) and 2021 MN S.F. 3178 (NS), introduced February 17, 2022, would amend MN ST ? 62A.673 (Coverage
of services provided through telehealth) and MN ST ? 256B.0625 (Covered services) updating definitions related to telehealth and the
coverage requirements for telehealth services.

¢ 2021 MN S.F. 3355 (NS), engrossed March 28, 2022, would establish the Interstate 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 MN S.F. 3364 (NS), engrossed March 30, 2022, 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 MN S.F. 3662 (NS), introduced March 2, 2022, would amend MN ST ? 256B.0625 (Covered Services) to update the definition
for 'telehealth."

¢ 2021 MN S.F. 3940 (NS), engrossed March 29, 2022, would adopt MN ST ? 151.103 (Delegation of Vaccine Administration) to
provide that direct supervision of a pharmacy technician or pharmacist intern in administering vaccines must be in-person and must not
be done through telehealth.

¢ 2021 MN S.F. 4165 (NS), engrossed May 10, 2022, amends MN ST ? 256B.0625 (Covered services) to allow for telehealth visits to
be provided through accessible video-based platforms, to remove requirement that the provider document the client's verbal approval
or electronic written approval for mental health services or assessments delivered through telehealth, and to update the definition

for 'health care provider." The bill would adopt temporary telephone-only telehealth authorization for face-to-face requirements for
reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health services,
638 Tribal clinic, and certified community behavioral health clinic during the COVID-19 federal public health emergency.

¢ 2021 MN S.F. 4198 (NS), engrossed April 4, 2022, would adopt MN ST ? 151.103 (Delegation of Vaccine Administration) clarifying
that direct supervision of a pharmacy technician or pharmacist intern in the administration of vaccines must be in-person and must not
be done through telehealth. Enact 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 MN S.F. 4410 (NS), engrossed May 3, 2022, would adopt Temporary Telephone-Only Telehealth Authorization to allow
telehealth visits provided through telephone to satisfy the face-to-face requirements for 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 amend MN

ST ? 256B.0625 (Covered services) to allow for telehealth visits to be provided through accessible video-based platforms and removing
documentation requirements for consent for mental health services or assessments delivered through telehealth. The bill 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 MN S.F. 4500 (NS), introduced April 19, 2022, would adopt MN ST ? 342.19 (Manufacturer of Medical Cannabis Duties) to allow
a health care practitioner to conduct a patient assessment to issue recertification via telehealth. Allow a consultation to be conducted
remotely by secure videoconference, telephone, or other remote means if the employee providing the consultation is able to confirm the
identity of the patient and the consultation adheres to patient privacy requirements that apply to health care services delivered through
telehealth.

¢ 2022 MN REG TEXT 504656 (NS), published October 3, 2022, amends IVIN ADC 4764.0040 (Health Care Homes Standards)
providing that for level 2 certification the health care home must demonstrate offering options beyond the traditional in-person office visit
such as expanded hours of operation, electronic virtual visits, delivery of services in locations other than the clinic setting, and other
efforts that increase patient access to the health care home team and that enhance the health care home's ability to meet the patient's
preventative, acute, and chronic care needs. The regulation is effective October 11, 2022.

Mississippi
* 2022 MS H.B. 424 (NS), adopted March 23, 2022, adopts the Audiology and Speech-Language Pathology Interstate Compact to
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 must come into effect on the date on which the Compact statute is enacted into law
in the 10th member state. The bill is effective July 1, 2022.

¢ 2022 MS H.B. 452 (NS), engrossed February 9, 2022, would amend MS ST ? 83-9-351 (Telemedicine services coverage) to update
the definition for 'telemedicine' and to require all health insurance and employee benefit plans in MS must reimburse providers who
are out-of-network for telemedicine services under the same reimbursement policies applicable to other out-of-network providers of
healthcare services, to require health insurance and employee benefit plans to reimburse providers for telemedicine services using the
proper medical codes, and to clarify that nothing in this section may be interpreted to provide that a healthcare provider who delivers
services through the use of telemedicine is not held to the same standards of professional practice as a similar licensee of the same
practice area or specialty that is providing the same healthcare through in-person encounters.

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¢ 2022 MS H.B. 674 (NS) and 2022 MS S.B. 2891 (NS), introduced January 17, 2022, would amend MS ST ? 73-25-34 (Telemedicine
or practice across state lines) to delete the exception from having a Mississippi license to practice medicine for certain physicians
outside of the state who render services by telemedicine.

¢ 2022 MS H.B. 1056 (NS), adopted March 16, 2022, enacts the Professional 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.
The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective July 1, 2022.

¢ 2022 MS S.B. 2179 (NS), introduced January 13, 2022, would enact 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.

* 2022 MS S.B. 2313 (NS), introduced January 17, 2022, and 2022 MS H.B. 300 (NS), introduced January 4, 2022, would amend MS
ST ? 43-13-117 (Care and services covered; discontinuation of optional services) to require the Division to reimburse for substance
abuse and mental health services for pregnant and postpartum women, and delivered in a community-based, telehealth or faith-based
care setting.

¢ 2022 MS S.B. 2345 (NS), introduced January 17, 2022, and 2022 MS H.B. 212 (NS), introduced January 4, 2022, would amend
MS ST ? 43-13-117 (Care and services covered; discontinuation of optional services) to require that the distant or hub site provider
for telehealth services provided by federally qualified health centers and community health centers be reimbursed the applicable
Medicaid fee for the telehealth services provided and to require that telenealth services provided by federally qualified health centers
and community health centers 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 mental health centers under the prospective payment system.

¢ 2022 MS S.B. 2738 (NS), adopted April 18, 2022, amends MS ST ? 83-9-351 (Telemedicine services coverage) to update the
definition of 'telemedicine' and require all health insurance and employee benefit plans in MS to reimburse providers who are out-
of-network for telemedicine services under the same reimbursement policies applicable to other out-of-network providers of health
services and to reimburse providers for telemedicine services for telemedicine services using the proper medical codes. The bill is
effective July 1, 2022.

Missouri

* 2022 MO H.B. 1936 (NS), introduced January 5, 2022, would adopt 334.115 to allow follow-up interview to be conducted by means of
telehealth.

¢ 2022 MO H.B. 2149 (NS), adopted June 7, 2022, 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 must come into effect on the date on which the Compact statute is enacted into law
in the 10th member state. The bill is effective June 7, 2022.

¢ 2022 MO H.B. 2165 (NS) and 2022 MO S.B. 829 (NS), introduced January 5, 2022, would amend lViO ST 191.1145 (Definitions
telehealth services authorized, when) to update the definition for 'telehealth" or 'telemedicine." Amend MO ST 191.1146 (Physician-
patient relationship required, how established) to require that any use of an adaptive questionnaire be sufficient to establish an
informed diagnosis as through the medical interview or physical examination has been performed in person. Amend MO ST 334.108
(Telemedicine or internet prescriptions and treatment, establishment of physician-patient relationship required) to allow physicians to
use a digital format through an adaptive questionnaire based on professional practice standards. Amend MO ST 376.1900 (Definitions--
reimbursement for telehealth services, when) to update the definition for 'electronic visit" or 'e-visit."

¢ 2022 MO H.B. 2331 (NS), amended/substituted May 2, 2022, 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.

* 2022 MO H.B. 2383 (NS), introduced January 11, 2022, and 2022 MO H.B. 2434 (NS), amended/substituted March 2, 2022, would
amend iO ST 335.175 (Utilization of telehealth by nurses established--rulemaking authority) to remove provision allowing an advanced
practice registered nurse (APRN) providing nursing services under a collaborate practice arrangement to provide such services outside
the geographic proximity requirements fi 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.

¢ 2022 MO H.B. 2510 (NS), amended/substituted April 4, 2022, would amend MO ST 191.1145 (Definitions--telehealth services
authorized, when) to update the definition for 'telehealth" or 'telemedicine' and amend MO ST 191.1146 (Physician-patient relationship
required, how established) to clarify that physicians licensed under chapter 334 or licensed by another state, a territory of the United
States, or the District of Columbia who use telemedicine in order to treat patients in this state must ensure that a properly established
physician-patient relationship exists with the person who receives the telemedicine services.

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¢ 2022 MO H.B. 2749 (NS), introduced February 23, 2022, would adopt the Licensed Professional Counselors 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.

¢ 2023 MO H.B. 271 (NS), prefiled December 1, 2022, would amend MO ST 191.1146 (Physician-patient relationship required, how
established) to allow advanced practice registered nurses to use telemedicine as long as a properly established patient relationship
exists. Amend MO ST 334.108 (Telemedicine or internet prescriptions and treatment, establishment of physician-patient relationship
required) to provide that the use of telemedicine prescriptions by advanced practice registered nurses must not be governed by the
provisions of this section but must instead be governed by the provisions of MO ST 335.176. Amend MO ST 335.175 (Utilization of
telehealth by nurses established--rulemaking authority) to remove provision allowing an advanced practice registered nurse (APRN)
providing nursing services under a collaborative practice arrangement under MO 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 advanced practice
registered nurse utilize telehealth in the care of the patient and if the services are provided in a rural area of need and remove provision
requiring the Boards to jointly promulgate rules governing the practice of telehealth, including standards for the use of telehealth.
Adopt MO ST 335.176 to establish the requirements for prescribing any drug, controlled substance, or other treatment by an advanced
practice registered nurse through telemedicine.

* 2023 MO H.B. 284 (NS), prefiled December 1, 2022, would amend MO ST 335.175 (Utilization of telehealth by nurses established--
rulemaking authority) to remove 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 WO ST 334.104 if the collaborating physician and advanced practice registered nurse utilize telehealth in the
care of the patient and if the services are provided in a rural area of need.

¢ 2022 MO S.5B. 978 (NS), amended/substituted March 21, 2022, and 2022 MO H.B. 2138 (NS), amended/substituted February 16,
2022, 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.

¢ 2022 MS REG TEXT 601047 (NS), filed October 21, 2022, adopts 30 MS ADC Pt. 2901, R. 11, Telehealth, establishing the
requirements for the use of telehealth in the delivery of optometric care. New sections include: 30 MS ADC Pt. 2901, R. 11.1
(Definition), 30 MS ADC Pt. 2901, R. 11.2 (Providers), 30 MS ADC Pt. 2901, R. 11.3 (Maintenance and retention of records), 30 MS
ADC Pt. 2901, R. 11.4 (Confidentiality), 30 MS ADC Pt. 2901, R. 11.5 (Patient Identity and Communication), 30 MS ADC Pt. 2901, R.
11.6 (Patient Relationships), 30 MS ADC Pt. 2901, R. 11.7 (Established Treatment Site), and 30 MS ADC Pt. 2901, R. 11.8 (Distant
Site Provider). This final rule continues the previous emergency rulemaking without change and is effective November 21, 2022. The
most recent emergency rule, 2022 MS REG TEXT 627424 (NS), was effective October 19, 2022.

Nebraska

¢ 2021 NE L.B. 752 (NS), adopted April 18, 2022, enacts the Licensed Professional 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.
The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective July 20, 2022.

¢ 2021 NE L.B. 1249 (NS), introduced January 20, 2022, would adopt uncodified section to provide that the practice of dietetics and
nutrition means the integration and application of scientific principles derived from the study of food, nutrition, biochemistry, metabolism,
nutrigenomics, physiology, food management, and from behavioral and social sciences in achieving and maintaining health throughout
the life span and in providing nutrition-care services in person or by telehealth, including medical nutrition therapy, for the purpose of
disease management and prevention, or to treat or rehabilitate an illness, injury or condition.

New Hampshire

¢ 2021 NH H.B. 503 (NS), adopted June 24, 2022, amends NH ST ? 167:4-d (Medicaid Coverage of Telehealth Services) providing that
coverage must include the use of telehealth or telemedicine for Medicaid-covered services provided within the scope of practice of a
physician or other health care provider as a method of delivery of medical care by which telemedicine services for primary care and
remote patient monitoring must only be covered in the event that the patient has already established care at an originating site via face-
to-face in-person service.

¢ 2021 NH H.B. 1390 (NS), adopted June 17, 2022, amends NH ST ? 310-A:1-g (Telemedicine and Telehealth Services) requiring an
individual providing services by means of telemedicine or telehealth directly to a patient must provide meaningful language access

if the individual is practicing in a facility that is required to ensure meaningful language access to limited-English proficient speakers
pursuant to 45 CFR ? 92.101 (Meaningful access for individuals with limited English proficiency) or NH ST T. XXXI, Ch. 354-A (State
Commission for Human Rights), or to deaf or hard of hearing individuals pursuant to 45 CFR ? 92.102 (Effective communication for

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individuals with disabilities), NH ST T. LIII, Ch. 521-A (Interpreters for the Deaf), or NH ST T. XXXI, Ch. 354-A (State Commission for
Human Rights). The bill is effective June 17, 2022.

¢ 2021 NH H.B. 1648 (NS), introduced January 5, 2022, would adopt NH ST ? 188-1:2 (Definitions) to provide the definition for
'telehealth," NH ST ? 188-1:6 (Local Partnerships) to require each public college or university to meet a benchmark ratio of 1 clinical,
non-student staff member to 1,250 students through a combination of on-campus capacity, off-campus linkage agreements with mental
health service providers, and contracted telehealth therapy services, and NH ST ? 188-1:8 (Evaluation) to require local partnership
programs to be monitored for effectiveness and quality of student satisfaction with on-campus or off-campus telehealth therapy
providers and number and range of student outreach initiatives, such as telehealth mindfulness workshops or campus-wide wellness
fairs, and number of students being served annually.

¢ 2021 NH S.B. 382 (NS), adopted June 7, 2022, amends NH ST ? 310-A:1-g (Telemedicine and Telehealth Services) to clarify
that unless otherwise prescribed by statute, an out-of-state health care professional providing services by means of telemedicine or
telehealth must be required to be licensed, certified, or registered by the appropriate New Hampshire licensing body if the patient is
physically located in New Hampshire at the time of service. The bill is effective August 6, 2022.

¢ 2021 NH S.B. 390 (NS), adopted August 3, 2022, amends NH ST ? 310-A:1-g (Telemedicine and Telehealth Services) to provide
the definition for 'asynchronous interaction," asynchronous interaction," and update the definition for 'telehealth" and 'telemedicine,"
amends NH ST ? 318:1 (Definitions) and NH ST ? 329:1-c (Physician-Patient Relationship) to update the definition for 'physician-
patient relationship" to include an exam using telemedicine, and amend NH ST ? 329:1-d (Telemedicine) to update the definition for
'telemedicine." The bill is effective August 3, 2022.

* 2021 NH S.B. 397 (NS), adopted June 24, 2022, enacts the mental health counseling compact to facilitate the interstate practice of
licensed professional counselors with the goal of improving public access to professional counseling services with a stated goal to allow
for the use of telehealth technology to facilitate increased access to professional counseling services. The Compact must come into
effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is effective June 24, 2022.

¢ 2021 NH S.B. 430 (NS), introduced January 5, 2022, would amend NH ST ? 329:21 (Persons Excepted) providing that the chapter
does not apply to a physician licensed and in good standing in another state, when providing consultations services or follow-up care
via telemedicine to a patient who previously received services from the physician in the state where the physician is licensed.

New Jersey

* 2020 NJ A.B. 5988 (NS), amended/substituted December 6, 2021, and 2020 NJ S.B. 4283 (NS), introduced December 16, 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) establishing the 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 must, at the discretion of the applicable board or State
entity, be licensed to provide services in the same mental health profession in this State using telehealth and telemedicine. The bill
would require a person licensed in this State to provide each biennial renewal period, a minimum of 40 hours of therapy services on a

volunteer basis to individuals in this State using telehealth or telemedicine.

¢ 2020 NJ A.B. 6239 (NS), introduced December 20, 2021, would amend NJ ST 45:1-61 (Definitions) to update the definition for
'telemedicine' and NJ ST 45:1-62 (Use of telemedicine and telehealth by health care providers; requirements) to provide an exception
to the requirement that telemedicine services be provided using interactive, real-time, two-way communication technologies for the
provision of behavioral health care services. Allows behavioral health care services to be provided using audio-only technology.

¢ 2020 NJ S.B. 2559 (NS), adopted December 21, 2021, amends 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) requiring the State Medicaid and NJ FamilyCare programs and health insurers to
provide coverage payment for health care services delivered to a benefits recipient through telemedicine or telehealth, on the same
basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the
services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered when
delivered through in-person contact and consultation in New Jersey. Prohibits the State Medicaid and NJ FamilyCare programs from
imposing place of service requirements on providers or patients in connection with telemedicine or telehealth services, restrict the
ability of the provider to use any electronic or technological platform to provide services, denying coverage for or refusing to provide
reimbursement for routine patient monitoring performed using telemedicine and telehealth, and limiting coverage to services provided
by select third party telemedicine or telehealth providers. Defines 'asynchronous store-and-forward," 'distant site," 'originating site,"
'telemedicine or telehealth organization." The bill is effective January 3, 2022.

* 2022 NJ A.B. 2193 (NS), amended/substituted October 27, 2022, 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, require a healthcare provider engaging in telemedicine or telehealth to make a good faith effort to
provide the name and location of the patient to emergency services in oral and written form, determine the location of patient if a patient
is unaware of his or her location, and provide his or her contact information to emergency services, and require a healthcare provider

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engaging in telemedicine or telehealth to report suicide attempts of patient during a telehealth or telemedicine visit to the Department of
Health in a manner that is consistent with federal and State privacy laws emergency and document emergencies which occur during a
telehealth or telemedicine visit.

¢ 2022 NJ A.B. 3334 (NS), introduced March 7, 2022, would adopt a new section to require the Division of Medical Assistance and
Health Services in the Department of Human Services (DHS), or a managed care organization contracted with the Division to provide
benefits to Medicaid beneficiaries, to reimburse a local education agency for behavioral health services covered under Medicaid,
delivered in-person or via telehealth, and provided to a student who is an eligible Medicaid beneficiary.

* 2022 NJ A.B. 3488 (NS), introduced March 8, 2022, would adopt new sections to require health care facilities engaged in telemedicine
and telehealth to provide language interpretation under specified circumstances.

* 2022 NJ A.B. 3595 (NS), introduced March 14, 2022, would require a plan to have a sufficient number of mental health providers to
ensure that 100 percent of the covered persons have access to either in-network mental health providers that can provide services
delivered in person and within certain geographic and temporal requirements, or access to in-network or out-of-network mental health
providers that can provide services delivered through telemedicine or telehealth. A plan that provides access to in-network or out-of-
network mental health providers that can provide services delivered through telemedicine or telehealth is required to provide coverage
for out-of-network mental health care services delivered through telemedicine or telehealth on the same basis as when the services
are delivered through in-person contact and consultation in New Jersey and at a provider reimbursement rate of not less than the
corresponding Medicaid provider reimbursement rate. A carrier is not to charge any deductible, copayment, or coinsurance for a mental
health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance
amount that is applicable to an in-person, in-network consultation.

¢ 2022 NJ A.B. 3794 (NS), introduced May 2, 2022, would require the Division to reimburse partial care services providers under
Medicaid at the per diem rate, established by the Division for partial care services provided by telehealth during the COVID-19
emergency period, for 180 days following the expiration of the federal Medicaid waiver authorizing the per diem rate and require
telehealth services to be provided without the imposition of any prior authorization or other utilization management requirements and in
accordance with the policy guidance issued by the division regarding the qualifications for the per diem rate, provided that a partial care
services provider: is open for onsite services; and submits a status report to the division following day 90, day 150, and day 180 of the
180-day period.

¢ 2022 NJ A.B. 4000 (NS), introduced May 16, 2022, would adopt new section to require adult day health care facilities to establish
hybrid model for provision of adult day health care services under certain circumstances. Define 'telehealth" and require that the
services offered by an adult day health care facility to an adult day health care beneficiary is to be provided through the use of
telehealth.

¢ 2022 NJ A.B. 4087 (NS), introduced May 26, 2022, would amend NJ ST 45:1-61 (Definitions) to clarify that, for the purposes of the
telemedicine and telehealth law, the term 'health care provider" does not include veterinarians.

* 2022 NJ A.B. 4485 (NS), introduced September 15, 2022, would require health insurers to provide adequate network of physicians.
Insurers would not be precluded from offering services via telehealth or telemedicine, but services offered via telehealth or telemedicine
would not be counted toward compliance with network adequacy requirements.

¢ 2022 NJ A.B. 4619 (NS), introduced September 22, 2022, would amend NJ ST 45:9-27.13 (Requirements for license; renewal; out-
of-state license in lieu of examination; inactive status) and NJ ST 45:11-26 (Professional nurses) providing that a temporary license
issued must authorize the person to practice as a physician assistant, and provide services both in person and using telemedicine and
telehealth, until such time as the person is either issued a full physician assistant license or the person fails the physician assistant
licensure examination. Amend NJ ST 45:14B-20 (License without examination) providing that a psychologist who is not licensed in New
Jersey who provides in-person, face-to-face psychology services or telepsychology services in New Jersey must not be deemed to be
practicing as a psychologist in New Jersey without holding a license.

¢ 2022 NJ A.B. 4629 (NS), introduced September 22, 2022, 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.

* 2022 NJ S.B. 1896 (NS), introduced March 3, 2022, would adopt new sections requiring the Division to reimburse partial care services
providers under Medicaid at the per diem rate, established by the Division for partial care services provided by telehealth during the
COVID-19 emergency period, for 180 days following the expiration of the federal Medicaid waiver authorization the per diem rate and
requiring telehealth services reimbursed under the bill to be provided without the imposition of any prior authorization or other utilization
managements and in accordance with the policy guidance issued by the Division regarding the qualifications for the per diem rate,
provided that a partial care services provider is open for onsite services and submits a status report to the Division following day 90,
day 150, and day 180 of the 180-day period.

* 2022 NJ S.B. 1954 (NS), introduced March 3, 2022, would adopt new sections requiring the Commissioner of Health to authorize
licensed adult day health service facilities to provide adult day health services on a remote basis to enrollees of the facility who
are unable or unwilling to receive services from the facility on an in-person basis, including daily wellness checks conducted using

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telemedicine or telehealth that include screenings for, and the assessment of, the enrollee's current needs and status, which may
include screenings for food insecurity, the need for assistance with self-care and activities of daily living, medication supply and
adherence to daily medication regimens, signs or symptoms of physical illness, changes in the enrollee's home environment, and
changes in the enrollee's mood or behavior. Define 'telehealth" and 'telemedicine."

¢ 2022 NJ S.B. 2416 (NS), introduced Mary 9, 2022 would require the Division, or a managed care organization contracted with the
Division to provide benefits to Medicaid beneficiaries, to reimburse a local education agency for behavioral health services covered
under Medicaid, delivered in person or via telehealth, and provided to a student who is an eligible Medicaid beneficiary.

* 2022 NJ S.B. 2500 (NS), introduced May 12, 2022, would require health benefits plans and carriers to meet certain requirements
concerning network adequacy and mental health care. The bill would define 'telehealth" and 'telemedicine' and provide the
requirements for a carrier to provide coverage for out-of-network mental healthcare services delivered through telemedicine or
telehealth.

¢ 2022 NJ S.B. 2529 (NS), introduced May 12, 2022, would establish a pilot program for 24-hour urgent care for behavioral health. Each
participating urgent care facility shall integrate behavioral health care with the facility's existing physical health care services, which
shall, at a minimum, include: employing a behavioral health team of at least one licensed behavioral clinician and one licensed clinical
social worker; partnering with one or more licensed psychiatrists to provide services, as needed, via telemedicine and telehealth;
providing behavioral health awareness and intervention training to staff; and using warm hand-offs, rapid referrals, supportive contacts,
and other efficient and supportive care transition methods.

¢ 2022 NJ S.B. 3061 (NS), introduced September 29, 2022, would enact the mental health counseling compact to facilitate the interstate
practice of licensed professional counselors with the goal of improving public access to professional counseling services with a stated
goal to allow for the use of telehealth technology to facilitate increased access to professional counseling services. The Compact must
come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2022 NJ S.B. 3236 (NS), introduced October 27, 2022, 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.

New Mexico

¢ 2022 NM REG TEXT 596445 (NS), published March 22, 2022, amends NIM ADC 16.23.1.7 (Definitions) to define 'telemedicine." The
regulation is effective April 21, 2022.

¢ 2022 NM REG TEXT 598665 (NS), published March 22, 2022, adopts NIV ADC 8.314.5.15 (NMAC DDW Covered Waiver Services)
allowing nursing services, therapy services, living supports, behavioral support consultation services, and nutritional counseling
services to be delivered in person and via remote or telehealth services. The regulations are effective April 1, 2022.

¢ 2022 NM REG TEXT 616375 (NS), filed May 11, 2022, amends NM ADC 16.10.2.11 (Telemedicine License) clarifying that each
applicant for a telemedicine license must apply online using HSC as their application processor, submit the required fees, application
processing fee to HSC, and all required documentation. The regulation was amended via emergency and is effective May 11, 2022.

New York

* 2021 NY A.B. 3322 (NS), amended/substituted May 25, 2022, 2021 NY S.B. 9444 (NS), introduced May 27, 2022, would adopt NY
STATE FIN ? 99-pp (Public college student health center abortion by medication fund) providing that services performed by public
college student health centers available for moneys from this fund must include costs associated with enabling public college student
health centers to deliver telehealth services.

¢ 2021 NY A.B. 7613 (NS), amended/substituted January 21, 2022, would adopt NY MENT HYG ? 32.05-a (Certification of recovery
living residences) to require regulations to provide for access to a certified alcohol and substance abuse counselor either onsite or via
telehealth services and access to a licensed professional whose scope of practice includes the diagnosis of mental health disorders
either onsite or via telehealth services for those recovering from a co-occurring mental health disorder.

¢ 2021 NY A.B. 9007 (NS), adopted April 9, 2022, amends NY PUB HEALTH ? 2999-dd (Telehealth delivery of services), 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 that health care services delivered by means of telehealth must be entitled to reimbursement on the
same basis, at the same rate, and to the same extent the equivalent services are reimbursed when delivered person, provided,
however, that health care services delivered by means of telehealth must not require reimbursement to a telehealth provider for certain
costs, including but not limited to facility fees or costs reimbursed through ambulatory patient groups or other clinic reimbursement
methodologies, if such costs were not incurred in the provision of telehealth services due to neither the originating site nor the distant
site occurring within a facility or other clinic setting. The bill also requires that for services licensed, certified or otherwise authorized
pursuant to article sixteen, article thirty-one or article thirty-two of the mental hygiene law, such services provided by telehealth, as
deemed appropriate by the relevant commissioner, shall be reimbursed at the applicable in person rates or fees established by law,

or otherwise established or certified by the office for people with developmental disabilities, office of mental health, or the office of
addiction services and supports pursuant to article forty-three of the mental hygiene law. The bill is effective April 9, 2022.

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¢ 2021 NY A.B. 9148 (NS), introduced January 31, 2022, would amend NY PUB HEALTH ? 3614 (Payments for certified home health
agency services, long term home health care programs and AIDS home care programs) clarifying that reimbursement for telehealth
services under this section must be provided for telehealth services. The bill would also clarify that reimbursement provided under this
subdivision must be for services to patients with conditions or clinical circumstances associated with the need for frequent monitoring,
the need for frequent physician, skilled nursing or acute care services, where the provision of telehealth services can appropriately
reduce the need for on-site or in-office visits or acute or long term care facility admission, or where the telehealth services appropriately
allow for a home care service by means of telehealth technology instead of an in-person visit by the home care services agency.

¢ 2021 NY A.B. 9332 (NS), introduced February 23, 2022, would amend NY MENT HYG ? 5.05 (Powers and duties of the head of the
department) to require the program to provide up to 5 mental telehealth services annually at no cost to the individual, for acute crisis
response, mental health assessment, or initiation of care to reduce barriers and facilitate engagement in long term care.

* 2021 NY A.B. 9467 (NS), amended/substituted May 12, 2022, would amend NY PUB HEALTH ? 2999-cc (Definitions) to update the
definition for 'telehealth provider."

¢ 2021 NY A.B. 9753 (NS), amended/substituted April 26, 2022, would adopt NY EDUC ? 362 (Student mental health) and NY EDUC ?
6235 (Student mental health) to require the university to create opportunities for telehealth and virtual counseling options.

¢ 2021 NY A.B. 9718 (NS), amended/substituted May 29, 2022, would amend NY INS ? 5504 (Policies) prohibiting insurers from
taking any adverse action against an abortion or reproductive health care provider who performs an abortion or provides reproductive
health care that is legal in the state of New York on someone who is from out of the state and requires each policy to include medical
professionals who prescribe abortion medication to out-of-state patients by means of telehealth.

¢ 2021 NY A.B. 10149 ( NS), introduced May 4, 2022, and 2021 NY S.B. 9055 (NS), introduced May 6, 2022, would amend NY WORK
COMP ? 13-m (Care and treatment of injured employees by duly licensed psychologists) requiring telehealth visits for psychological
testing, treatment, and counseling by psychiatrists, psychologists, and licensed clinical social workers to be permitted with 1 in-person
visit within 12 months of the first video telehealth visit within 6 months of the first audio-only telehealth visit unless (a) in the provider's
professional judgment, an in-person visit service is likely to cause disruption in service delivery or has the potential to worsen the
patient's condition, or (b) would create undue hardship upon the patient or their family.

¢ 2021 NY A.B. 10663 (NS), introduced August 12, 2022, would amend NY PUB HEALTH ? 2999-cc (Definitions) to provide the
definition for 'telehealth reproductive health services.' Adopt NY PUB HEALTH ? 2999-ff (Telehealth reproductive health services)
providing that the provision of telehealth reproductive health services by a telehealth provider located at a distant site within the state of
New York must be legally protected where such service is otherwise permitted under the laws of state of New York, regardless of the
originating site.

* 2021 NY S.B. 6846 (NS), amended/substituted February 18, 2022, would amend NY PUB HEALTH ? 2999-cc (Definitions) to update
the definition for 'telehealth provider."

¢ 2021 NY S.B. 8277 (NS), introduced February 8, 2022, would amend NY MENT HYG ? 5.05 (Powers and duties of the head of the
department) to require the commissioners of the Office of Mental Health and the Office of Addiction Services and Supports to establish
a youth mental telehealth services program to facilitate access to mental health services, including substance use disorder services,
for youth to respond to identified mental health needs, including those needs that may have resulted from the COVID-19 pandemic,
and for youth or families that may not have access to mental health professionals in-person. Require the program to provide up to 5
mental telehealth services annually at no cost to the individual, for acute crisis response, mental health assessment, or initiation of care
to reduce barriers and facilitate engagement in long term care.

¢ 2021 NY S.B. 8295 (NS), introduced February 10, 2022, would amend NY PUB HEALTH ? 3614 (Payments for certified home health
agency services, long term home health care programs and AIDS home care programs) to require that reimbursement for telehealth
services provided under this section must be provided for telehealth services described in this section, as well as telehealth as defined
in article 29-G and to require reimbursement where the telehealth services appropriately allows for a home care service by means of
telehealth technology instead of an in-person visit by the home care services agency.

«2021 NY S.B. 9080 (NS), adopted June 13, 2022, amends NY INS ? 5504 (Policies) to prohibit insurers from taking adverse action
against medical professionals who prescribe abortion medication to out-of-state patients by means of telehealth. The bill is effective
June 13, 2022.

* 2021 NY S.B. 9444 (NS), amended/substituted October 26, 2022, would adopt NY STATE FIN ? 99-pp (Public college student health
center abortion by medication fund) providing that services performed by public college student health centers available for moneys
from this fund must include costs associated with enabling public college student health centers to deliver telehealth services.

¢ 2021 NY S.B. 9584 (NS), introduced October 26, 2022, would amend NY PUB HEALTH ? 2999-dd (Telehealth delivery of services)
clarifying that services licensed, certified or otherwise authorized pursuant to article sixteen, article thirty-one or article thirty-two of the
mental hygiene law, such services provided by telehealth must be reimbursed at the applicable in person rates of fees established

by law, or otherwise established or certified by the office for people with developmental disabilities, office of mental health, or the
office of addiction services and supports pursuant to article forty-three of the mental hygiene law, unless a specific service is deemed
inappropriate by the relevant commissioner. Remove the April 1, 2024 expiration date for the section.

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¢ 2022 NY REG TEXT 590445 (NS), field January 3, 2022, amends 10 NY ADC 756.3 (Patient management) requiring the operator to
ensure that prior to the abortion service, the patient receives a clinically relevant examination, which may be satisfied, when clinically
appropriate, through a review of the patient's medical history and discussion of patient symptoms conducted through telemedicine. The
regulation is effective January 19, 2022.

¢ 2022 NY REG TEXT 590955 (NS),filed June 13, 2022, amends 14 NY ADC 600.11 (Staffing) requiring the Intensive Crisis
Stabilization Center to have 24/7 access to a Data 2000 waivered prescriber on-site or available via on-call or telehealth to ensure
availability of buprenorphine. The regulation is effective June 13, 2022.

¢ 2021 NY REG TEXT 594170 (NS), filed December 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. Amends 11 NY ADC 52.18 (Rules relating to content of forms for group insurance)

by adding new section (h) titled 'telenealth' and provides that telehealth has the meaning in NY INS ? 3217-h and NY INS ? 4306-g
and includes audio-only visits. The rulemaking adopts previous emergency rules (VY REG TEXT 588640 (NS)) as final and is effective
December 22, 2021.

* 2022 NY REG TEXT 599724 (NS), filed January 26, 2022, 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
rulemaking adopts previous emergency rules as final and is effective February 16, 2022.

¢ 2022 NY REG TEXT 600117 (NS), filed September 12, 2022, 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 '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.
Affected sections include: 14 NY ADC 596.1 (Background and intent), 14 NY ADC 596.2 (Legal base), 14 NY ADC 596.3 (Applicability),
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 rulemaking is effective September 13, 2022.

¢ 2022 NY REG TEXT 600117 (NS), filed April 25, 2022, 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.
Affected 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). This emergency rulemaking continues the previous emergency rulemaking without
change and is effective April 25, 2022.

* 2022 NY REG TEXT 600117 (NS), filed February 11, 2022, 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.
Affected 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). This emergency rulemaking continues the previous emergency rulemaking without
change and is effective February 11, 2022.

* 2022 NY REG TEXT 603111 (NS), filed December 17, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages)
prohibiting a policy from imposing copayments, coinsurance, or annual deductibles for visits to diagnose the novel coronavirus
(COVID-19) at the following locations, including through telehealth. The rulemaking was amended via emergency rulemaking and is
effective December 17, 2021.

¢ 2022 NY REG TEXT 604007 (NS), filed December 22, 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. This emergency rulemaking continues the previous emergency rulemaking (2021 NY REG TEXT 596094 (NS))
without changes and is effective December 22, 2021.

¢ 2022 NY REG TEXT 605771 (NS), filed October 11, 2022, 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

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emergency. Notes requirements for telemedicine providers in emergency situations. Updates the variants language to replace 'Delta
variant' with more general language referencing 'new variants.' 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. The rulemaking was adopted via emergency and is
effective October 11, 2022.

¢ 2022 NY REG TEXT 605771 (NS), filed January 11, 2022, 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. Updates the variants language to replace 'Delta
variant' with more general language referencing 'new variants.' 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. The rulemaking was adopted via emergency and is
effective April 4, 2022.

* 2022 NY REG TEXT 609551 (NS), filed August 30, 2022, amends 16 NY ADC 822.7 (General program standards) would update
terminology to use 'telehealth" instead of 'telepractice." The regulation is effective October 1, 2022,

* 2022 NY REG TEXT 609553 (NS), filed August 30, 2022, amends 14 NY ADC 817.2 (General program standards) and 14 NY ADC
817.7 (Staffing) updating terminology to use 'telehealth" instead of 'telepractice." The regulation is effective October 1, 2022.

¢ 2022 NY REG TEXT 610094 (NS), filed August 30, 2022, amends 14 NY ADC 830.5 (Telehealth) requiring the delivery of addiction
services via telehealth to be performed in compliance with the Telehealth Standards and clarifying that the Office supports the use of
telehealth as an appropriate component of the delivery of addiction services to the extent that it is delivered by appropriate staff working
within their scope of practice. Removes requirement that the patient be admitted to or seeking admission to a certified program and
instead requires the patient be seeking services from a certified program. Clarifies documentation requirements. Updates terminology to
use 'services delivered via telehealth" instead of 'telehealth services," 'patient' instead of 'person," and 'addiction treatment" instead of
'assisted treatment." Makes technical and conforming changes. The regulation is effective October 1, 2022.

¢ 2022 NY REG TEXT 610097 (NS), filed August 29, 2022, adopts 18 NY ADC 538.1 (Definitions) providing that 'telehealth' has the
meaning set forth in NY PUB HEALTH ? 2999-cc (Definitions) and includes the terms listed in this section. Adopts 18 NY ADC 538.2
(Modalities and applicable standards) providing that payment for telehealth services must be made in accordance with 18 NY ADC
538.3 (Reimbursement) only if the provision of such services appropriately reduces the need for on-site or in-office visits and the
standards in this section are met. The regulation is effective September 14, 2022.

¢ 2022 NY REG TEXT 610097 (NS), filed June 17, 2022, adopts 18 NY ADC 538.1 (Authorized providers) providing that for purposes
of medical assistance reimbursement, 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. This emergency rulemaking continues the previous emergency rulemaking (2022 NY
REG TEXT 611145 (NS) without change and is effective June 17, 2022.

¢ 2022 NY REG TEXT 611142 (NS), filed March 16, 2021, amends 11 NY ADC 52.16 (Prohibited provisions and coverages) prohibiting
a policy from imposing copayments, coinsurance, or annual deductibles for visits to diagnose the novel coronavirus (COVID-19) at the
following locations, including through telehealth. The rulemaking was amended via emergency rulemaking and is effective March 16,
2021.

¢ 2022 NY REG TEXT 611145 (NS), filed March 22, 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. This emergency rulemaking continues the previous emergency rulemaking (2021 NY REG TEXT 596094 (NS)) without
changes and is effective March 22, 2022.

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¢ 2022 NY REG TEXT 616231 (NS), filed November 8, 2022, amends 14 NY ADC 599.14 (Medical assistance billing standards) to
provide that psychiatric consultation services must be face-to-face with the individual, or using telehealth, where approved by the
Office and must be billed by the Program in the same manner as Psychiatric Assessments and to clarify that brief crisis intervention
services must be done in person or via telehealth. Repeals 14 NY ADC 599.17 (Telepsychiatry services). The regulations are effective
November 23, 2022.

¢ 2022 NY REG TEXT 617953 (NS), filing June 13, 2022, continues the emergency adoption of 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 is effective June 13, 2022.

* 2022 NY REG TEXT 620286 (NS), filed July 12, 2022, 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 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. This rulemaking continues the previous emergency
rulemaking with minor changes and is effective July 12, 2022.

* 2022 NY REG TEXT 622869 (NS), filed August 16, 2022, adopts 18 NY ADC 538.1 (Authorized providers) providing that for purposes
of medical assistance reimbursement, 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. This emergency rulemaking continues the previous emergency rulemaking without
change and is effective August 16, 2022.

¢ 2022 NY REG TEXT 624997 (NS), filed September 9, 2022, amends 11 NY ADC 52.16 (Prohibited provisions and coverages)
prohibiting a policy from imposing copayments, coinsurance, or annual deductibles for visits to diagnose the novel coronavirus
(COVID-19) at the following locations, including through telehealth. The rulemaking was amended via emergency rulemaking and is
effective September 9, 2022.

North Carolina

* 2021 NC H.B. 149 (NS), engrossed June 1, 2022, would adopt NC ST ? 58-50-305 (Coverage for telehealth services) to establish
the coverage requirements for telehealth services. Adopt NC ST ? 90-21.19A (Telehealth consumer protections) to establish telehealth
consumer protections.

¢ 2021 NC H.B. 791 (NS), adopted July 7, 2022, enacts 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 becomes effective on the date on which the Compact is enacted into law in the 10th member state.

¢ 2021 NC H.B. 1119 (NS), introduced May 31, 2022, would allow a health care provider to provide abortion services to a patient, and
the patient has a statutory right to receive abortion services, without a limitation on a health care provider's ability to provide abortion
services via telemedicine or telehealth, other than a limitation generally applicable to a health care provider's ability to provide medical
or health care services via telemedicine or telehealth generally as applied to each health care provider's scope of practice.

¢ 2021 NC H.B. 1126 (NS), introduced May 31, 2022, would adopt NC ST ? 90-18.8 (Prohibit use of telehealth for erectile dysfunction
drugs) providing a licensee from providing advice on the use of, or prescribe any drug used for, the treatment of erectile dysfunction via
telehealth.

Ohio

¢ 2021 OH H.B. 122 (NS), adopted December 22, 2021, amends 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. Amends 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. Adopts 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 also updates terminology to use 'telehealth' instead of 'telemedicine. The bill is
effective March 23, 2022.

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¢ 2021 OH H.B. 645 (NS), introduced May 11, 2022, would adopt OH ST ? 4729.554 to authorize the operation of remote dispensing
pharmacies.

¢ 2021 OH H.B. 714 (NS), introduced August 31, 2022, would renumber and amend OH ST ? 4761.30 (Telehealth services) as OH
ST ? 4761.25 (Telehealth services) allowing an advanced practice respiratory therapist to provide telehealth services.

* 2021 OH H.B. 730 (NS), introduced October 17, 2022, would adopt OH ST ? 4772.091 to allow a certified mental health assistant to
provide telehealth services in accordance with OH ST ? 4743.09 (Telehealth services).

¢ 2021 OH S.B. 204 (NS), adopted June 14, 2022, enacts the Professional 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.
The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is
effective August 10, 2022.

¢ 2021 OH S.B. 261 (NS), engrossed December 15, 2021, would adopt OH ST ? 4731.303 to a physician certified to recommend
treatment of a qualifying medical condition with medical marijuana to make such a recommendation via telemedicine.

¢ 2021 OH S.B. 304 (NS), introduced March 1, 2022, would adopt OH ST ? 2919.2911 to require any health care profession who
provided the patient with an abortion-inducing drug, who diagnoses or treats a patient at any time for an abortion complication or
adverse event related to the abortion-inducing drug to complete a report that includes whether the patient obtained the abortion-
inducing drug from a mail-order pharmacy or web site and, as applicable, the pharmacy's or web site's name, the web site address, and
telemedicine provider.

¢ 2021 OH S.B. 364 (NS), introduced October 17, 2022, would adopt OH ST ? 4772.091 to allow a certified mental health assistant to
provide telehealth services in accordance with OH ST ? 4743.09 (Telehealth services). Amend OH ST ? 5164.95 (Telehealth services)
adding a certified mental health assistant licensed under Chapter 4772 of the Revised Code.

* 2022 OH REG TEXT 600247 (NS), filed February 14, 2022, amends OH ADC 5122-2-28 (Intensive home based treatment (IHBT)
service) allowing IHBT to be provided via telehealth. The regulation is effective March 1, 2022.

¢ 2022 OH REG TEXT 600253 (NS), filed February 10, 2022, adopts new OH ADC 5160-27-05 (Intensive home based treatment
service) providing that payment may be provided for IHBT services rendered via telehealth. The regulation is effective March 1, 2022.

¢ 2022 OH REG TEXT 602096 (NS), filed March 11, 2022, amends OH ADC 4732-9-01 (Requirements for admission to the
examination for a psychologist license), OH ADC 4732-9-02 (Requirements for admission to the examination for a school psychologist
license), OH ADC 4732-13-03 (Supervision definitions), and OH ADC 4732-17-01 (General rules of professional conduct pursuant to
section 4732.17 of the Revised Code) updating definitions and requirements related to the practice of telepsychology. The regulations
are effective March 21, 2022.

* 2022 OH REG TEXT 609498 (NS), filed June 15, 2022, amends OH ADC 5122-29-31 (Telehealth) to update the list of services

that may be provided via telehealth to include mobile response and stabilization service. Mobile response and stabilization service
(MRSS) is a structured intervention and support service provided by a mobile response and stabilization service team that is designed
to promptly address certain crisis situations with young people. The regulation is effective July 1, 2022.

« 2022 OH REG TEXT 610241 (NS), filed May 31, 2022, amends OH ADC 5122-40-01 (Definitions and applicability) providing the
definition for 'telemedicine." The regulation is effective June 10, 2022.

¢ 2022 OH REG TEXT 610439 (NS), filed June 15, 2022, adopts new OH ADC 5160-15-14 (Mobile response and stabilization service)
establishing the instances where MRSS can be delivered using a telehealth modality. The regulation is effective July 1, 2022.

¢ 2022 OH REG TEXT 612225 (NS), filed June 21, 2022, adopts OH ADC 5160-59-01 (OhioRISE: definitions) providing the definitions
for 'electronic health record (EHR)" and 'telehealth" Adopts OH ADC 5160-59-03.2 (OhioRISE: care coordination) providing that care
coordination activities may be provided via telehealth. Adopts OH ADC 5160-59-03.3 (OhioRISE: intensive home-based treatment
service) allowing payment to be made for IHBT services rendered via telehealth. The rulemaking is effective July 1, 2022.

* 2022 OR REG TEXT 612226 (NS), filed June 21, 2022, adopts OH ADC 5160-28-01 (Federally qualified health center (FQHC) and
rural health clinic (RHC) services; definitions and explanations) to allow a visit to be conducted through telehealth. The regulation is
effective July 1, 2022.

* 2022 OH REG TEXT 612958 (NS), filed July 5, 2022, amends OH ADC 3701-56-02 (Eligibility and application process) and OH
ADC 3701-58-03 (Requirements for contract) providing the definition for 'teledentistry," requiring the originating site (location of the
patient) and the approved practice site to be located in dental health resource shortage areas, requiring all teledentistry activities to be
conducted at the practice site specified in the dentist's contract, and requiring the contract to include the extent to which the dentist's
teledentistry activities will be counted toward the dentist's full-time or part-time practice hours under the contract. The regulation is
effective July 15, 2022.

¢ 2022 OH REG TEXT 616890 (NS), filed August 22, 2022, adopts OH ADC 4755-7-05 (Telehealth) to define 'telehealth" and
establishing the requirements for an occupational therapist or occupational therapy assistant providing telehealth services. Adopts

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OH ADC 4755-27-09 (Telehealth) to define 'telehealth" and establishing the requirements for a physical therapist or physical therapist
assistant providing telehealth services. The rulemaking is effective September 1, 2022.

¢ 2022 OH REG TEXT 623335 (NS), filed November 8, 2022, adopts OH ADC 5160-19-03 (Comprehensive maternal care program)
requiring the CMC entity to offer at least 1 alternative to traditional office visits to increase access to the patient care team and clinicians
in way that best meet the needs of the population, including e-visits, telehealth, phone visits, group visits, home visits, alternate location
visits, or expanded hours in the early mornings, evenings, or weekends. The rulemaking is effective November 18, 2022.

Oregon

* 2022 OR H.B. 4003 (NS), adopted March 23, 2022, requires the Oregon State Board of Nursing to support an Oregon nonprofit
organization, exempt from taxation, that promotes the well-being of Oregon health professionals through education, coordinated
regional counseling, telemedicine services and research, in order to allow nurses authorized to practice in Oregon to receive the benefit
of the services offered by the nonprofit organization. The bill is effective March 23, 2022.

¢ 2022 OR H.B. 4034 (NS), adopted March 23, 2022, adopts new section to define 'telemedicine' and to allow a physician or physician
assistant to use telemedicine to provide health care services, including the establishment of a patient-provider relationship, the
diagnosis or treatment of a medical condition or the prescription of drugs, to a patient physically located in this state. The bill amends
OR ST ? 442.015 (Definitions) to update the definition for 'telemedicine." The bill would amend OR ST ? 689.522 (Pharmacies and
pharmacists; filling prescriptions with biological products; restrictions) 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 also adopts new section to establish the requirements for a pharmacist, pharmacy technician or intern, or an individual similarly
licensed or otherwise authorized by another state, who is contacted or employed by a pharmacy to access the pharmacy's electronic
database regardless of whether the pharmacist, pharmacy technician or intern, or other individual is physically located inside the
pharmacy. The bill is effective March 23, 2022.

¢ 2021 OR REG TEXT 597520 (NS), filed December 16, 2021, amends OR ADC 855-019-0300 (Duties of a Pharmacist-in-Charge)
providing that a pharmacist may not be designated Pharmacist-in-Charge of more than three pharmacies instead of two pharmacies.
Adopts a new division, OR ADC 855-139 to allow for provision of pharmacy services via telepharmacy to a patient at a remote location.
The rulemaking is effective January 1, 2022.

«2021 OR REG TEXT 601679 (NS), filed December 14, 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 CPT? 2022 The
rulemaking makes a temporary rule and is effective January 1, 2022 through June 29, 2022.

* 2022 OR REG TEXT 597027 (NS), filed January 11, 2022, amends OR ADC 847-005-0005 (Licensure Fees) adding a fee for
registration of a physician assistant telemedicine license. Increases the Oregon Health Authority's Prescription Drug Monitoring
Program (PDMP) fee from $25 to $35 per year. Removes the Oral Specialty or Competency Examination fee. The regulation is effective
January 11, 2022.

¢ 2022 OR REG TEXT 597030 (NS), filed January 11, 2022, amends OR ADC 847-025 (Rules for Licensure to Practice Medicine
Across State Lines) to include physician assistants in the requirements. Adds a physician assistant telemedicine license to allow a
physician assistant to practice medicine across state lines when providing care to Oregon patients. Affected sections include OR
ADC 847-025-0010 (Definitions), OR ADC 847-025-0020 (Exemptions), OR ADC 847-025-0030 (Limitations), OR ADC 847-025-0040
(Qualifications) and OR ADC 847-025-0050 (Application). The regulations are effective January 15, 2022.

¢ 2022 OR REG TEXT 597494 (NS), field December 30, 2021, amends OR ADC 410-141-3515 (Network Adequacy) to require an
access plan and associated monitoring protocol must address the availability of telemedicine within the MCE's contracted provider
network. Amends OR ADC 410-141-3566 (Telemedicine and Telehealth Delivered Health Service and Reimbursement Requirements)
updating the section title from 'Telehealth Service and Reimbursement Requirements," updating definitions, requiring CCOs to ensure
that Providers OHP members are offered choice of how services are received, including services offered via telemedicine or telehealth
modalities and in-person services, requiring CCOs to provide reimbursement for telemedicine or telehealth services and reimburse
Certified and Qualified Health Care Interpreters (HCls) for interpretation services provided via telemedicine at the same reimbursement
rate as if it were provided in person, and updates terminology to use telemedicine or telehealth. The regulations are effective January 1,
2022.

* 2022 OR REG TEXT 598280 (NS), filed January 5, 2022, amends OR ADC 410-120-1990 (Telemedicine and Telehealth Delivered
Health Care Services) changing the section title from 'Telehealth' and updating the requirements for Medicaid coverage of medically
necessary and appropriate physical, behavioral and oral health services through telemedicine or telehealth. Amendments were needed
to reflect current and developing practice standards utilizing telecommunication technologies as a modality of delivering health care
services to individuals. The regulation is effective January 5, 2022.

* 2022 OR REG TEXT 599976 (NS), field February 11, 2022, adopts OR ADC 836-053-1430 (Form and manner for behavioral health
benefits reporting) establishing the telehealth claims reporting requirements. The regulation is effective February 15, 2022.

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¢ 2022 OR REG TEXT 601664 (NS), filed March 15, 2022, amends OR ADC 409-045-0025 (Definitions) providing the definition

for 'instant-site" and 'originating-site." Amends OR ADC 409-045-0120 (Telemedicine Providers Standard List of Credentialing
Documents), OR ADC 409-405-0125 (Telemedicine Providers Distant-Site or Health Care Facility Agreements), and OR ADC
409-045-0135 (Telemedicine Providers Information Sharing or Use of Data) updating the requirements for the credentialing of
telemedicine practitioners and expands telemedicine to all the current modalities of telemedicine used. Repeals OR ADC 409-045-0130
(Telemedicine Providers Hold Harmless Clause). The regulations are effective March 15, 2022.

¢ 2022 OR REG TEXT 605661 (NS), filed March 2, 2022, amends OR ADC 436-009-0012 (Telehealth) clarifying that medical services
that may be provided through telemedicine are not limited to those listed in Appendix P of CPT 202. The regulation is effective April 1,
2022.

* 2022 OR REG TEXT 605979 (NS), filed March 23, 2022, amends OR ADC 410-172-0600 (Acronyms and Definitions) adding the
definition for 'face to face" and amends OR ADC 410-172-0830 (Personal Care Attendant Service Assessment, Authorization, and
Monitoring) requiring at least quarterly in-person, face-to-face asynchronous audio/video telehealth, or telephone interviews with the
individual or their legal representative completed by the PCA Service Coordinator. The regulations are effective March 23, 2022.

* 2022 OR REG TEXT 608323 (NS), filed February 23, 2022, amends OR ADC 855-139-0005 (Definitions) updating the definition for
'RDSP Affiliated Pharmacy," 'Remote Dispensing Site Pharmacy" or 'RDSP," and 'Telepharmacy." The regulation is effective April 20,
2022.

¢ 2022 OR REG TEXT 610899 (NS), filed March 29, 2022, amends OR ADC 410-123-1510 (Additional Dental Care Benefits for
Pregnant Individuals) to provide for additional dental care benefits for pregnant individuals will continue 12 months following the end
of the pregnancy, including treatment in person or via teledentistry for an OHP-covered service. The rulemaking continues a previous
emergency rule without changes and is effective April 1, 2022.

¢ 2022 OR REG TEXT 612013 (NS), filed October 12, 2022, amends OR ADC 847-025-0000 (Preamble) updating terminology to

use 'telemedicine licensee' rather than 'a physician or physician assistant granted a license to practice medicine across state lines'

or 'physician or physician assistant'. Also removes the prohibition on writing prescriptions for medication resulting only from a sale or
consultation over the Internet. Amends OR ADC 847-025-0010 (Definitions) adding definitions for 'applicant' and 'telemedicine licensee'
and updating the definition of 'the practice of medicine across state lines'. Amends OR ADC 847-025-0030 (Limitations) updating
terminology to use 'telemedicine licensee' rather than 'a physician or physician assistant granted a license to practice medicine across
state lines' or 'physician or physician assistant'. Provides that a telemedicine licensee must not act as a dispensing physician or
dispensing physician assistant or prescribe controlled substances for the treatment of a diagnosed condition causing pain to a person
located within Oregon. Also provides that a telemedicine licensee must not prescribe medication based only on a sale or form over
the Internet, unless an appropriate provider-patient relationship is established and the standard of care described in OR ST ? 677.095
(Duty of care; matters not precluded by investigation or administrative proceeding) and OR ST ? 677.265 (Powers of board; physician
standard of care) is met. The regulation is effective October 12, 2022.

* 2022 OR REG TEXT 613179 (NS), filed April 26, 2022, amends OR ADC 855-139-0005 (Definitions) updating the definition for 'RDSP
Affiliated Pharmacy," 'Remote Dispensing Site Pharmacy" or 'RDSP,." and 'Telepharmacy." The regulation is effective June 16, 2022.
The rulemaking adopts previous temporary rules as final.

* 2022 OR REG TEXT 616769 (NS), agency approved July 29, 2022, repeals OR ADC 333-006-0170 (Newborn Nurse Home Visiting
Services Provided by Telehealth). The rule describes use of telehealth during a public health emergency. Rules is no longer in effect
given the end of the Governor declared public health emergency. The rulemaking is effective July 3, 2022.

¢ 2022 OR REG TEXT 617037 (NS), filed June 16, 2022, adopts OR ADC 309-081-0010 (Definitions) providing the definition for
'telehealth" and adopts OR ADC 309-081-0040 (Application and Review Process) allowing behavioral health care workers to deliver
telehealth services as all or part of their services. The rulemaking is temporary and is effective Jun 16, 2022 through December 12,
2022.

¢ 2022 OR REG TEXT 622395 (NS), filed August 19, 2022, adopts OR ADC 333-006-0190 (Reimbursement Methodology) requiring
health benefit plans to reimburse at the case rate for newbom nurse home visiting services conduct via telemedicine pursuant to
OR ADC 333-006-0120 (Newborn Nurse Home Visiting Service Requirements) and OR ST ? 743A.058 (Coverage of health service
provided using telemedicine). The regulation is effective January 1, 2023.

* 2022 OR REG TEXT 625634 (NS), filed September 30, 2022, amends OR ADC 410-141-3566 (Telemedicine and Telehealth
Delivered Health Service and Reimbursement Requirements) changing PHP or CCO to Managed Care Entity (MCE). The regulation is
effective September 30, 2022.

Pennsylvania

¢ 2021 PAH.B. 1421 (NS), adopted July 11, 2022, adopts a new section requiring the Commission to issue a report on its
recommendations for the allocation of funding for the delivery of services by telemedicine.

¢ 2021 PA H.B. 1642 (NS), adopted July 7, 2022, amends PA ST 24 P.S. ? 13-1306-B (School Safety and Security Grant Program)
requiring the Committee to provide grants to school entities for programs that address school mental health and safety and security,

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including expanding telemedicine delivery of school-based mental health services, including equipment. The bill is effective July 7,
2022.

¢ 2021 PA H.B. 2503 (NS), introduced April 8, 2022, would adopt new section (Peripartum Cardiomyopathy Diagnostic Testing
Coverage) to require a health insurance policy to include coverage an waive cost-sharing requirements for services related to the
diagnosis of peripartum cardiomyopathy, including consultation services, including the delivery of services remotely via telehealth.
Provide the definition for 'telehealth" and 'telehealth technologies."

¢ 2021 PA H.B. 2603 (NS), introduced May 19, 2022, would establish the interstate 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 PA H.B. 2852 (NS), introduced September 26, 2022, would enact the mental health counseling compact to facilitate the
interstate practice of licensed professional counselors with the goal of improving public access to professional counseling services
with a stated goal to allow for the use of telehealth technology to facilitate increased access to professional counseling services. The
Compact must come into effect on the date on which the Compact statute is enacted into law in the 10th member state.

¢ 2021 PA H.B. 2877 (NS), introduced October 20, 2022, would adopt PA ST 35 P.S. ? 91-9121 (Telemedicine) allowing a patient to
meet with a physician electronically via telemedicine to satisfy the requirements of section 9109 (relating to determination of gestational
age), as well as for nonsurgical medica abortions if the abortion is to be performed in the first trimester of pregnancy.

¢ 2021 PA S.B. 910 (NS), introduced December 13, 2021, would adopt the 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 PA S.B. 967 (NS), amended/substituted June 15, 2022, would establish the Women, Infants and Children State Advisory Board
to advise on technology improvements and enhancements to be made using the American Rescue Plan Act of 2021 funds including
maximizing innovations in telehealth to reduce the need for in-person office visits and developing the ability to obtain weight and height
measurements from a primary care physician through telehealth.

¢ 2021 PAS.B. 1348 (NS), introduced October 6, 2022, would enact the Counseling Compact to facilitate the interstate practice of
licensed professional counselors with the goal of improving public access to professional counseling services with a stated goal to allow
for the use of telehealth technology to facilitate increased access to professional counseling services. The Compact must come into
effect on the date on which the Compact statute is enacted into law in the 10th member state.

Rhode Island

¢ 2021 RI H.B. 7501 (NS) and 2021 RI S.B. 2605 (NS), adopted June 21, 2022, enacts 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. The bill is
effective June 21, 2022.

¢ 2021 RI H.B. 8229 (NS), introduced May 11, 2022, would establish the Interstate 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.

South Carolina

¢ 2021 SC H.B. 3599 (NS), adopted May 13, 2022, enacts the interstate 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 takes effect on the date on which the compact statute is enacted into law in the 10th member state. The bill is
effective May 13, 2022.

¢ 2021 SC H.B. 3833 (NS), adopted May 13, 2022, enacts 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. The bill is effective May 13, 2022.

* 2021 SC H.B. 3840 (NS), adopted May 13, 2022, enacts 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 takes effect on the date on which the compact statute is enacted into law in the 10th
member state. The bill is effective May 13, 2022.

* 2021 SC H.B. 5113 (NS), amended/substituted March 30, 2022, would amend SC ST ? 62-5-303D (Procedure for court appointment
of a guardian; report evaluating condition of alleged incapacitated individual) to allow an examination to determine capacity to be
conducted in person or virtually via telemedicine.

¢ 2021 SC H.B. 5161 (NS), introduced March 29, 2022, would enact the South Carolina Telehealth and Telemedicine Modernization Act
to define terms, establish applicability, and to prohibit actions. Amend SC ST ? 40-47-20 (Definitions) to define 'telehealth" and SC ST ?

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40-47-37 (Practice of telemedicine, requirements) relating to the practice of telemedicine, so as to allow for the prescribing of Schedule
Il and Schedule III medications via telehealth in specific circumstances.

¢ 2021 SC H.B. 5483 (NS), introduced August 31, 2022, would adopt SC ST ? 40-140-330 (Practice of telemedicine; requirements) to
allow a physician practicing telemedicine to prescribe abortion-inducing drugs.

¢ 2021 SC S.B. 150 (NS), amended/substituted April 20, 2022, 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 S.B. 613 (NS), adopted May 16, 2022, adopts SC ST ? 40-47-196 to prohibit a task being performed via means of
telemedicine from being delegated to a CMA. The bill is effective July 15, 2022.

¢ 2021 SC S.B. 1136 (NS), amended/substituted April 27, 2022, 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.

¢ 2022 SC S.B. 1179 (NS), adopted May 13, 2022, adopts SC ST ? 40-63-35 and SC ST ? 40-75-800 to define 'behavioral telehealth"
and authorize individuals who hold an active license to provide independent social work services or professional counseling, addiction
counseling, marriage and family therapy, and licensed psycho-educational specialist services in another state or jurisdiction to provide
these services using behavioral telehealth to a client located in South Carolina.

¢ 2021 SC S.B. 1348 (NS), introduced June 15, 2022, would adopt SC ST ? 44-139-330 to allow a physician practicing telemedicine in
accordance with the requirements in SC ST ? 40-47-37 (Practice of telemedicine, requirements) to prescribe abortion-inducing drugs.

South Dakota

¢ 2022 SD H.B. 1029 (NS), introduced January 11, 2022, would amend SD ST ? 58-17-167 (Definitions pertaining to telehealth
coverage) to update the definition for 'telehealth."

¢ 2022 SD H.B. 1280 (NS), engrossed February 11, 2022, would SD ST ? 34-20G-1 (Definitions) to update the definition for 'bona fide
practitioner-patient relationship" to allow for an examination via telehealth.

* 2022 SD H.B. 1318 (NS), adopted March 23, 2022, prohibits medical abortion by telemedicine. The bill is effective July 1, 2022.
Tennessee

¢ 2021 TN H.B. 1841 (NS), introduced January 20, 2022, would amend TN ST ? 56-7-1012 (Reimbursement for healthcare provided
through telehealth encounter) to remove the section's April 1, 2022 repeal date and TN ST ? 56-7-1003 (Healthcare services provided
through provider-based telemedicine) to update the definition for 'provider-based telemedicine."

¢ 2021 TN H.B. 1843 (NS), adopted April 8, 2022, amends TN ST ? 56-7-1003 (Healthcare services provided through provider-

based telemedicine) providing that a healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting
for reimbursement of an audio-only encounter must confirm and maintain documentation that the patient does not own the video
technology necessary to complete an audio-video provider-based telemedicine encounter, is at a location where an audio-video
encounter cannot take place due to lack of service, or has a physical disability that inhibits the use of video technology, and notify the
patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person
or video encounters, prior to the audio-only telemedicine encounter. The bill is effective April 8, 2022.

¢ 2021 TN S.B. 1848 (NS), introduced January 24, 2022, would adopt the Occupational Therapy Licensure 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 TN H.B. 2561 (NS), adopted April 19, 2022, enacts the 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.
The bill is effective April 19, 2022.

¢ 2021 TN H.B. 2641 (NS), introduced February 2, 2022, would adopt TN ST ? 68-7-210 to prohibit a qualified physician from issuing a
written certification to a qualified patient based on an assessment conducted via telemedicine.

¢ 2021 TN H.B. 2735 (NS), introduced February 2, 2022, and 2021 TN S.B. 2848 (NS), introduced February 3, 2022, would require the
Department of Health to study the utilization of provider-based telemedicine in Tennessee among individuals over 65 years of age.

¢ 2021 TN H.B. 2841 (NS), introduced February 2, 2022, and 2021 TN S.B. 2500 (NS), introduced February 3, 2022, would adopt TN
ST ? 33-12-101 to define 'telehealth" and to require the Department to require metrics related to the number of calls transferred to
telehealth with physical response follow-up and the number of calls transferred to telehealth without physical response follow-up.

¢ 2021 TN S.B. 1027 (NS), adopted May 27, 2022, adopts the Interstate Compact for License Portability Act. 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

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services. The Compact will come into effect on the date on which the Compact statute is enacted into law in the 10th member state.
The bill is effective May 27, 2022.

¢ 2021 TN S.B. 1846 (NS), introduced January 24, 2022, would amend TN ST ? 56-7-1003 (Healthcare services provided through
provider-based telemedicine) to update the definition for 'provider-based telemedicine."

¢ 2021 TN S.B. 1848 (NS), introduced January 24, 2022, would adopt the 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.

¢ 2021 TN S.B. 2281 (NS), introduced February 2, 2022, would adopt TN ST ? 63-6-1107 to require reports on chemical abortions to
include whether the patient obtained abortion-inducing drugs via mail or an internet website, and, if so, information identifying the name
of the source, URL address, or telemedicine provider.

¢ 2021 TN REG TEXT 586850 (NS), filed December 20, 2021, adopts TN ADC 1045-02-.19 (Telehealth in the Practice of Optometry)
establishing the requirements for telehealth in the practice of optometry. The regulation is effective March 20, 2022.

¢ 2022 TN REG TEXT 596993 (NS), filed March 23, 2022, adopts TN ADC 1045-02-.18 (Telehealth in the Practice of Optometry)
establishing the requirements for telehealth in the practice of optometry. The rulemaking is effective June 21, 2022.

Texas

* 2023 TX H.B. 592 (NS), prefiled November 14, 2022, would amend TX INS ? 1455.001 (Definitions) to update the definition of 'health
professional' to include an individual providing teledentistry dental services. Amend TX OCC ? 111.001 (Definitions) to update the
definition for 'telehealth service" and 'telemedicine medical service." Adopt TX OCC ? 111.010 (Provision of Telehealth or Telemedicine
Medical Service by Health Professional Located Outside of State) to establish the requirement for a health professional located outside
of this state who does not hold a license or certification issued by an agency of this state to provide a telehealth or telemedicine medical
service under this chapter.

¢ 2023 TX H.B. 594 (NS), prefiled November 14, 2022, would amend TX OCC ? 562.110 (Telepharmacy Systems) updating the
requirements for the provision of telepharmacy services.

¢ 2023 TX H.B. 617 (NS), prefiled November 14, 2022, and 2023 TX S.B. 251 (NS), prefiled November 28, 2022, would adopt the
Next Generation ? 1 Telemedicine Medical Services and Telehealth Services Pilot Project to provide emergency telemedicine medical
services and telehealth services in rural areas.

* 2023 TX S.B. 137 (NS), prefiled November 14, 2022, would require the Department to develop a counseling and crisis management
program to provide mental and behavioral telehealth services and mobile mental and behavioral health intervention services to relative
or other designated caregivers and children in the managing conservatorship of the Department who are placed with relative or other
designated caregivers. Establish requirements for mental and behavioral telehealth services provided under the section.

* 2021 TX REG TEXT 593249 (NS), filed December 10, 2021, amends 16 TX ADC ? 111.2 (Definitions) providing the definition for
'tele-supervision," amends 16 TX ADC ? 111.51 (Assistant in Speech-Language Pathology License--Supervision Requirements) and
16 TX ADC ? 111.91 (Assistant in Audiology License-- Supervision Requirements) clarifying that tele-supervision may be used for
direct and indirect supervision, 16 TX ADC ? 111.210 (Definitions Relating to Telehealth) updating the definition for 'telehealth" and
'telehealth services" and removing the definition for 'telepractice" and 'telepractice services," 16 TX ADC ? 111.211 (Service Delivery
Models) updating terminology to use 'telehealth service" instead of 'telepractice," and adopts 16 TX ADC ? 111.212 (Requirements for
Providing Telehealth Services and Using Telehealth) establishing the requirement for providing telehealth services and using telehealth
by speech-language pathologists, speech-language pathology interns, speech-language pathology assistants, audiologists, audiology
interns, audiology assistants, and dual speech-language pathologist and audiologist license holders. The rulemaking is effective
December 30, 2021.

¢ 2021 TX REG TEXT 593250 (NS), filed December 10, 2021, amends 16 TX ADC ? 112.2 (Definitions) providing the definition for
'telehealth," adopts 16 TX ADC ? 112.130 (Definitions Relating to Telehealth) providing definitions related to telehealth, and adopts 16
TX ADC ? 112.132 (Requirements for Providing Telehealth Services and Using Telehealth) establishing the requirement for providing
telehealth services and using telehealth by hearing instrument fitters and dispensers, apprentice permit holders, and temporary training
permit holders. The rulemaking is effective December 30, 2021.

¢ 2022 TX REG TEXT 600824 (NS), filed February 25, 2022, amends 26 TX ADC ? 350.103 (Definitions) updating the definition for
'telehealth." The regulation is effective March 17, 2022.

* 2022 TX REG TEXT 602500 (NS), filed February 23, 2022, amends 22 TX ADC ? 291.29 (Professional Responsibility of Pharmacists)
establishing the determination of a valid prescription issued as a result of teledentistry dental services. The regulation is effective March
15, 2022.

* 2022 TX REG TEXT 604357 (NS), filed March 23, 2022, amends 1 TX ADC ? 355.8101 (Rural Health Clinics Reimbursement)
clarifying that a medical visit includes a telemedicine medical service encounter between an RHC patient and a physician, physician
assistant, advanced nurse practitioner, certified nurse-midwife, visiting nurse, or clinical nurse practitioner and that an 'other' health visit
includes a telehealth service encounter between an RHC patient and a clinical social worker. The rulemaking is effective April 12, 2022.

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¢ 2022 TX REG TEXT 606029 (NS), filed April 11, 2022, adopts 16 TX ADC ? 100.61 (Definitions) to define 'telehealth services," 16 TX
ADC ? 100.62 (License Requirement) to specify the licensing requirements for telehealth, 16 TX ADC ? 100.63 (Standard of Care) to
establish that a telehealth service is subject to the same standard of care as an in-person service, 16 TX ADC ? 100.64 (Appropriate
Client Care and Fraud Prevention) to provide guidelines for health professionals providing telehealth services to ensure appropriate
client care and fraud prevention, and 16 TX ADC ? 100.65 (Client Privacy) to require health professionals providing telehealth services
to protect client privacy as required by federal and state law. The regulations are effective May 1, 2022.

¢ 2022 TX REG TEXT 606926 (NS), filed July 13, 2022 amends 28 TX ADC ? 10.2 (Definitions) by adding the definitions of 'Telehealth
service, telemedicine medical service, and teledentistry dental service.' Amends 28 TX ADC ? 10.22 (Contents of application) updating
requirements for what must be included in network configurations to include maps for each specialty providing services to injured
employees, information identifying which network providers provide telehealth, telemedicine medical services, or teledentistry dental
services, and access plans for service areas where networks do not meet accessibility and availability requirements. Amends 28 TX
ADC ? 10.27 (Modifications to network configurations) by requiring that, if a network modification request involves adding or modifying
telehealth service, telemedicine medical service, or teledentistry dental service, an explanation of how the network will update its
provider directory, and any statements or restrictions on services, must be included. Amends 28 TX ADC ? 10.60 (Notice of network
requirements; Employee information) requiring the clear identification of providers who are providing telehealth, telemedicine medical
services, or teledentistry dental services in the list of certified network providers. The regulation is effective August 2, 2022.

* 2022 TX REG TEXT 607918 (NS), filed February 3, 2022, amends 26 TX ADC ? 500.21 (ESRD Facility Requirements During the
COVID-19 Pandemic) to allow home patient visits to be conducted using telemedicine medical services. The rulemaking was adopted
via emergency and is effective February 5, 2022.

* 2022 TX REG TEXT 609015 (NS), filed May 9, 2022, amends 40 TX ADC ? 372.1 (Provision of Services) updating the requirements
regarding the provision of occupational therapy services, including services delivered via telehealth. The regulation is effective June 1,
2022.

¢ 2022 TX REG TEXT 609016 (NS), filed May 9, 2022, amends 40 TX ADC ? 373.1 (Supervision of Non-Licensed Personnel) providing
that when telehealth may be used for the supervision of non-licensed personnel as described in this section, the licensee may attend
via telehealth, provided the licensee maintains line of sight of the services provided. The regulation is effective June 1, 2022.

¢ 2022 TX REG TEXT 609438 (NS), filed May 13, 2022, amends 22 TX ADC ? 108.7 (Minimum Standard of Care, General) to update
the requirements regarding the limited physical evaluation of dental patients. Provides that each dentist shall perform and review

a limited physical examination when a reasonable and prudent dentist would do so under the same or similar circumstances. At a
minimum, a limited physical examination should be performed and reviewed annually. Requires, at a minimum, a medical history should
be reviewed and updated annually. Makes other clarifying and conforming changes. The regulation is effective June 2, 2022.

* 2022 TX REG TEXT 609439 (NS), filed May 13, 2022, adopts 22 TX ADC ? 108.16 (Teledentistry) to establish the standards of
practice for teledentistry as provided in 2021 TX H.B. 2056 (NS). The regulation is effective June 2, 2022.

* 2022 TX REG TEXT 612839 (NS), filed April 5, 2022, adopts 26 TX ADC ? 500.41 (CDTF Telemedicine or Telehealth During the
COVID-19 Pandemic) to allow a physician, physician assistant, nurse practitioner, registered nurse, or licensed vocational nurse (LVN)
to use telemedicine medical service or telehealth service to screen a client for admission to a detoxication program. The regulation was
adopted via emergency rulemaking and is effective April 10, 2022 through August 7, 2022.

¢ 2022 TX REG TEXT 623699 (NS), filed November 4, 2022, adopts 22 TX ADC ? 75.10 (Chiropractic Telehealth Requirements)
establishing the requirements for a licensee to provide echopractic telehealth services. The regulation is effective November 24, 2022.

Utah

¢ 2022 UT H.B. 154 (NS), adopted March 23, 2022, adopt the 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 must come into effect on the date on which the compact statute is enacted into law in the 10th member state.
The bill is effective May 4, 2022.

¢ 2022 UT H.B. 363 (NS), adopted March 24, 2022, amends UT ST ? 62A-15-631 (Involuntary commitment under court order--
Examination--Hearing--Power of court--Findings required--Costs) allowing designated examiners to conduct examinations through
telehealth. The bill is effective May 4, 2022.

¢ 2022 UT H.B. 365 (NS), introduced February 10, 2022, would amend UT ST ? 26-60-102 (Definitions) to update the definition for
'telehealth services" and UT ST ? 26-60-103 (Scope of telehealth practice) updating the requirements for a provider offering telehealth
services.

¢ 2022 UT S.B. 237 (NS), adopted March 24, 2022, enacts 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 must come into effect on the date on which the compact statute is enacted into law in the 10th member state.
The bill is effective May 4, 2022.

Vermont

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¢ 2021 VT S.B. 74 (NS), adopted April 27, 2022, amends VT ST T. 18 ? 5281 (Definitions) to define 'telemedicine' and VT ST T. 18 ?
5283 (Requirements for Prescription and Documentation; Immunity) to allow a patient to make an oral request to the physician by
telemedicine, if the physician determines the use of telemedicine to be clinically appropriate. The bill is effective April 27, 2022.

¢ 2021 VT H.B. 577 (NS), introduced January 12, 2022, 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 VT H.B. 654 (NS), adopted March 22, 2022, establishes the requirements for a health care professional who holds a valid
license, certificate, or registration to provide health care services in any other U.S. jurisdiction to be deemed licensed, certified, or
registered to provide, through March 31, 2023, health care services to a patient located in Vermont using telehealth. Require the

Office of Professional Regulation and Board of Medical Practice to, from April 1, 2022, through June 30, 2023, register a health care
professional who is not licensed or registered to practice in Vermont but who seeks to provide health care services to patients or clients
located in Vermont using telehealth. The bill is effective March 22, 2022.

* 2021 VT H.B. 655 (NS), adopted May 9, 2022, adopts VT ST T. TWENTY-SIX, Ch. 56 (Telehealth Licensure and Registration for
Out-of-State Health Care Professionals) establishing a regulatory system for telehealth that would allow a health care professional
who is licensed, certified, or registered to provide health care services in another U.S. jurisdiction to obtain a license or registration to
deliver health care services to Vermont residents using telehealth. New sections include VT ST T. 26 ? 3051 (Scope), VT ST T. 26 ?
3052 (Definitions), VT ST T. 26 ? 3053 (Telehealth Licensure or Telehealth Registration Required), VT ST T. 26 ? 3054 (Scope of
Telehealth License and Telehealth Registration), VT ST T. 26 ? 3055 (Scope of Practice; Standard of Practice), VT ST T. 26 ? 3056
(Records), VT ST T. 26 ? 3057 (Effect of Disciplinary Action on Out-of-State License, Certificate, or Registration), VT ST T. 26 ? 3058
(Jurisdiction; Application of Vermont Laws), and VT ST T. 26 ? 3059 (Exemptions from Registration and Licensure Requirements). The
bill is effective May 9, 2022.

* 2021 VT S.B. 205 (NS), introduced January 6, 2022, would amend VT ST T. 8 ? 4100k (Coverage of health care services delivered
through telemedicine and by store-and-forward means) and VT ST T. 8 ? 9361(Health care providers delivering health care services
through telemedicine or by store-and-forward means) to remove requirement that health insurers reimburse health care providers the
same amounts for services provided in person and using telemedicine through plan year 2025, allow out-of-state providers to treat
Vermont patients using telemedicine, and prohibit a health insurance plan from requiring a health care provider to have previously
conducted an in-person examination or consultation with a patient prior to delivering health care services to the patient through
telemedicine.

¢ 2021 VT S.B. 266 (NS), introduced January 18, 2022, would adopt 18 VT ST ? 4815 (Harm Reduction Centers) to require a network
of approved harm reduction centers must be established at geographically diverse locations throughout the State for the purpose of
preventing overdoses and providing services to individuals with substance use disorder, including providing telehealth services to the
extent permitted under federal law.

Virginia

¢ 2022 VA H.B. 81 (NS) and 2022 VA S.B. 436 (NS), adopted April 27, 2022, amends VA ST ? 32.1-122.03:1 (Statewide Telehealth
Plan) to require the Board of Health to leverage the expertise of the Virginia Telehealth Network, or another Virginia-based
nongovernmental organization focused on telehealth if the Virginia Telehealth Network is no longer in existence, to (i) provide direct
consultation to any advisory groups and groups tasked by the Board with implementation and data collection, (ii) track implementation
of the Statewide Telehealth Plan, and (iii) facilitate changes to the Statewide Telehealth Plan as accepted medical practices and
technologies evolve. The bills are effective July 1, 2022.

* 2022 VA H.B. 264 (NS) and 2022 VA S.B. 369 (NS), adopted April 27, 2022, amends VA ST ? 54.1-2901 (Exceptions and exemptions
generally) to provide that the provisions of VA ST T. 54.1, Subt. Ill, Ch. 29 (Medicine and Other Healing Arts) do not prevent or prohibit
any practitioner of a profession regulated by the Board who is licensed in another state, the District of Columbia, or a United States
territory or possession and who is in good standing with the applicable regulatory agency in that state, the District of Columbia, or that
United States territory or possession from engaging in the practice of that profession in the Commonwealth with a patient located in

the Commonwealth when (i) such practice is for the purpose of providing continuity of care through the use of telemedicine services

as defined in VA ST ? 38.2-3418.16 (Coverage for telemedicine services) and (ii) the patient is a current patient of the practitioner with
whom the practitioner has previously established a practitioner-patient relationship. The bills are effective April 27, 2022.

¢ 2022 VA S.B. 170 (NS), introduced January 12, 2022, would require the Department of Health to amend the Statewide Telehealth
Plan to require health care providers providing telehealth services to directly contact and coordinate with emergency services in
accordance with the standard of care that is appropriate to the patient's situation and to the services rendered during the telehealth visit.

¢ 2022 VA S.B. 257 (NS), amended/substituted January 26, 2022, would adopt the Licensed Professional Counselors 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 VA S.B. 369 (NS), adopted April 27, 2022, amends VA ST ? 54.1-2901 (Exceptions and exemptions generally) to provide that
the provisions of VA ST T. 54.1, Subt. Ill, Ch. 29 (Medicine and Other Healing Arts) do not prevent or prohibit any practitioner of a

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profession regulated by the Board who is licensed in another state, the District of Columbia, or a United States territory or possession
and who is in good standing with the applicable regulatory agency in that state, the District of Columbia, or that United States territory
or possession from engaging in the practice of that profession in the Commonwealth with a patient located in the Commonwealth
when (i) such practice is for the purpose of providing continuity of care through the use of telemedicine services as defined in VA ST ?
38.2-3418.16 (Coverage for telemedicine services) and (ii) the patient is a current patient of the practitioner with whom the practitioner
has previously established a practitioner-patient relationship. The bill is effective April 27, 2022.

¢ 2022 VA H.B. 537 (NS), adopted April 8, 2022, amends VA ST ? 54.1-2901 (Exceptions and exemptions generally) to allow a
practitioner who provides behavioral health services to be a patient located in the Commonwealth through use of telemedicine services
pursuant to this subdivision to provide such services for a period of no more than 1 year from the date on which the practitioner began
providing such services to such patient. Amends VA ST ? 54.1-3501 (Exemption from requirements of licensure), VA ST ? 54.1-360
(Exemption from requirements of licensure), and VA ST ? 54.1-3701 (Exemption from requirements of licensure) to allow practitioner
who provide behavioral health services and who are licensed in another state, the District of Columbia, or a United States territory

or possession and in good standing with such regulatory agency to engage in the practice of that profession in the Commonwealth
with a patient located in the Commonwealth when (i) such practice is for the purpose of providing continuity of care through the use
of telemedicine services and (ii) the practitioner has previously established a practitioner-patient relationship with the patient. The

bill provides that a practitioner who provides behavioral health services to a patient located in the Commonwealth through use of
telemedicine services may provide such services for a period of no more than one year from the date on which the practitioner began
providing such services to such patient. The bill is effective July 1, 2022.

¢ 2021 VT H.B. 654 (NS), adopted March 22, 2022, establishes the requirements for a health care professional who holds a valid
license, certificate, or registration to provide health care services in any other U.S. jurisdiction to be deemed licensed, certified, or
registered to provide, through March 31, 2022, health care services to a patient located in Vermont using telehealth. The bill also
requires the Office of Professional Regulation and Board of Medical Practice to, from April 1, 2022, through June 30, 2023, register
a health care professional who is not licensed or registered to practice in Vermont but who seeks to provide health care services to
patients or clients located in Vermont using telehealth. The bill is effective March 22, 2022.

* 2022 VA H.B. 1323 (NS) and 2022 VA S.B. 672 (NS), adopted May 27, 2022, amends VA ST ? 54.1-3303.1 (Initiating of treatment
with and dispensing and administering of controlled substances by pharmacists) to clarify that a pharmacist may initiate treatment with,
dispense, or administer, in person or through telehealth, drugs, devices, controlled paraphernalia, and other supplies and equipment
through telemedicine services. The bill is effective July 1, 2022.

* 2022 VA S.B. 426 (NS), adopted April 8, 2022, 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
provide for the payment of medical assistance for remote patient monitoring services provided via telemedicine (i) for patients who have
experienced an acute health condition and for whom the use of remote patient monitoring may prevent readmission to a hospital or
emergency department, (ii) for patient-initiated asynchronous consultations, and (iii) for provider-to-provider consultations. The bill is
effective July 1, 2022.

¢ 2022 VA S.B. 436 (NS), adopted April 27, 2022, would amend VA ST ? 32.1-122.03:1 (Statewide Telehealth Plan) to require the
Board of Health to leverage the expertise of the Virginia Telehealth Network, or another Virginia-based nongovernmental organization
focused on telehealth if the Virginia Telehealth Network is no longer in existence, to (i) provide direct consultation to any advisory
groups and groups tasked by the Board with implementation and data collection, (ii) track implementation of the Statewide Telehealth
Plan, and (iii) facilitate changes to the Statewide Telehealth Plan as accepted medical practices and technologies evolve. The bill is
effective July 1, 2022.

¢ 2022 VA S.B. 663 (NS), adopted April 11, 2022, 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)
requiring the Board to include a provision for payment of the originating site fee to emergency medical service agencies for facilitating
synchronous telehealth visits with a distant site provider delivered to a Medicaid member. Defines 'distant site." The bill is effective July
1, 2022.

* 2022 VA S.B. 672 (NS), adopted March 27, 2022, amends VA ST ? 54.1-3303.1 (Initiating of treatment with and dispensing and
administering of controlled substances by pharmacists) to clarify that a pharmacist may initiate treatment with, dispense, or administer,
in person or through telehealth, drugs, devices, controlled paraphernalia, and other supplies and equipment to persons 18 years of age
or older and establish the drugs and devices a pharmacist may initiate treatment with, dispense, or administer, in person or through
telehealth, to persons 3 years of age or older. The bill is effective upon the expiration of the provisions of the federal Declaration Under
the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19 related to the vaccination
and COVID-19 testing of minors.

¢ 2022 VA S.B. 788 (NS), prefiled November 20, 2022, would adopt VA ST ? 4.1-1601 (Certification for use of cannabis for treatment) to
require the practitioner to use his professional judgment to determine the manner and frequency of patient care and evaluation and may
employ the use of telemedicine, provided that the use of telemedicine includes the delivery of patient care through real-time interactive
audiovisual technology.

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* 2022 VA S.B. 802 (NS), prefiled December 5, 2022, 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. The Compact will come into effect on the date on which the compact statute is enacted into law in the 10th
member state.

¢ 2022 VA REG TEXT 604649 (NS), filed December 22, 2021, adopts 12 VA ADC 30-80-26 (Reimbursement for Indian Health Service
tribal 638 facilities) to establish the reimbursement for trial health clinics, including outpatient telemedicine visits. The regulation was
adopted via fast-track and is effective March 3, 2022.

Washington

* 2021 WAH.B. 1043 (NS), amended/substituted February 2, 2022, 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. 1286 (NS), adopted March 4, 2022, 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
must come into effect on the date on which the Compact statute is enacted into law in the 10th member state. The bill is effective June
8, 2022.

¢ 2021 WAH.B. 1708 (NS), adopted March 24, 2022, adopts a new section in WA ST T. 70, Ch. 70.41 (Hospital Licensing and
Regulation) to prohibit a hospital that is an originating site for audio-only telemedicine to charge a facility fee. The bill is effective June 8,
2022.

¢ 2021 WAH.B. 1821 (NS), adopted March 30, 2022, amends WA ST 41.05.700 (Reimbursement of health care services provided
through telemedicine or store and forward technology--Audio-only telemedicine), WA ST 48.43.735 (Reimbursement of health care
services provided through telemedicine or store and forward technology---Audio-only telemedicine), WA ST 71.24.335 (Reimbursement
for behavioral health services provided through telemedicine or store and forward technology--Coverage requirements--Audio-only
telemedicine), and WA ST 74.09.325 (Reimbursement of a health care service provided through telemedicine or store and forward
technology--Audio-only telemedicine) to update the definition of 'established relationship" for purposes of audio-only telemedicine.

¢ 2021 WA H.B. 1950 (NS), amended/substituted January 31, 2022, would adopt new section in WA ST T. 18, Ch. 18.32 (Dentistry) to
establish the teledentistry requirements for orthodontia and to define 'teledentistry."

¢ 2021 WA S.B. 5518 (NS), adopted March 24, 2022, adopts the 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 must come into effect on the date on which the Compact statute is enacted into law in the 10th member state.
The bill is effective

¢ 2022 WA REG TEXT 556136 (NS), filed September 16, 2022, adopts WA ADC 246-358-002 (Additional requirements to protect
occupants in temporary worker housing form 2019 novel coronavirus (COVID-19) exposure) requiring the operator to ensure each
occupant in isolation has or is provided a working telephone with a clear connection for evaluations done by telehealth. The regulation
was adopted via emergency rulemaking and is effective September 16, 2022.

¢ 2022 WA REG TEXT 556136 (NS), filed May 20, 2022, adopts WA ADC 246-358-002 (Additional requirements to protect occupants
in temporary worker housing form 2019 novel coronavirus (COVID-19) exposure) requiring the operator to ensure each occupant in
isolation has or is provided a working telephone with a clear connection for evaluations done by telehealth. The regulation was adopted
via emergency rulemaking and is effective May 20, 2022.

* 2022 WA REG TEXT 556137 (NS), filed September 16, 2022, adopts WA ADC 296-307-16102 (Additional requirements to protect
occupants in temporary worker housing from 2019 novel coronavirus (COVID-19) exposure) requiring an operator of an isolation
facilities for suspected SARS-CoV-2 cases or SARS-CoV-2 positive TWH occupants to ensure that a licensed health care professional
visits or assesses symptomatic occupants daily and asymptomatic occupants upon initial placement in isolation and upon request of
the asymptomatic occupant or the licensed health care professional, at the employer's expense to perform a health check for each
individual in isolation and allowing those evaluations to be performed in person, using audio telemedicine, or video telemedicine. The
regulation was adopted via emergency rulemaking and is effective September 16, 2022.

¢ 2022 WA REG TEXT 556137 (NS), filed May 20, 2022, adopts VWWA ADC 296-307-16102 (Additional requirements to protect occupants
in temporary worker housing from 2019 novel coronavirus (COVID-19) exposure) requiring an operator of an isolation facilities for
suspected SARS-CoV-2 cases or SARS-CoV-2 positive TWH occupants to ensure that a licensed health care professional visits

or assesses symptomatic occupants daily and asymptomatic occupants upon initial placement in isolation and upon request of the
asymptomatic occupant or the licensed health care professional, at the employer's expense to perform a health check for each
individual in isolation and allowing those evaluations to be performed in person, using audio telemedicine, or video telemedicine. The
regulation was adopted via emergency rulemaking and is effective May 20, 2022.

¢ 2022 WA REG TEXT 571418 (NS), filed October 21, 2022, amends WA ADC 182-507-0115 (Alien emergency medical program
(AEM)) providing that for the assessment and treatment of the COVID-19 virus, the agency covers one physician visit provided in any

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outpatient setting, including the office or clinic setting, or via telemedicine, online digital or telephonic services to assess/evaluate and
test, if clinically indicated. The rulemaking was adopted via emergency and is effective October 21, 2022.

¢ 2022 WA REG TEXT 571418 (NS), filed February 24, 2022, amends WA ADC 182-507-0115 (Alien emergency medical program
(AEM)) providing that for the assessment and treatment of the COVID-19 virus, the Agency covers one physician visit provided in any
outpatient setting, including the office or clinic setting, or via telemedicine, online digital or telephonic services to assess/evaluate and
test, if clinically indicated. The rulemaking was adopted via emergency and is effective February 24, 2022.

* 2022 WA REG TEXT 577145 (NS), filed March 29, 2022, amends WA ADC 182-513A-1200 (Applied behavior analysis (ABA}-
Services provided via telemedicine) to allow speech language pathology services to be provided via telemedicine when not otherwise
available in person. The regulation is effective April 29, 2022.

¢ 2022 WA REG TEXT 571418 (NS), filed June 24, 2022, amends WA ADC 182-507-0115 (Alien emergency medical program
(AEM)) providing that for the assessment and treatment of the COVID-19 virus, the agency covers one physician visit provided in any
outpatient setting, including the office or clinic setting, or via telemedicine, online digital or telephonic services to assess/evaluate and
test, if clinically indicated. The rulemaking was adopted via emergency and is effective June 24, 2022.

¢ 2021 WA REG TEXT 587381 (NS), filed November 22, 2021, amends WA ADC 284-170-130 (Definitions) updating and adding
definitions related to telemedicine and adopts WA ADC 284-170-433 (Provider contracts-Telemedicine) establishing the provider
contract requirements for telemedicine. The regulation is effective December 23, 2021.

¢ 2021 WA REG TEXT 588742 (NS), filed November 30, 2021, amends WA ADC 284-170-260 (Provider Directories) requiring printed
and online provider directories to include information about any available telemedicine services, including any audio-only telemedicine
services that are available, and specifically describe the services and how to access those services. The regulation is effective January
1, 2022.

* 2022 WA REG TEXT 591235 (NS), filed November 23, 2022, amends WA ADC 246-335-510 (Definitions-Home health) and WA
ADC 246-335-610 (Definitions-Hospice) updates the definition for 'telemedicine." Amends WA ADC 246-335-545 (Supervision of
home health services) and WA ADC 246-335-645 (Supervision of hospice services) providing that supervisory visits may be conducted
on-site or via telemedicine. The regulations were adopted by emergency rulemaking and are effective November 23, 2022.

* 2021 WA REG TEXT 591235 (NS), filed December 1, 2021, amends VWWA ADC 246-335-510 (Definitions-Home Health) and WA
ADC 246-335-610 (Definitions-Hospice) updating the definition for 'telemedicine' and WA ADC 246-335-545 (Supervision of home
health services) and WA 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 December 1, 2021.

¢ 2022 WA REG TEXT 591235 (NS), filed March 31, 2022, amends WA ADC 246-335-510 (Definitions-Home health) and WA ADC
246-335-610 (Definitions-Hospice) to update the definition for 'telemedicine,' Amends VWA ADC 246-335-545 (Supervision of home
health services) and WA ADC 246-335-645 (Supervision of hospice services) to allow the supervisory visit to be conduct on-site or via
telemedicine. The rulemaking continuous previous emergency rules and is effective March 31, 2022.

¢ 2022 WA REG TEXT 591235 (NS), filed July 29, 2022, amends WA ADC 246-335-510 (Definitions-Home health) and WA ADC
246-335-610 (Definitions-Hospice) updating the definition of 'Telemedicine' to include supervision of direct care providers. Also
provides that 'Telemedicine' includes the provision of health care services and evaluating compliance with the plan of care using audio-
visual technology instead of a face-to-face visit. Amends VWWA ADC 246-335-545 (Supervision of home health services) and WA ADC
246-335-645 (Supervision of hospice services) removing the requirement that supervision of aide services must be 'during an on-site
visit' and adding language that the supervisory visit 'may be conducted on-site or via telemedicine.' The rulemaking was adopted via
emergency and is effective July 29, 2022.

¢ 2022 WA REG TEXT 611214 (NS), filed October 27, 2022, amends VWWA ADC 182-548-1100 (Federally qualified health centers-
Definitions) and WA ADC 182-549-1100 (Rural health clinics-Definitions) updating the definition for 'encounter' to include a face-to-
face or telemedicine (including audio-only telemedicine) visit between an encounter-eligible client and an RHC provider who exercises
independent judgment when providing services that qualify for encounter rate reimbursement. The rulemaking is effective January 1,
2023.

West Virginia

¢ 2022 WV H.B. 302 (NS), adopted September 16, 2022, adopts WV ST ? 30-1-26 (Telehealth practice) defining 'interstate telehealth
services" and 'telehealth services." Requires a health care board to propose an emergency rule for legislative approval to regulate
telehealth practice by a telehealth practitioner. The bill is effective September 16, 2022.

¢ 2022 WV H.B. 4369 (NS), adopted March 9, 2022, amends WV ST ? 30-21A-3 (Compact privilege to practice telepsychology) to
update the licensing requirements for a psychologist to exercise the Authority to Practice Interjurisdictional Telepsychology. The bill is
effective February 21, 2022.

¢ 2022 WV H.B. 4731 (NS), amended/substituted February 22, 2022, would establish the interstate 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.

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¢ 2022 WV S.B. 213 (NS), adopted March 23, 2022, 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 must come into effect on the date on which the compact statute is enacted into law in the 10th member state.
The bill is effective June 6, 2022.

¢ 2022 WV S.B. 221 (NS), adopted March 8, 2022, establishes the interstate 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. The bill is effective May 26, 2022.

* 2022 WV S.B. 371 (NS), engrossed February 24, 2022, would authorize the Board of Medicine to promulgate a legislative rule relating
to telehealth and interstate telehealth registration for physicians, podiatric physicians, and physician assistants, authorize the Board of
Osteopathic Medicine to promulgate a legislative rule relating to telehealth practice and interstate telehealth registration for osteopathic
physicians and physician assistants, and authorize the Board of Registered Professional Nurses to promulgate a legislative rule relating
to telehealth practice.

* 2022 WV S.B. 699 (NS), introduced February 21, 2022, would amend WV ST ? 30-4-3 (Definitions) to define 'teledentistry" or
'teledentistry services." Adopt WV ST ? 30-4-25 (Teledentistry) to establish the requirements for the practice of teledentistry.

¢ 2022 WV REG TEXT 585814 (NS), filed April 1, 2022, adopts WV ST ? 4-9-3 (Application for Registration and Annual Review)
establishing the registration requirements for doctors of chiropractic licensed to practice in other jurisdictions who seek to provide
limited interstate telehealth services in West Virginia and WV ST ? 4-9-4 (Standard of Care, Administrative Discipline, and Restrictions
on Registration) establishing the standard of care for the provision of telehealth services. The rulemaking is effective June 30, 2022.

¢ 2021 WV REG TEXT 586079 (NS), filed December 13, 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 January 24, 2022.

* 2022 WV REG TEXT 586082 (NS), filed May 3, 2022, 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). Note: This final rulemaking adopts the previous emergency rulemaking (2021 WV REG TEXT 586079
(NS)) without change. The regulation is effective July 1, 2022.

* 2022 WV REG TEXT 586689 (NS), filed May 2, 2022, adopts WV ADC ? 5-11-5 (Teledentistry Registrant Continuing Education
Requirements) providing that a dentist registered to provide teledentistry services shall complete continuing education as required
by the State her or she is licensed in, and shall complete 3 hours of drug diversion every two years. Provides that a dental hygienist
registered to provide teledentistry services shall complete continuing education as required by the State her or she is licensed in.
Provides that the Board may randomly audit the continuing education records maintained by a teledentistry registrant. Also provides
that a false statement on a renewal form or continuing education reporting form constitutes unprofessional conduct and may result in
disciplinary action against the registrant. The regulation is effective July 1, 2022.

¢ 2022 WV REG TEXT 587560 (NS), filed May 9, 2022, amends WV ADC ? 11-1B-11 (Practice Notifications) to require a practice
notification to include certification by the physician assistant and the health care facility that the physician assistant holds a license
issued by the Board to practice as a physician assistant or an interstate telehealth registration and providing that a practice notification
automatically terminates if the physician assistant's license or interstate telehealth registration expires. The regulation is effective June
1, 2022.

¢ 2022 WV REG TEXT 587565 (NS), filed May 9, 2022, amends WV ADC ? 11-14-2 (Registration for Out-Of-State Physicians and
Physician Assistants to Practice in West Virginia During Declared State of Emergency) providing that emergency registration expires
60 days after issuance or 5 business days after the declared state of emergency terminates, whichever is sooner, and thereafter, the
emergency registrant must hold an active West Virginia license or interstate telehealth registration to practice medicine and surgery to
patients in West Virginia. Amends WV ADC ? 11-14-3 (Registration for Inactive and Retired West Virginia Physicians and Physician
Assistants to Practice in West Virginia During Declared State of Emergency) providing that emergency registration issued to a retired
or inactive physician or physician assistant expires 60 days after issuance or 5 business days after the declared state of emergency
terminates, whichever is sooner, and thereafter, the emergency registrant must hold an active West Virginia license or interstate
telehealth registration to practice medicine and surgery to patients in West Virginia. The regulation is effective June 1, 2022.

¢ 2022 WV REG TEXT 587566 (NS), filed May 9, 2022, adopts WV ADC ? 11-15 (Telehealth and Interstate Telehealth Registration
for Physicians, Podiatric Physicians and Physician Assistants) to establish the scope of practice for the provision of medical services
via telehealth technologies and the process for allopathic, podiatric and osteopathic physicians and physician assistants to obtain an
interstate telehealth registration with the Board. New sections include: WV ADC ? 11-15-1 (General), WV ADC ? 11-15-2 (Definitions),
WV ADC ? 11-15-3 (Telehealth Practice Requirements), WV ADC ? 11-15-4 (Interstate Telehealth Registration Eligibility; Invalidation
and Reinstatement), WV ADC ? 11-15-5 (Interstate Telehealth Registration Application, Renewal and Expiration), WV ADC ? 11-15-6

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(Establishment of the Provider-Patient Relationship), WV ADC ? 11-15-7 (Standard of Care, Delivery of Telehealth Services and
Medical Records), WV ADC ? 11-15-8 (Prescribing Authority and Limitations), WV ADC ? 11-15-9 (Complaint and Disciplinary
Procedures for Interstate Telehealth Registrants), WV ADC ? 11-15-10 (Registration Denial, Professional Conduct, and Discipline), and
WV ADC ? 11-15-11 (Required Records). This rulemaking adopts the previous emergency rule (2021 WV REG TEXT 587686 (NS))
with changes and is effective June 1, 2022.

¢ 2022 WV REG TEXT 587586 (NS), filed April 20, 2022, adopts WV ADC ? 24-10 (Telehealth Practice and Interstate Telehealth
Registration for Osteopathic Physicians and Physician Assistants) to establish the scope of practice for the provision of medical
services via telehealth technologies and the process for osteopathic physicians and physician assistants to obtain an interstate
telehealth registration with the Board. New sections include: WV ADC ? 24-10-2 (Definitions), WV ADC ? 24-10-3 (Telehealth
Practice Requirements), WV ADC ? 24-10-4 (Interstate Telehealth Registration Eligibility; Invalidation and Reinstatement), WV ADC ?
24-10-5 (Interstate Telehealth Registration Application, Renewal and Expiration), WV ADC ? 24-10-6 (Establishment of the Provider-
Patient Relationship), WV ADC ? 24-10-7 (Standard of Care, Delivery of Telehealth Services and Medical Records), WV ADC ?
24-10-8 (Prescribing Authority and Limitations), WV ADC ? 24-10-9 (Complaint and Disciplinary Procedures for Interstate Telehealth
Registrants) and WV ADC ? 24-10-10 (Registration Denial, Professional Conduct, and Discipline). This final rulemaking adopts the
previous emergency rulemaking (2021 WV REG TEXT 587690 (NS)) with certain changes and is effective May 1, 2022.

* 2022 WV REG TEXT 587595 (NS), filed April 28, 2022, adopts WV ADC ? 25-1-2 (Definitions) defining 'interstate telenealth services"
and 'telehealth services," WV ADC ? 25-1-5 (Telehealth Services) establishing the requirements for social workers providing social
work or therapy via telehealth to persons residing and located in West Virginia, including being licensed or registered by the West
Virginia Board of Social Work, and WV ADC ? 25-1-6 (Interstate Registration as a Telehealth Provider) establishing the eligibility
requirements for an applicant to be registered as an interstate telehealth social worker. The rulemaking adopts previous emergency
rules as final and are effective July 1, 2022.

* 2022 WV REG TEXT 590643 (NS), filed May 3, 2022, 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). This final rulemaking adopts the previous emergency rulemaking (2021 WV REG TEXT
590028 (NS)) with certain clarifying changes and is effective May 3, 2022

¢ 2022 WV REG TEXT 604597 (NS), filed January 10, 2022, adopts WV ADC ? 27-14 (Telehealth and Interstate Telehealth
Registration for Licensed Professional Counselors and Licensed Marriage & Family Therapists) establishing the scope of practice

for the provision of counseling services via telehealth technologies and the process for licensed professional counselors or licensed
marriage and family therapists to obtain an interstate telehealth registration with the Board. New sections include WV ADC ? 27-14-14
(General), WV ADC ? 27-14-2 (Definitions), WV ADC ? 27-14-3 (Telehealth Practice Requirements), WV ADC ? 27-14-4 (Interstate
Registration as a Telehealth Provider), WV ADC ? 27-14-5 (Interstate Telehealth Registration Application, Renewal and Expiration),
WV ADC ? 27-14-6 (The Standard of Care for the Provision of Telehealth Services), WV ADC ? 27-14-7 (Complaint and Disciplinary
Procedures for Interstate Telehealth Registrants), and WV ADC ? 27-14-8 (Registration Denial, Professional Conduct, and Discipline).
The regulations were adopted via emergency and are effective January 13, 2022.

¢ 2022 WV REG TEXT 622874 (NS), filed August 25, 2022, adopts WV ADC ? 14-12 (Optometric Telehealth Practice) establishing
requirements for telehealth registration and telehealth practice. New sections include WV ADC ? 14-12-1 (General), WV ADC ? 14-12-2
(Definitions), WV ADC ? 14-12-3 (Requirements for Optometric Telemedicine), WV ADC ? 14-12-4 (Registration and renewal), and WV
ADC ? 14-12-5 (Restrictions). The emergency rulemaking is effective October 6, 2022.

¢ 2022 WV REG TEXT 622874 (NS), filed August 25, 2022, would adopt WV ADC ? 14-12 (Optometric Telehealth Practice) to
establish the requirements for telehealth registration and telehealth practice for optometrists. New sections include WV ADC ? 14-12-2
(Definitions), WY ADC ? 14-12-3 (Requirements for Optometric Telemedicine) and WV ADC ? 14-12-4 (Registration and Renewal).
This rulemaking was adopted via emergency and continues the previous emergency rulemaking with changes and is effective
November 15, 2022.

Wisconsin

¢ 2021 WI A.B. 537 (NS), adopted February 4, 2022, 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 February 5, 2022.

¢ 2021 WI S.B. 309 (NS), adopted February 4, 2022, would amend WV! ST 440.01 (Definitions) to define 'asynchronous telehealth
service," 'interactive telehealth," 'remote patient monitoring," and 'telehealth. Adopt VV! ST 440.17 (Telehealth) to define 'telehealth."

The bill is effective February 5, 202.

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¢ 2021 WI S.B. 412 (NS), adopted February 4, 2022, 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 bill is effective February 5, 2022.

Wyoming

* 2022 WY H.B. 68 (NS), introduced February 18, 2022, would adopt a new section to require the Wyoming Department of Health to
establish a program to provide American Rescue Plan Act funds for grants to health care providers to purchase and use telehealth
equipment to provide telehealth services to Wyoming residents, provide outreach and education related to telehealth, and obtain
technical support for telehealth and telehealth equipment.

* 2022 WY H.B. 69 (NS), introduced February 18, 2022, would amend WY ST ? 9-12-1501 (Broadband development program
established; purposes; eligibility; definitions) to provide the definition for 'telehealth."

¢ 2022 WY H.B. 117 (NS), adopted March 11, 2022, establishes the Interstate 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 must come into effect on the date on which the compact statute is enacted into law in the 10th member
state. The bill is effective July 1, 2022.

¢ 2023 WY S.F. 10 (NS), prefiled November 30, 2022, 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. The Compact will come into effect on the date on which the compact statute is enacted into law in the 10th
member state.

* 2023 WY S.F. 26 (NS), prefiled December 2, 2022, 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. The
Compact will come into effect on the date on which the compact statute is enacted into law in the 10th member state.

* 2022 WY S.F. 54 (NS), introduced February 18, 2022, would enact 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 WY REG TEXT 594372 (NS), published January 26, 2022, amends WY ADC 034.0001.1 ? 3 (Definitions) providing the
definition for 'teledentistry," 'synchronous technology," and 'asynchronous technology." Adopts new WY ADC 034.0001.4 ? 1
(Authority) providing that the Board is authorized to promulgate rules and regulations related to telemedicine in Wyoming and WY ADC
034.0001.4 ? 3 (Teledentistry) establishing the requirements for the practice of teledentistry. The regulations are effective January 14,
2022.

¢ 2022 WY REG TEXT 601573 (NS), published April 6, 2022, adopts WY ADC 062.0001.7 ? 9 (Telehealth) to establish the
requirements and guidelines for the use of telehealth by physical therapists and physical therapy assistants. Defines 'telehealth." The
rulemaking is effective April 7, 2022.

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.

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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 State Activity
California

2021 CA A.B. 852 (NS), adopted September 25, 2022, amends CA BUS & PROF ? 688 (Electronic data transmission prescriptions;
prescriptions for controlled substances; transfer or forward of prescriptions; transmission failure; valid prescriptions; administrative
sanctions; liability; services to inmates) prohibiting a pharmacy, pharmacist, or other practitioner authorized to dispense or furnish

a prescription from refusing to dispense or furnish an electronic prescription solely because the prescription was not submitted via,
or is not compatible with, their proprietary software. Authorize a pharmacy, pharmacist, or other authorized practitioner to decline to
dispense or furnish an electronic prescription submitted via software that fails to meet any one of specified criteria, including compliance
with the federal Health Insurance Portability and Accountability Act of 1996. Establish additional exceptions to the requirement that
health care practitioners issue a prescription as an electronic data transmission prescription, including for a prescriber who registers
with the California State Board of Pharmacy and states that they satisfy one or more criteria, including that they issue 100 or fewer
prescriptions per calendar year. Makes specified exceptions to the requirement for a pharmacy to immediately transfer an electronic
prescription to an alternative pharmacy upon request of the patient, including if the action would result in a violation of any state or
federal law. The bill is effective January 1, 2023.

Hawaii

2021 HI S.B. 2423 (NS), introduced January 21, 2022, would amend HI ST ? 329-104 (Confidentiality of information; disclosure

of information) to provide that this section does not prevent the disclosure, at the discretion of the administrator, of investigative
information to controlled substances prescribers, dispensers, and pharmacists of the United States Department of Veterans Affairs
facilities within the State who submit data, as described in HI ST ? 329-101 (Reporting of dispensation of controlled substances;
electronic prescription accountability system; requirements; penalty), to the electronic prescription accountability system.

Illinois

2021 IL H.B. 5846 (NS), introduced November 29, 2022, would amend IL ST CH 720 ? 570/311.6 (Opioid prescriptions) to provide that
the requirement that a prescription for a substance classified in Schedule II, Ill, IV, or V is effective beginning January 1, 2024.

lowa

2021 IA REG TEXT 590596 (NS), filed November 17, 2021, amends !|A ADC 657-21.6(124,155A) (Electronic prescription applications),
IA ADC 657-21.7(124,155A) (Facsimile transmission of a prescription), IA ADC 657-21.8(124,155A) (Electronic prescription mandate
and exemptions), and IA ADC 657-21.9(124,155A) (Exemption from electronic prescription mandate--petition) updating processes
relating to the submission and review of petitions for an exemption to the electronic prescription transmission mandate, as well as
providing conforming language with other Board administrative rules. The regulations are effective January 19, 2022.

Kansas

2021 KS H.B. 2262 (NS), amended/substituted February 4, 2022, would adopt KS ST 65-4101 to define 'electronic prescription,"
'electronic prescription application," 'electronic transmission," and 'facsimile transmission."

Kentucky

¢ 2022 KY H.B. 328 (NS), introduced January 20, 2022, would adopt a new section requiring the Cabinet for Health and Family Services
to provide a copy of a patient's electronic prescription record upon request of the patient, the patient's legal guardian, or the patient's
parent or legal guardian if the patient is a minor, require the cabinet to make corrections to a patient's electronic prescription record,
require the cabinet to promulgate administrative regulations to implement a process for requesting records, require the cabinet to

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respond to a request within at least 30 days of a completed request, and permit the cabinet to charge a reasonable fee for a request of
a copy of a record but not for making a record correction.

¢ 2022 KY H.B. 529 (NS), adopted April 8, 2022, adopts a new section to prohibit a health care provider requesting that a medical
laboratory test for a patient is performed must not engage in information blocking as described in 42 USCA ? 300jj-52 (Information
blocking).The bill prohibits the following reports or test results and any other related results from being disclosed to a patient as part of
the patient's electronic health record until 72 hours after the results are finalized, unless the health care provider directs the release of
the results before the end of that 72 hour period: pathology reports or radiology reports that have a reasonably likelihood of showing a
finding of malignancy or tests that could reveal genetic markers. The bill is effective April 8, 2022.

Missouri

2022 MO REG TEXT 609326 (NS), published August 1, 2022, adopts 20 MO ADC 220-2.011 (Electronic Final Product Verification
(Pharmacists) establishing the requirements for electronic final product verification by a pharmacist using qualifying technology. The
regulation is effective August 30, 2022.

New Jersey

¢ 2022 NJ A.B. 3186 (NS), introduced March 7, 2022, would adopt new sections to regulate Internet pharmacies and electronic
prescriptions.

* 2022 NJ A.B. 4545 (NS), introduced September 22, 2022, would amend NJ ST 45:14-58 (Prescriptions transmitted by telephone
or electronic means; Schedule II controlled dangerous substances; electronic health records system requirements) prohibiting a
pharmacist from charging any fee for processing a prescription transmitted by telephone or electronic means unless the fee is also
charged for processing a prescription transmitted in writing.

¢ 2022 NJ S.B. 1325 (NS), introduced February 3, 2022, would amend NJ ST 45:14-58 (Prescriptions transmitted by telephone

or electronic means; Schedule II controlled dangerous substances; electronic health records system requirements) to prohibit a
pharmacist from charging any fee for processing a prescription transmitted by telephone or electronic means unless the fee is also
charged for processing a prescription transmitted in writing.

New York

¢ 2021 NY A.B. 5411 (NS), amended/substituted May 4, 2022, and 2021 NY S.B. 4620 (NS), amended/substituted May 17, 2022,
would adopt NY INS ? 341-a. (Patient prescription pricing transparency) to define 'interoperability element," 'electronic health record,"
'electronic prescribing system, 'electron prescription," and 'real-time benefit tool."

* 2021 NY S.B. 4620 (NS), amended/substituted May 17, 2022, would adopt NY INS ? 341-a. (Patient prescription pricing transparency)
to define 'interoperability element,' 'electronic health record,' 'electronic prescribing system, ' electron prescription,' and 'real-time
benefit tool.'

North Carolina

2021 NC H.B. 103 (NS), adopted July 11, 2022, amends NC ST ? 90-85.28 (Selection by pharmacists permissible; prescriber

may permit or prohibit selection; price limit on selected drugs; communication of dispensed biological products under specified
circumstances) to provide that within 5 business days following the dispensing of a biological product requiring a prescription,

the pharmacist or a designee must communicate to the prescriber the product name and manufacturer of the specific biological

product dispensed to the patient. The required communication must be conveyed by making an entry into any of the following that is
electronically accessible to the prescriber an interoperable electronic medical records system, electronic prescribing technology, a
pharmacy benefit management system, the North Carolina Health Information Exchange Network, or a pharmacy record. Entry into one
of the electronic records systems by the pharmacist or a designee is presumed to provide the required communication and notice to the
prescriber. The bill is effective July 1, 2022.

Ohio

2021 OH H.B. 193 (NS), adopted June 24, 2022, amends OH ST ? 3719.05 (Rules for pharmacists) clarifying the requirements

for a schedule II controlled substance to be dispense only upon an electronic prescription. Amends OH ST ? 3719.06 (Rules for
licensed health professionals; prescriptions) adding exceptions to the requirement for issuing a prescription for a schedule II controlled
substance upon an electronic prescription. The bill is effective September 23, 2022.

Oregon

2022 OR REG TEXT 617419 (NS), filed June 22, 2022, amends OR ADC 855-019-0210 (Duties of the Pharmacist Receiving a
Prescription) removing 'not result solely from a questionnaire or an internet based relationship" and adding 'issued pursuant to a valid
patient-practitioner relationship." The rulemaking is temporary and is effective July 1, 2022 through December 27, 2022.

Utah

* 2022 UT H.B. 74 (NS), introduced January 19, 2022, would adopt UT ST ? 75-2c-106 (Attending physician responsibilities) to require
that if the attending physician writes a prescription for aid-in-dying medication, the attending physician must electronically contact a

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pharmacist and inform the pharmacist of the prescription for the aid-in-dying medication, personally send an electronic prescription to
the pharmacist for the aid-in-dying medications, and inform the Department of Health of the prescription for the aid-in-dying medication,
including the name of the aid-in-dying medication prescribed.

¢ 2022 UT S.B. 91 (NS), adopted March 23, 2022, amends UT ST ? 58-83-301 (Licensure required--Issuance of licenses) removing
stating that a licensee under UT ST ? 58-83 (Online Prescribing, Dispensing, and Facilitation Licensing Act) is not required to engage in
electronic prescribing under UT ST ? 58-82 (Electronic Prescribing Act) due to repeal. The bill is effective May 4, 2022.

Virginia

¢ 2022 VA H.B. 360 (NS) and 2022 VA S.B. 428 (NS), adopted April 8, 2022, amends VA ST ? 38.2-3407.15:2 (Carrier contracts;
required provisions regarding prior authorization) to require a carrier, beginning July 1, 2025, to establish and maintain an online
process that (i) links directly to e-prescribing systems and electronic health record systems that utilize the National Council for
Prescription Drug Programs SCRIPT standard; (ii) can accept electronic prior authorization requests from a provider; (iii) can approve
electronic prior authorization requests for which no additional information is needed by the carrier to process the prior authorization
request, no clinical review is required, and that meet the carrier's criteria for approval; and (iv) otherwise meets the requirements of this
section and require a participating health care provider, beginning July 1, 2025, to ensure that any e-prescribing system or electronic
health record system owned by or contracted for the provider to maintain an enrollee's health record has the ability to access the
electronic prior authorization process established by a carrier as required by subdivision 15 and the real time cost information data for a
covered prescription drug made available by a carrier pursuant to ? 38.2-3407.15:7. The bills are effective July 1, 2022.

¢ 2022 VA REG TEXT 542623 (NS), filed December 2, 2021, adopts 18 VA ADC 60-21-107 (Waiver for electronic prescribing) providing
that a prescription for a controlled substance that contains an opioid must be issued as an electronic prescription consistent with VA

ST ? 54.1-340802, unless the prescription qualifies for an exemption of VA ST ? 54.1-340802(C). Provides for a 1-year waiver from the
requirement if the practitioner can demonstrate economic hardship technological limitations or other exception circumstances beyond
the practitioner's control. The regulation is effective February 2, 2022.

¢ 2022 VA REG TEXT 543297 (NS), filed December 2, 2021, adopts 18 VA ADC 90-40-122 (Waiver for electronic prescribing) providing
that a prescription for a controlled substance that contains an opioid must be issued as an electronic prescription consistent with VA

ST ? 54.1-340802, unless the prescription qualifies for an exemption of VA ST ? 54.1-340802(C). Provides for a 1-year waiver from the
requirement if the practitioner can demonstrate economic hardship technological limitations or other exception circumstances beyond
the practitioner's control. The regulation is effective February 2, 2022.

Washington

* 2022 WA REG TEXT 553783 (NS), filed October 20, 2022, amends WA ADC 246-945-010 (Prescription and chart order-Minimum
requirements) providing that a 'signed prescription" includes 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
regulation was amended via emergency rulemaking and is effective October 20, 2022.

¢ 2022 WA REG TEXT 533783 (NS), filed June 22, 2022, amends WA ADC 246-945-010 (Prescription and chart order-Minimum
requirements) providing that a 'signed prescription" includes 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
regulation was amended via emergency rulemaking and is effective June 22, 2022.

Wisconsin

2021 WI A.B. 740 (NS), introduced December 7, 2021, would amend WV! ST 450.135 (Using interchangeable biological product in
dispensing prescriptions) to change the section title to 'Using drug product equivalent in dispensing prescriptions; therapeutic exchange
for drug products prescribed to counteract anaphylaxis" and 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.

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

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[FN2]

. 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,
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[FN5]

. Erin McCann, 'HIPAA Breach for 34K After Staff Slipup,' HealthcarelTNews, June 13, 2014, available at: http://
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[FN6]

. '6th Annual HIMSS Security Survey,' HIMSS, February 19, 2014, available at: http://himss.files.cms-
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12, 2012, available at: http:/Avwww.ama-assn.org/amednews/2012/1 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
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[FN9]

. Healthcare Vendors Identified as the 'Unlocked Backdoor to Healthcare Data,' CORL Technologies Press Release, June 27, 2014,
available at: http:/Avww.prweb.com/releases/2014/06/prweb1 1977024.htm.

[FN10]

. Mary Mosquera, "HHS: Patients Should Receive Easily Understood HIE Privacy Notices," Government

Health IT, Oct. 18, 2010, available at: http:/Avww.govhealthit.com/newsitem.aspx?nid=74873. For

more information on the recommendations of the panel accesshitp://healthit.hhs.gov/portal/server.pt?
open=5128&o0bjID=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 201 1
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[FN12]

. "New Tools to Help providers Protect Patient Data on Mobile Devices," Department of Health and Human Services Press Release,
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. 'HHS Releases Security Risk Assessment Tool to Help Providers with HIPAA Compliance,' Department of Health & Human Services
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. Pamela Lewis Dolan, 'Data Breach Insurance Goes Mainstream in Health Care,' Amednews.com, Aug. 19, 2013, available at: http://
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. '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:
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[FN 16]

- '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/
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[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.hhs.gov/oei/
reports/oei-01-11-00571 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.nhhs.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/07/2013071 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.

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. Physicians on Twitter,' JAMA, Feb. 9, 2011, JAMA. 2011;305(6):566-568. doi:10.1001/jama.201 1.68, available at: http://
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. 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
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[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/
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. In the Matter of LabMD, Inc., a corporation, 2014 WL 253518 (F.T.C., Jan. 16, 2014).
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. 'Actions Needed to Address Weaknesses in Information Security and Privacy Controls,' U.S. Government Accountability Office
Report, Sept. 16, 2014, available at: http:/Avww.gao.gov/products/GAO-14-730.

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. Eric D. Fader, "GAO Report Critical of HHS Cybersecurity Guidance and Oversight," Monday (September 28, 2016), available at 2016
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[FN28]

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. Joe Davidson, "Cyberattacks on personal health records growing 'exponentially'," The Washington Post (September 28, 2016),
available at 2016 WLNR 29622964.

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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
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. David Blumenthal MD and David Squires, "2014 The Health Care Year in Review," The Commonwealth Fund, Dec. 23, 2014,
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. Data and Program Reports, EHR Incentive Programs, U.S. Department of Health and Human Services, last updated Sept. 3, 2014,
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[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:/Avww.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-
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. 'Healthgrades Partners With Athenahealth to Provide Easier Access to Online Appointment Scheduling," Healthgrades' Press
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. 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
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. 'Allscripts Introduced iPad Application for EHRs,' Allscripts News Release, April 5, 2012, available at: http://investor.allscripts.com/
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[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,
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[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-
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[FN40]

. Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD, 'Physician Capability
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[FN41]

. "Governance Framework for Trusted Electronic Health Information Exchange," The Office of the National
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. 'Accreditor for ONC Health IT Certification Program Approved for Second Term,' Department of Health & Human Services Press
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. Alicia Chang, "Study: Few US Hospitals Use Digital Records," AP Online, March 25, 2009. 3/25/09 Associated Press (AP) Newswires
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. 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,
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. Russ Mitchell, 'Farzad Mostarshari: Man on a Digital Mission,' Kaiser Health News in partnership with FORTUNE, Mar. 9, 2012,
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. '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:/Avww.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.

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. '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:/Awww.hhs.gov/news/press/2015pres/10/20151006a.html.

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. 'CMS FACT SHEET: EHR Incentive Programs in 2015 and Beyond,' Oct. 6, 2015, available at: https:/Awww.cms.gov/Newsroom/
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- '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=&keywordType=All&chkNews
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[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:/Avww.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf.

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. Eric Whitney, 'Rural Hospitals Face Tough Choices on Computerized Records,' Kaiser Health News, April 24, 2014, available at:
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. '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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. Provision of Electronic Health Record (EHR) 'Navigators' during Hospital and Critical Access Hospital (CAH) Surveys,' Memorandum
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. Chitra Mohla, Director of Community College Workforce Program, "Health IT: Coming Soon to a Class Near You." Health IT Buzz,
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. 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/
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. 'HHS Proposes Path To Improve Health Technology and Transform Care,' a Department of Health and Human Services Press
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. News Release, 'Final Federal Health IT Strategic Plan 2015-2020 Released,' HHS, Sept. 21, 2015, available at: http://www.hhs.gov/
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. 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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. 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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. 'Computers Reading Doctors' Notes?', United States Department of Veteran's Affairs Press Release, September 20, 2011, available
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. Electronic Health Records No Cure-All,' The Chart, January 24, 2011, available at: http://thechart.blogs.cnn.com/2011/01/24/
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. 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://
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. 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:/Avww.kaiserhealthnews.org/Stories/2013/
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. Amy Standen, 'Veterans To Create World's Largest Medical Database,' National Public Radio, Nov. 17, 2011, available at: http://
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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.

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. 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.

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. 'HIMSS Analytics Honors Atrius Health and its Affiliate, Reliant Medical Group with Stage 7 Ambulatory Award.' HIMISS Analytics
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. 'HIMSS Analytics Honors Truman Medical Centers Ambulatory Clinics with Stage 7 Ambulatory Award.' HIMISS Analytics Press
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- 'HIMSS Analytics Honors University of Missouri's Ambulatory Clinics with State 7 Ambulatory Award,' HIMISS Analytics Press
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- 'HIMSS Innovation Center Opens in Cleveland Highlighting the Value of Health IT,' HIMSS Press Release, Oct. 8, 2013, available at:
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. Colene M. Byrne, Lauren M. Mercincavage, Eric C. Pan, Adam G. Vincent, Douglas S. Johnston and Blackford Middleton, "The Value
From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs," Health Affairs, 29 No. 4 (2010):
629-38. Abstract available at: http://content.healthaffairs.org/cgi/content/abstract/29/4/629.

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. 'Veterans Affairs Health Information Technology Improves Quality of Health Care While Reducing Costs," US Federal News, April 8,
2010. 2010 WLNR 7222894.

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. 'Contest Launched to Seek Ideas to Use Data to Address Public Health Challenges," Maryland Department of Health and Mental
Hygiene Press Release, March 20, 2012, available at: http://dhmh.maryland.gov/publicrelations/pr/Lists/Posts/Post.aspx?ID=209.

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. 'HHS Launches Meaningful Consent Site,' Department of Health & Human Services Press Release, Sept. 17, 2013, available at:
http:/Awww.hhs.gov/news/press/201 3pres/09/20130917a.htm.

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. 'Mercom Capital Group Reports First Billion Dollar Quarter for Healthcare Information Technology Sector: VC Funding Doubled Over
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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. 'HIT Workforce Engagement' Healthcare IT Leaders, July 2014, available at: http:/Avww.healthcareitleaders.com/assets/img/page/
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. Arkanksha Jayanthi, 'Pairing Veterans With Health IT Careers,' Becker's Hospital Review, July 2, 2014, available at: http://
www.beckershospitalreview.com/healthcare-information-technology/pairing-veterans-with-health-it-careers.html.

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. 'HIMSS Veterans Career Services Initiative, HIMSS, available at: http:/Avww.himss.org/veterans-career-services-initiative.

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. 'HHS Secretary Names Members for Federal Health Information and Standards Committees,' Department of Health & Human
Services, Centers for Medicare & Medicaid Services Press Release, Nov. 4, 2014, available at: http:/Avww.hhs.gov/news/
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. Online Tools and Resources Available to Help State Use Health IT to Improve Health Care Quality and Lower Costs," Department of
Health & Human Services Press Release, April 2, 2015, available at: http:/Awww.hhs.gov/news/press/2015pres/04/20150402a.html.

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. Patrick Conway, MD, 'CMS Intends to Modify Requirements for Meaningful Use,' The CMS Blog, Jan. 29, 2015, available at: http://
blog.cms.gov/2015/01/29/cms-intends-to-modify-requirements-for-meaningful-use/.

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. 'More Than $38 Million Awarded to Improve Coordinated Health Information Sharing in Communities Across America," Department of
Health & Human Services Press Release, July 28, 2015, available at: http:/Awww.hhs.gov/news/press/2015pres/07/20150728a.html.

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. "Guidance on HIPAA & Cloud Computing," U.S. Department of Health and Human Services (October 7, 2016) available at: http://
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. Adam Tanner, "Patient power through records," Boston Globe (January 8, 2016), available at: 2017 WLNR 634984

[FN88]
Chad Terhune, Hospital ICUs lean on telemedicine amid U.S. COVID-19 crisis, Reuters (September 14, 2020).

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Antonita Madonna, Regulatory relief and insurers' adoption of telehealth key to keeping momentum in U.S., Thomson Reuters
Regulatory Intelligence (September 21, 2020).

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. Elise Viebeck, 'Analysis Predicts Spike in Telehealth Patients, Healthwatch, THE HILL's Healthcare Blog, Feb. 8, 2013, available at:
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. The White House Office of Communications Weekly Wrap Up, April 26, 2011, 2011 WL 15587718.

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. Mike Shields, 'VA Poised to Expand Telemedecine for Kansas Vets,' Kansas Health Institute News Service, Nov. 13, 2012, available
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. Anne Harding, "Telemedicine Improves Care for Kids Seen in Rural ERs," Reuters Health, Aug. 19, 2013, available at: http://
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. Sean Dobbin, 'Telemedicine Helps Improve Asthma Care For Students,' Rochester Democrat & Chronicle, Oct. 10, 2013, available at:
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. Daniela Hernandez, "When Connecting with a Dentist Doesn't Mean an Office Visit, Kaiser Health News in collaboration with the Los
Angeles Daily News, April 7, 2014, available at: http:/Awww.kaiserhealthnews.org/Stories/201 4/April/07/teledentistry-brings-care-to-
needy-in-schools-nursing-homes.aspx

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. 2013 CA A.B. 1774 (NS).

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. Jacqueline Fellows, 'Telemedicine Providers Welcome AMA Guidelines,' HealthLeaders Media, July 17, 2014, available at:http://
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. 'TeleHealth Services Announces Availability of New Line of Samsung LED High-Definition Hospital Television,' PR Newswire Press
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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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. 'Doctor on Demand Accredited for Online Patient Consultation," Pharma & Healthcare Monitor Worldwide (February 3, 2016) available
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. 'Analogic Launches Cloud-Based Ultrasound Telehealth Services With Oncura Partners," Pharma & Healthcare Monitor Worldwide
(February 2, 2016) available at: 2016 WLNR 3170254.

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. Meg Graham, "Can telehealth keep patients in nursing homes out of hospitals?" Chicago Tribune (February 17, 2016), available at
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. Yvette Brazier, "Virtual consultations vary in quality of care," Yerepouni Daily News (Lebanon), April 5, 2016, available at: 2016 WLNR
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. "Abortion without the clinic on offer with revolutionary new US program," Equities.com,, April 5, 2016, available at: 2016 WLNR
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. Mena Report, "United States: Cigna Telehealth Connection Expands Access and Choice to Millions, Including Adding Access to
Behavioral Health Consults," SyndiGate (September 29, 2016), available at 2016 WLNR 29721996.

[FN108]

HHS.gov, "Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health
emergency," last reviewed March 17, 2020, available at: https:/Avww.hhs.gov/hipaa/for-professionals/special-topics/emergency-
preparedness/notification-enforcement-discretion-telehealth/index.html

[FN109]

Department of Financial Services, "FIFTY-EIGHTH AMENDMENT TO 11 NYCRR 52 (INSURANCE REGULATION 62)," dated March
16, 2020, available at: https://www.dfs.ny.gov/system/files/documents/2020/03/re62_58 amend_text.pdf

[FN110]

Press release, "Blunt Rochester, Burgess Introduce Bill to Increase Access to Telehealth," Lisa Blunt Rochester Proudly Serving
Delaware, October 1, 2020, available at https://bluntrochester.house.gov/news/documentsingle.aspx?DocumentID=2563.

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[FN111]

. Lisa Rapaport, Telemedicine offsets some drop in U.S. outpatient visits during COVID-19, Reuters Health Medical News (November
16, 2020).

[FN112]

Zoe Sagalow, Washington state extends coverage requirement in telehealth, COVID-19 tests, CQ Roll Call (November 18, 2020) at:
http://go-ri.tr.com/xEA3YM.

[FN113]

. Meghan Huftader, PhD; Matthew Swain, BBA; and Michael F. Furukawa, PhD, 'State Variation in E-Prescribing Trends
in the United States,' ONC Data Brief, No. 4, November 2012, available at: http:/Avww.healthit.gov/sites/default/files/us_e-
prescribingtrends_onc_brief_4_nov2012.pdf.

[FN114]

. 'User Guide: 2013 Electronic Prescribing (eRx) Incentive Program Feedback Reports,' Centers for Medicare & Medicaid Services,
October 2014, available at: http:/Avww.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/
Downloads/2013_eRxFeedbackReportUserGuide_F04042014.pdf.

[FN115]

. "Governor Cuomo Announces Mandatory Electronic Prescribing to Take Effect March 27," Mena Report (March 19, 2016) available at:
2016 WLNR 8536051.

Produced by Thomson Reuters Accelus Regulatory Intelligence 27-Jun-2023

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