CMS Updates Telemedicine Guidelines

Emily Berry and Janice Simmons, May 26, 2010

Hospitals and critical access hospitals (CAH) will soon be able to use credentialing and privileging information about telemedicine providers from the remote location, according to proposed Centers for Medicare & Medicaid Services (CMS) changes to the Conditions of Participations (CoP). The proposed rule will be published in the Federal Register for public comment on May 26.

Previously, CMS allowed hospitals and CAH to accept credentialing information about telemedicine providers from the distant site, but not privileging information.

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

Additionally, CMS cited smaller hospitals' lack of clinical expertise to adequately evaluate a variety of privileges as one of the reasons why a change was needed.

CMS will post the proposed rule on the Federal Register for a 60-day comment period, and the public can submit comments to The revised language is contained in two sections of the CoPs: §482.12, "Governing body," and §482.22, "Medical staff."

"Upon reflection," CMS noted, "we came to the conclusion that our present requirement is a duplicative and burdensome process for physicians, practitioners, and the hospitals involved in this process, particularly small hospitals, which often lack adequate resources to fully carry out the traditional credentialing and privileging process for all of the physicians and practitioners that may be available to provide telemedicine services."

Under current CMS regulations, hospitals receiving telemedicine services from a distant site must privilege each physician or practitioner providing services to their patients as if the practitioners were onsite. While those hospitals could use third-party credentialing and verification organizations to make the process easier, the hospital's governing body remains responsible for all privileging decisions.

This process had been simplified: Hospitals that were accredited by The Joint Commission were deemed to also have met their Medicare condition of participation—including credentialing and privileging requirements—under the Commission's statutory deeming authority.

But with the passage of the Medicare Improvements for Patients and Providers Act of 2008, the statutory recognition of The Joint Commission's hospital accreditation program was ending—effective in several weeks on July 15. The law now would require The Joint Commission to secure CMS approval of its standards to confer Medicare deemed status on hospitals.

With this change, small and critical-access hospital medical staffs using telemedicine services could face "the burden of privileging hundreds of specialty physicians and practitioners" that large academic medical centers make available to them, CMS noted in the Register proposal.

Emily Berry is an associate editor for Briefings on Credentialing and Credentialing Resource Center Connection, and manages the Credentialing Resource Center. You can reach her at
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at
John Commins

John Commins is a senior editor at HealthLeaders Media.

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