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Sezvo Dhipatimendi reHutano neHuman Services (HHS kana Dhipatimendi) richienderera mberi nehurongwa hwekuchinja kubva kuCCIDID-19 dzechimbichimbi, Dhipatimendi rinoda kujekesa remangwana remubatanidzwa telehealth uye kure kure kudzora kuchinjika kuitira kuti varwere varambe vachigamuchira nekuwana rubatsiro rwavanoda. need.Pazasi pane pepa rechokwadi rinotsanangura zvichachinja kune varwere nevarapi vehutano kana Munyori weHHS azivisa Public Health Emergency (PHE) yeCCIDID-19 zvichienderana neChikamu 319 chePublic Health Service Act (ona pazasi)), iyo icharamba isina kuchinjwa. se "COVID".-19 PHE”).PHE inopera.Congress yakapasisa Omnibus Appropriations Act ya2023, ichiwedzera akawanda ehurongwa hwehutano hwenharembozha hwave kuvimbwa nahwo panguva yePHE COVID-19 kusvika mukupera kwa2024. uyezve, Health Resources and Services Administration (HRSA) inoshandisa webhusaiti yeHHS www.Telehealth.HHS.gov, iyo icharamba ichishanda sechipo chevarwere, vatapi vehutano uye nyika dzeruzivo rwe telemedicine senge telemedicine maitiro akanakisa, kuvandudzwa kwepolicy. uye kudzoserwa, marezinesi epakati, kuwana Broadband, mikana yemari, uye zviitiko.
Medicare neTerehealth Munguva yePHE, vanhu vane Medicare vane mukana wakakura wekuwana masevhisi enharembozha, kusanganisira mudzimba dzavo, pasina zvirambidzo zvenzvimbo kana nzvimbo nekuda kweClerk of Appropriations Act ichipa maSupplements kuAppropriations Preparedness and Response Act yeTelemedicine 2020 neCoronavirus.Rubatsiro, Ruyamuro uye Kuchengetedzwa Kwehupfumi Mutemo.Telemedicine inosanganisira masevhisi anounzwa kuburikidza nenharembozha masisitimu akadai semakomputa uye inobvumira varapi vehutano kuti vape rubatsiro kuvarwere vari kure kwete ivo pachavo muhofisi.Iyo Consolidated Appropriations Act ye2023 inowedzera akawanda Medicare telemedicine shanduko kusvika Zvita 31, 2024, senge:
Pamusoro pezvo, mushure meZvita 31, 2024, kana shanduko idzi dzapera, mamwe maACO anogona kupa masevhisi enhare, achibvumira varapi vanotora chikamu cheACO nevamwe varapi kuti vatarisire varwere vasina kushanya mumunhu, zvisinei nekuti vanogara kupi.Kana mupi wehutano achitora chikamu muACO, vanhu vanofanirwa kutarisa navo kuti vaone kuti ndeapi masevhisi efoni angave aripo.Medicare Advantage Plans inofanira kuvhara Medicare-yakavharwa telehealth masevhisi uye inogona kupa mamwe masevhisi efoni.Vanhu vakanyoresa muchirongwa cheMedicare Advantage vanofanira kutarisa kuvharwa kwavo nefoni nehurongwa hwavo.
Nyika dzine Medicaid, CHIP, neTelehealth dzine shanduko huru mukuvhara Medicaid neChirongwa cheInishuwarenzi Yehutano Yevana (CHIP) masevhisi anopihwa kuburikidza nenharembozha.Saka nekudaro, kuchinjika kwe telemedicine kunosiyana nenyika, vamwe vakasungirirwa kumagumo eCCIDID-19 PHE, vamwe vakasungirirana nechiziviso chePHE chehurumende nezvimwe zvekukurumidzira, uye zvimwe zvakapihwa nezvirongwa zvehurumende zveMedicaid neCHIP nguva refu denda risati rasvika.Mushure mekupera kwemubatanidzwa wePHE chirongwa, Medicaid uye CHIP telehealth mitemo icharamba ichisiyana nenyika.The Centers for Medicare and Medicaid Services (CMS) inokurudzira nyika kuti dzirambe dzichibhadhara Medicaid neCHIP masevhisi anopihwa kuburikidza nenharembozha.Kubatsira nyika mukuenderera mberi, kutora, kana kuwedzera kuvharika kwenharembozha uye mitemo yekubhadhara, CMS yakaburitsa State Medicaid neCHIP Telehealth Toolkit, pamwe negwaro rekuwedzera rinotsanangura nyaya dzemitemo dzinofanirwa kutariswa kusimudzira kugamuchirwa kwenharembozha: https:// www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
Yakavanzika Hutano Inishuwarenzi uye Telemedicine Sezviri kuitika panguva yePHE COVID-19, kana PHE COVID-19 yapera, kuvharwa kwe telemedicine uye mamwe masevhisi ekuchengeta ari kure achasiyana nehurongwa hweinishuwarenzi.Kana zvasvika kune telemedicine uye mamwe masevhisi ekuchengeta kure, makambani einishuwarenzi akazvimirira anogona kunyorera kugovana mutengo, kupihwa mvumo yekutanga, kana mamwe maitiro ekurapa manejimendi emasevhisi akadaro.Kuti uwane rumwe ruzivo nezve nzira yeinishuwarenzi kune telemedicine, varwere vanofanirwa kubata nhamba yavo yeinishuwarenzi yevatengi iri kuseri kwekadhi yavo yeinishuwarenzi.
Munguva yePHE COVID-19, kekutanga, varapi vehutano vari pasi peHIPAA Kuvanzika, Chengetedzo, uye Kutyora Chiziviso Rule (HIPAA Rule) vari kutsvaga kutaurirana nevarwere nekupa masevhisi enhare vachishandisa off-the-sherufu kure kure kutaurirana matekinoroji anogona haisati yanyatsonzwisiswa.HIPAA Inopindirana Inodiwa.HHS Hofisi yekodzero dzevanhu (OCR) yakazivisa kuti kubva munaKurume 17, 2020, ichashandisa hungwaru hwayo uye haizotemese faindi kune varapi vehutano vasingatevedzeri mitemo yeHIPAA.Vanopa vanoshandisa chero kure kure yekutarisa tekinoroji vanogona kuvashandisa pasina njodzi yekuti OCR irangwe nekusatevedzera mitemo yeHIPAA.Hungwaru iyi inoshanda kune telemedicine masevhisi anopihwa chero chikonzero, ingave kana kwete telemedicine masevhisi ane chekuita nekuongororwa uye kurapwa kwechirwere chekurapa chine chekuita neCOVID-19.
Musi waKubvumbi 11, 2023, OCR yakazivisa kuti nekuda kwekupera kwePHE COVID-19, iyi Enforcement Notice ichapera muna Chivabvu 11, 2023 na11:59 pm.OCR icharamba ichitsigira kushandiswa kwe telemedicine mushure mePHE nekupa vatapi vehutano vakavharidzirwa nguva ye90-day shanduko yekuita chero shanduko inodiwa kumabasa avo kupa telemedicine nenzira yakavanzika uye yakachengeteka maererano nezvinodiwa zveHIPAA mitemo yezvokurapa. .Munguva ino yekuchinja, OCR icharamba ichisimbisa kungwara kwayo uye haizorangi vatapi vehutano vakavharwa nekutadza kutevedzera HIPAA Telemedicine Fair Practice Rules.Nguva yekushandura ichatanga muna Chivabvu 12, 2023 uye ichipera Nyamavhuvhu 9, 2023 na23:59.
Kuti uwane rumwe ruzivo, ndapota shanyira iyo OCR webhusaiti yezviziviso zvekupera kwenguva yezvimwe zviziviso zvekusimudzira zvakapihwa nekuda kweCCIDID-19 yehutano hweveruzhinji.
Telebehavioral Health muOpioid Kurapa ZvirongwaKubva pakatangwa PHE, HHS Substance Abuse uye Mental Health Services Authority (SAMHSA) yakaburitsa nhungamiro yekushanduka-shanduka kune akawanda opioid kurapwa zvirongwa (OTPs) kubatsira kugadzirisa hutano hwekutangisa munharaunda muOTP nevarwere vayo. ..
Personal Medical Examination Waiver: SAMHSA inoregedza chinodiwa cheOTP chekuongororwa kwekurapa pasaiti kune chero murwere achagamuchira OTP buprenorphine, kunze kwekunge chiremba wechirongwa, chiremba wepamusoro, kana nyanzvi yehutano yakatenderwa inotariswa neChiremba's Decision Program.Kuongororwa kwakakwana kwehutano hwemurwere kunogona kuitwa uchishandisa telemedicine.SAMHSA yakazivisa kuti kuchinjika uku kuchawedzerwa kusvika Chivabvu 11, 2024. Kuwedzerwa kuchaita Chivabvu 11, 2023, uye SAMHSA irikukurudzirawo kuita kuti shanduko iyi iite zvachose sechikamu cheChiziviso cheProposed Rulemaking, icho chichaburitswa muna Zvita. 2022.
Mishonga Yepamba: Muna Kurume 2020, SAMHSA yakapa waiver yeOTP, pasi payo nyika dzinogona kuda "kuregererwa zvachose kune vese varwere vakagadzikana muOTP kuti vagamuchire anosvika mazuva makumi maviri nemasere emadhora epamba epioid.Mishonga Yekushandisa Zvinodhaka.Nyika dzinogonawo "kuda mazuva anosvika gumi nemana emushonga wepamba kune varwere vasina kugadzikana asi avo vanotariswa neOTP vanogona kubata iyi nhanho yemishonga yepamba zvakachengeteka."
Mumakore matatu kubva pakuregererwa uku kwakapiwa, vanoti, OTPs, uye vamwe vanobatanidzwa vakashuma kuti zvakakonzera kuwedzera kwehutano hwevarwere mukurapa, kuwedzera kugutsikana kwevarwere nekutarisira, uye zviitiko zvishomanana zvekushandisa zvinodhaka kana kutsauka.SAMHSA yakagumisa kuti kune uchapupu hwakakwana hwokuti kuregererwa uku kunosimbisa uye kunokurudzira kushandiswa kwemabasa eOTP mukutarisana nekuwedzera kukuru kwekufa kwekufa kwefentanyl.Muna Kubvumbi 2023, SAMHSA yakagadziridza gwara zvachose, ichidzokorora maitiro anoshanda kune zvipimo zveOTP zvekushandisa zvisina mutariri methadone.
Iyi nhungamiro ichangobva kuvandudzwa muna Kubvumbi 2023 ichashanda mushure mekupera kwePHE uye icharamba ichishanda kwegore rimwe mushure mekupera kwePHE kana kusvika HHS yapa mutemo wekupedzisira kugadzirisa 42 CFR Chikamu 8. Chiziviso cheKurudziro yeRulemaking Proposing Amendments Chikamu 8 che42 CFR (87 FR 77330), yakanzi "Mishonga Yekurapa kweOpioid Use Disorders", iyo SAMHSA iri kushanda pakupedzisa.
Iyo Kubvumbi 2023 yakagadziridzwa nhungamiro inobvisa chinodikanwa chekutora mishonga yekumba pasina kutariswa pasi pe42 CFR § 8.12(i) pasi pemamiriro ari pazasi.Kunyanya, iyo TRP inogona kushandisa iyi waiver kupa isingatarisirwe madosi emethadone kumba zvinoenderana neanotevera akajairwa nguva dzekurapa:
SAMHSA yakazivisa kare kuti shanduko iyi ichawedzerwa kusvika Chivabvu 11, 2024. Nyika dzichada kunyoresa mvumo yadzo kune iyi chibvumirano kuitira kuti maOTP eHurumende azvishandise.Nyika kana masangano ekurapa maopioid ehurumende ane mvumo yekuita akamiririra nyika anogona kunyoresa kubvuma kwavo kusunungurwa uku nekutumira fomu remvumo rakanyorwa kuDivision of Pharmacological Therapeutics mailbox chero nguva mushure mekuburitswa kwegwaro iri.Kuona shanduko yakanaka kune iyi nhungamiro kubva mukushanduka kwakaburitswa panguva yeCCIDID-19 yehutano hwekukurumidzira, nyika dzinokurudzirwa kuita izvi pasati papfuura Chivabvu 10, 2023. nyika inogona kuramba ichipa mvumo yakanyorwa.
SAMHSA irikukurudzirawo kuita kuti shanduko iyi igare zvachose sechikamu cheChiziviso chayo chaDecember 2022 cheProposed Rulemaking.Sezvo kuregererwa kwakapiwa, inotaura, OTPs nevamwe vanobatana vakashuma kuti kuchinja uku kwakawedzera kugutsikana kwevarwere nekurapa uye nekuvandudza kubatanidzwa kwevarwere.Rutsigiro rwekushanduka uku kwave kwakanyanyisa kunaka, nemishumo kubva kuhurumende masangano ekurapa opioid uye maOTP ega ega anoratidza kuti chiyero chinokurudzira uye chinonatsiridza kutarisirwa uku kuchideredza kusarura kunoenderana neopioid kushandisa kusagadzikana (OUD).
Drug Enforcement Administration (DEA) uye PHE mirairo Kubva munaKurume 2020, HHS neDEA vanobvumira varapi kuti vanyore Schedule II-V (“Zvinhu Zvinodzorwa”) zvinodzorwa zvinhu zvichibva pakushanya kwenhare pasina kuongororwa kwekutanga pasaiti.Pamusoro pezvo, DEA yakabvisa zvinodiwa kuti murapi anyoreswe kuDEA mudunhu remurwere kana murapi achikodzera kunyorera mishonga inodzorwa kuburikidza netelemedicine mudunhu umo murapi akanyoreswa neDEA uye kuUnited States.Chimiro chemurwere.Pamwe chete, ivo vanonzi "Controlled Medication Telemedicine Flexibility".
Muna Kurume 2023, DEA iri kutsvaga zvirevo pazviziviso zviviri zvakatemerwa zvekuvandudzwa kwemitemo inodzorwa nharembozha.Zvikumbiro izvi zvakagadzirirwa kusimudzira kuwaniswa kwemishonga inodzorwa, kusanganisira kune vanhu vakapinda mukurapa nekugadzikana.Iyo DEA, yakabatana neSAMHSA, inoronga kuburitsa mutemo wekupedzisira panosvika Mbudzi 11, 2023.
Pakupedzisa kwePHE, DEA neSAMHSA dzakapa mutemo wenguva pfupi uchiwedzera kuchinjika kwe telemedicine yezvinhu zvinodzorwa kusvika Mbudzi 11, 2023, tichifunga nezve shanduko kumutemo wakarongwa zvichienderana nemhinduro dzeveruzhinji.Pamusoro pezvo, varapi vakatanga hukama nevarwere kuburikidza ne telemedicine musi waNovember 11, 2023 usati wasvika vanogona kuramba vachipa mishonga inodzorwa kuvarwere ava pasina kuongororwa kwemunhu uye zvisinei nekuti chiremba wacho ari padanho remurwere DEA kunyoresa Mbudzi asati asvika. .11, 2024.
Telebehavioral Health Rezinesi Munguva yeCOVID-19 PHE, vazhinji vanopa hutano vanogona kupa interstate telehealth masevhisi kuburikidza nehurumende-yakapihwa rezenisi waiver.Kuwedzera kushandiswa kwe telemedicine, nyika dzinogona kufambisa kupihwa kweinterstate telemedicine kuburikidza nekutakura rezinesi.License portability inoreva kugona kwenyanzvi yekurapa ane rezinesi mune imwe nyika kudzidzira mushonga mune imwe nyika ine zvipingaidzo zvidiki uye zvirambidzo kuburikidza nekuendesa, kusimbiswa, kana kupihwa rezinesi.Kuwedzera kugona kuendesa marezinesi kunowedzera mukana wekuwana mabasa ehutano uye kunobatsira kusimudzira kuenderera mberi kwekutarisira varwere.
Pakati pezvimwe zvikomborero, kutakurwa kwerezinesi kunobvumira nyika kuchengetedza simba rekutonga, zvichibvumira vatapi vehutano kuti vabatsire varwere vakawanda, zvichibvumira varwere kuti vagamuchire rubatsiro kubva kune yakakura network yevanopa hutano, uye kubatsira nyika kuvandudza kuwanikwa kwenharaunda dzekuchengeta kumaruwa neakaderera- vanhu vanowana mari..Zvibvumirano zvekupa marezinesi zvibvumirano pakati penyika dzinorerutsa maitiro uye inobvumira vanopa masevhisi kuti vaise chikumbiro chimwe chete chekudzidzira mumatunhu ari kutora chikamu.Zvibvumirano zverezinesi zvinogona kurerutsa mutoro uye kuderedza nguva dzekumirira kuti vatapi vehutano vadzidzire kunze kwenyika, kuchengetedza hutongi hwehurumende, uye kuchengetedza muripo wevanopa hutano kumabhodhi erezinesi ehurumende.Mapepa erezinesi anobatsira kune ese ega uye telemedicine masevhisi.Zvibvumirano zviripo zvekupa marezinesi zvinosanganisira: Interstate Chibvumirano cheAudiology uye Kutaura Pathology, Counselling Treaty, Emergency Medical Care Treaty, Interstate Medical Licensing Treaty, Mukoti Rezinesi Chibvumirano, Occupational Therapy Chibvumirano, Physical Therapy Chibvumirano, uye Psychology inogona kuwedzera mune Treadic. mamwe mabasa.
Dambudziko rehutano hwekuita uye kushomeka kwevanopa hutano hwepfungwa, kusanganisira kurapwa kwekusagadzikana kwekushandisa zvinodhaka, kunongedza kudikanwa kwekuwedzera marezinesi ekuedza kumatunhu ese.Kune mikana yakawanda yekuti nyika dzishandise zviwanikwa zvemubatanidzwa kutsigira kuwedzera kwe telemedicine kuburikidza nekupa marezinesi epakati:
HHS yakawedzera nekatatu rutsigiro rwayo kuburikidza neHRSA kuFederation of State Medical Councils uye Association of State and Provincial Psychological Councils, iyo yakagadzira Interstate Medical Licensing Treaty, Provider Bridge, Psychological Inter-Jurisdictional Treaty, uye Multidisciplinary Rezinesi Zviwanikwa, zvichiteerana, kuburikidza nerezinesi. Transfer Grant.Chirongwa.
Pamusoro pezvo, zviwanikwa zvemarezenisi zvitsva zvine ruzivo rwazvino rwekupihwa marezenisi epakati, zvibvumirano zverezinesi, uye marezenisi evashandi vehutano vane hunhu.Ichi chinyorwa chinopa nhungamiro yemazuva ano pamusoro pekuita zviri pamutemo uye zvine hutsika kudzidzira kunze kwenyika uye inokurudzira kutorwa kwemhando dzerezinesi dzinowedzera kuwaniswa kwehutano.
Broadband Access Broadband Internet yekubatanidza inoita basa rakakosha mukubatsira nharaunda dzine mari yakaderera uye vanhu vanoshandisa telemedicine masevhisi.Kuwedzera kuwanikwa kwebroadband mudzimba nematunhu, Congress yakapasisa 2021 Consolidated Appropriations Act kugovera madhora mabhiriyoni mazana matatu nemazana maviri kuFederal Communications Commission (FCC) kugadzira Emergency Broadband Benefits Chirongwa (EBB Chirongwa) kubatsira mhuri dzine mari yakaderera kubhadhara mari yebroadband kuwana uye. network zvishandiso.
Mbudzi 15, 2021 Iyo Infrastructure Investment and Jobs Act (IIJA) inopa madhora mabhiriyoni makumi matanhatu neshanu mumari yebroadband, iyo madhora mazana mana nemakumi mana nemasere emadhora ichave inotungamirwa neNational Telecommunications and Information Administration (NTIA) yeDhipatimendi reCommerce mune ichangogadzirwa Connectivity Authority kune iyo. Internet.uye kukura.IIJA yakapawo FCC madhora bhiriyoni gumi nemazana mana emadhora ekusimudzira nekuwedzera (chirongwa cheEBB) Iyo Inodhura Yekubatanidza Chirongwa (ACP) uye madhora bhiriyoni maviri kuUSDA kuti itange macooperative kuti ape Broadband.
Zvirongwa zvebroadband izvi zvichabatsira kuvandudza kuwanikwa kwevarwere kumasevhisi einternet nemidziyo inodiwa kune masevhisi enhare, kuderedza kusaenzana uye mitoro yemari mukuwana mavhidhiyo anogonesa tekinoroji uye hutano masevhisi.