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Njengoko iSebe lezeMpilo kunye neeNkonzo zoLuntu (i-HHS okanye iSebe) liqhubeka nenkqubo yokutshintsha ukusuka kwimigaqo-nkqubo kaxakeka ye-COVID-19, iSebe lifuna ukucacisa ubume bexesha elizayo bomnxeba kunye nolawulo olukude ukuqinisekisa ukuba abaguli banokuqhubeka nokufumana kwaye bafumane uncedo isidingo.Ngezantsi kwiphepha leenyani elichaza oko kuya kutshintsha kwizigulane kunye nababoneleli bezempilo xa uNobhala we-HHS ebhengeza iNgxamiseko yezeMpilo kaRhulumente (PHE) ye-COVID-19 ngokungqinelana neCandelo lama-319 loMthetho weNkonzo yezeMpilo kaRhulumente (jonga ngezantsi) ), eya kuhlala ingatshintshi. njenge "COVID".-19 PHE”).I-PHE iphela.ICongress yapasisa uMthetho woLungelelwaniso lwe-Omnibus ka-2023, yandisa uninzi lwesicwangciso sezempilo ububhetyebhetye bezempilo abantu abathe bathembela kubo ngexesha le-PHE COVID-19 ukuya ekupheleni kuka-2024. Ukongeza, iMithombo yezeMpilo kunye noLawulo lweeNkonzo (i-HRSA) isebenzisa iwebhusayithi ye-HHS ethi www.Telehealth.HHS.gov, eya kuqhubeka isebenza njengesixhobo kwizigulane, ababoneleli bezempilo kunye namazwe ngolwazi lwe-telemedicine olufana neendlela ezingcono ze-telemedicine, ukuhlaziywa komgaqo-nkqubo. kunye neembuyekezo, iilayisensi zamazwe ngamazwe, ukufikelela kwibroadband, amathuba enkxaso-mali, kunye nemisitho.
I-Medicare kunye neTelehealth Ngexesha le-PHE, abantu abane-Medicare banofikelelo olubanzi kwiinkonzo ze-telehealth, kubandakanywa namakhaya abo, ngaphandle kwezithintelo eziqhelekileyo zejografi okanye zendawo ngenxa yoMthetho kaMabhalane we-Appropriations Act ekhupha izongezo kuMthetho woLungiselelo kunye neMpendulo yeTelemedicine ka-2020 kunye neCoronavirus.Uncedo, Uncedo kunye noMthetho woKhuseleko lwezoQoqosho.I-Telemedicine ibandakanya iinkonzo ezinikezelwa ngeesistim zonxibelelwano ezifana neekhompyutha kwaye ivumela ababoneleli bezempilo ukuba babonelele ngononophelo kwizigulane ezikude kunokuba bazenzele ngokwabo eofisini.UMthetho woLungelelwaniso oluDityanisiweyo wowama-2023 wandisa iimeko ezininzi zokuguquguquka kwe-Medicare nge-telemedicine ukuya nge-31 kaDisemba 2024, efana nale:
Ukongezelela, emva kwe-31 kaDisemba, i-2024, xa ezi ziguquguqukayo ziphela, ii-ACO ezithile zinokunikezela ngeenkonzo ze-telehealth, zivumela i-ACO ethatha inxaxheba oogqirha kunye nabanye oogqirha bezonyango ukuba banakekele izigulane ngaphandle kokutyelela kumntu, kungakhathaliseki ukuba bahlala phi.Ukuba umboneleli wezempilo uthatha inxaxheba kwi-ACO, abantu kufuneka bahlole nabo ukuze bafumane ukuba zeziphi iinkonzo ze-telehealth ezinokufumaneka.IziCwangciso ze-Medicare Advantage kufuneka zihlawule iinkonzo ze-telehealth ze-Medicare kwaye zinokubonelela ngeenkonzo zempilo ezongezelelweyo.Abantu ababhalise kwisicwangciso se-Medicare Advantage kufuneka bajonge i-telehealth coverage kunye nesicwangciso sabo.
Amazwe aneMedicaid, CHIP, kunye neTelehealth abhetyebhetye kakhulu ekuhlawuleni iMedicaid kunye neNkqubo yeInshurensi yeMpilo yaBantwana (CHIP) ezibonelelwa nge-telehealth.Ngaloo ndlela, ukuguquguquka kwe-telemedicine kuyahluka ngokoburhulumente, abanye bebotshelelwe ekupheleni kwe-COVID-19 PHE, abanye babotshelelwa kwisibhengezo se-PHE sikarhulumente kunye nezinye iimeko zikaxakeka, kwaye ezinye zabonelelwa yinkqubo ye-Medicaid kunye ne-CHIP yelizwe kwakudala ngaphambi kobhubhane.Emva kokupheliswa kwesicwangciso se-PHE ye-federal, imithetho ye-Medicaid kunye ne-CHIP ye-telehealth iya kuqhubeka iyahluka ngokwelizwe.AmaZiko eeNkonzo zeMedicare kunye neMedicaid (CMS) ikhuthaza amazwe ukuba aqhubeke nokuhlawula iinkonzo ze-Medicaid kunye ne-CHIP ezibonelelwa nge-telehealth.Ukunceda amazwe ekuqhubekeni, ekwamkeleni, okanye ekwandiseni i-telehealth coverage kunye nemigaqo-nkqubo yokuhlawula, i-CMS ikhuphe i-State Medicaid kunye ne-CHIP Telehealth Toolkit, kunye noxwebhu olongezelelweyo oluchaza izihloko zomgaqo-nkqubo ekufuneka amazwe kufuneka ajongane nawo ukukhuthaza ukwamkelwa okuqhelekileyo kwe-telehealth: https:// www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
I-Inshurensi yezeMpilo yaBucala kunye neTelemedicine Njengoko kunjalo ngoku ngexesha le-PHE COVID-19, nje ukuba i-PHE COVID-19 iphelile, ukhuseleko lwe-telemedicine kunye nezinye iinkonzo zokhathalelo olukude ziya kwahluka ngesicwangciso se-inshurensi yabucala.Xa kuziwa kwi-telemedicine kunye nezinye iinkonzo zokunakekelwa okude, iinkampani ze-inshurensi zabucala zinokufaka isicelo sokwabelana ngeendleko, ukugunyaziswa kwangaphambili, okanye ezinye iindlela zolawulo lwezonyango lweenkonzo ezinjalo.Ngolwazi oluthe kratya malunga nendlela ye-inshurensi kwi-telemedicine, izigulane kufuneka ziqhagamshelane nenombolo yenkonzo yomxhasi ye-inshurensi ebekwe ngasemva kwikhadi labo le-inshurensi.
Ngexesha le-PHE COVID-19, okokuqala, ababoneleli bezempilo abaxhomekeke kuBucala be-HIPAA, uKhuseleko, kunye noMgaqo weSaziso sokuLwaphulo (i-HIPAA Rule) bafuna ukunxibelelana nezigulana kunye nokubonelela ngeenkonzo zezempilo besebenzisa itekhnoloji yonxibelelwano olukude olunokuthi ayikaqondwa ngokupheleleyo.I-HIPAA ithobela ifuna.I-Ofisi ye-HHS yamaLungelo oLuntu (i-OCR) ivakalise ukuba ukususela ngo-Matshi 17, i-2020, iya kusebenzisa ukuqonda kwayo kwaye ayiyi kubeka iintlawulo kubaboneleli bezempilo abangayithobeli imithetho ye-HIPAA.Ababoneleli abasebenzisa nayiphi na iteknoloji yokubeka iliso ekude bangayisebenzisa ngaphandle komngcipheko we-OCR yokuhlwaywa ngenxa yokungahambelani nemithetho ye-HIPAA.Olu khetho lusebenza kwiinkonzo ze-telemedicine ezibonelelwa ngaso nasiphi na isizathu, nokuba iinkonzo ze-telemedicine okanye hayi zinxulumene noxilongo kunye nonyango lwemeko yonyango enxulumene ne-COVID-19.
Ngomhla we-11 ku-Epreli, 2023, i-OCR yabhengeza ukuba ngenxa yokuphelelwa kwe-PHE COVID-19, esi Saziso sokuNyanzeliswa siya kuphelelwa ngoMeyi 11, 2023 ngo-11:59 ebusuku.I-OCR iya kuqhubeka nokuxhasa ukusetyenziswa kwe-telemedicine emva kwe-PHE ngokunika ababoneleli bezempilo abagqunyiweyo ixesha le-90-day transition ukwenza naluphi na utshintsho oluyimfuneko kwimisebenzi yabo ukubonelela nge-telemedicine ngendlela eyimfihlo kwaye ekhuselekileyo ngokuhambelana neemfuno zemimiselo yezonyango ye-HIPAA. .Ngeli xesha lenguqu, i-OCR iya kuqhubeka nokunyanzelisa ingqiqo yayo kwaye ayiyi kuhlawulisa ababoneleli bezempilo abathintekayo ngenxa yokungaphumeleli ukuthobela i-HIPAA Telemedicine Fair Practice Rules.Ixesha lenguqu liya kuqala ngoMeyi 12, 2023 lize liphele ngo-Agasti 9, 2023 ngo-23:59.
Ngolwazi oluthe vetshe, nceda undwendwele iwebhusayithi ye-OCR ngezaziso zokuphelelwa kwexesha kwizaziso ezithile zonyanzeliso ezikhutshwe ngenxa yemeko kaxakeka yezempilo ye-COVID-19.
Impilo yeTelebehavioral kwiiNkqubo zonyango lwe-OpioidUkusukela ekusungulweni kwe-PHE, i-HHS Substance Abuse kunye ne-Mental Health Services Authority (SAMHSA) ikhuphe isikhokelo soguqulo lolawulo lweenkqubo ezininzi zonyango lwe-opioid (OTPs) ukunceda ukujongana neziphumo zempilo zokuphambuka ekuhlaleni kwi-OTP kunye nezigulana zayo. ..
I-Personal Medical Examination Waiver: I-SAMHSA iyayirhoxisa imfuneko ye-OTP yovavanyo lwezonyango kwisiza naso nasiphi na isigulana esiya kufumana i-OTP buprenorphine, ngaphandle kokuba ugqirha wenkqubo, ugqirha wokhathalelo oluphambili, okanye ingcali yezempilo egunyazisiweyo ibekwe esweni yiNkqubo yeSigqibo sikaGqirha.Uvavanyo olwaneleyo lwemeko yesigulane lunokwenziwa kusetyenziswa i-telemedicine.I-SAMHSA ibhengeze ukuba oku bhetyebhetye kuya kwandiswa ukuya kutsho ngoMeyi 11, 2024. Ulwandiso luya kuqala ukusebenza ngoMeyi 11, 2023, kwaye iSAMHSA iphakamisa ukwenza oku bhetyebhetye ngokusisigxina njengenxalenye yeSaziso sokuPhatha okuCetywayo, esiza kupapashwa ngoDisemba. 2022.
Iidosi zaseKhaya: NgoMatshi ka-2020, i-SAMHSA yakhupha i-OTP yokurhoxisa, apho amazwe anokufuna “ukukhululwa ngokubanzi kuzo zonke izigulana ezizinzileyo kwi-OTP ukuze zifumane ukuya kutsho kwiintsuku ezingama-28 zedosi yasekhaya yee-opioids.Amayeza okuphazamiseka kokusetyenziswa kweziyobisi.Amazwe anokuthi “afune ukuya kuthi ga kwiintsuku ezili-14 zamayeza asekhaya kwizigulana ezingazinzanga kodwa i-OTP imisela ukuba zinokuliphatha ngokukhuselekileyo eli nqanaba lamayeza asekhaya.”
Kwiminyaka emithathu ukususela ekunikezelweni kolu kukhululwa, i-OTPs, kunye nabanye abachaphazelekayo baye babika ukuba kubangele ukwanda kwesigulane kunyango, ukwandisa ukwaneliseka kwesigulane ngononophelo, kunye neziganeko ezimbalwa zokusetyenziswa gwenxa kweziyobisi okanye ukuphazamiseka.I-SAMHSA iqukumbele ukuba kukho ubungqina obaneleyo bokuthi olu kukhululwa luqinisa kwaye lukhuthaze ukusetyenziswa kweenkonzo ze-OTP ebusweni bokunyuka okubonakalayo kwi-fentanyl-related overdose ukufa.Ngo-Epreli wama-2023, i-SAMHSA yasihlaziya ngokupheleleyo isikhokelo, ihlaziya imigaqo esebenzayo kumalungiselelo e-OTP okusetyenziswa ngokungagadwanga kwemethadone.
Esi sikhokelo sitsha sihlaziyiweyo sika-Epreli ka-2023 siya kusebenza emva kokuphelelwa kwe-PHE kwaye siya kuhlala sisebenza unyaka omnye emva kokuphela kwePHE okanye de i-HHS ikhuphe umthetho wokugqibela olungisa i-42 CFR iSigaba 8. ISaziso sokuPhakanyiswa koMthetho oSindulula iziHlomelo Inxalenye ye-8 ye-42 CFR (87 FR 77330), enesihloko esithi "Amayeza oNyango lwe-Opioid Use Disorders", apho i-SAMHSA isebenza ekugqibeni.
Isikhokelo esihlaziyiweyo sika-Epreli ka-2023 siyayikhulula imfuneko yokuthatha amayeza asekhaya ngaphandle kweliso phantsi kwe-42 CFR § 8.12(i) phantsi kweemeko ezingezantsi.Ngokukodwa, i-TRP inokusebenzisa olu rhoxiso ukubonelela ngeedosi ezingagadwanga ze-methadone ekhaya ngokuhambelana nala maxesha alandelayo onyango:
I-SAMHSA ngaphambili ibhengeze ukuba olu tyekelo luya kwandiswa ukuya kutsho ngoMeyi 11, 2024. Amazwe kuya kufuneka abhalise ngokuqinisekisiweyo imvume yawo kolu kukhululwa ukuze ii-OTP zoMbuso zilusebenzise.Amazwe okanye ii-arhente zonyango ze-opioid ezigunyazisiweyo ukuba zenze egameni likarhulumente zingabhalisa imvume yazo kolu kukhululwa ngokuthumela ifomu yemvume ebhaliweyo kwiCandelo le-Pharmacological Therapeutics yebhokisi yeposi nangaliphi na ixesha emva kokupapashwa kwesi sikhokelo.Ukuqinisekisa utshintsho olugudileyo kwesi sikhokelo ukusuka ekubeni bhetyebhetye obukhutshwe ngexesha likaxakeka lezempilo likarhulumente le-COVID-19, amazwe ayakhuthazwa ukuba enze njalo ungadlulanga umhla we-10 kaMeyi, 2023. urhulumente usenakho ukunika imvume ebhaliweyo.
I-SAMHSA ikwacebisa ukwenza oku bhetyebhetye ngokusisigxina njengenxalenye yeSaziso sangoDisemba ka-2022 sokuPhatha okuCetywayo.Ekubeni ukukhutshwa kunikezelwe, ithi, ii-OTP kunye nabanye abachaphazelekayo baye babika ukuba oku kuguquguquka kuye kwandisa ukwaneliseka kwesigulane ngonyango kunye nokuphucula ukubandakanyeka kwesigulane.Inkxaso yolu tshintsho luye lwaba luhle kakhulu, kunye neengxelo ezivela kwii-arhente zonyango ze-opioid kunye ne-OTP nganye ebonisa ukuba umlinganiselo ukhuthaza kwaye uphucule ukhathalelo ngelixa unciphisa ukubekwa ibala elihambelana nokusetyenziswa kwe-opioid disorder (OUD).
I-Drug Enforcement Administration (DEA) kunye nemimiselo ye-PHE Ukususela ngo-Matshi 2020, i-HHS kunye ne-DEA zivumela iingcali ukuba zimisele iShedyuli II-V ("Izinto eziLawulwayo") ezilawulwayo ngokusekelwe kutyelelo lwe-telehealth ngaphandle kovavanyo lokuqala lwezonyango kwindawo.Ukongeza, i-DEA iyisusile imfuneko yokuba ingcali ibhaliswe kunye ne-DEA kwimeko yesigulane ukuba ugqirha ufanelekile ukumisela iziyobisi ezilawulwayo nge-telemedicine kwilizwe apho ingcali ibhaliswe kwi-DEA nase-United States.Ubume besigulane.Ngokudibeneyo, zibizwa ngokuba yi-"Controlled Medication Telemedicine Flexibility".
NgoMatshi ka-2023, i-DEA ifuna amagqabantshintshi kwizaziso ezimbini ezicetywayo zophuhliso lwemithetho elawulwayo yokuguquguquka kwempilo yeziyobisi.Ezi zindululo ziyilelwe ukukhuthaza ufikelelo olukhulu kumayeza alawulwayo, kubandakanywa nabantu abangene kunyango ngokuguquguquka.I-DEA, ngokusebenzisana ne-SAMHSA, iceba ukukhupha umthetho wokugqibela ngoNovemba 11, 2023.
Kwisiphelo se-PHE, i-DEA kunye ne-SAMHSA zikhuphe umgaqo wethutyana wokwandisa ukuguquguquka kwe-telemedicine kwizinto ezilawulwayo kude kube ngumhla we-11 kaNovemba 2023, ngelixa kuqwalaselwa utshintsho kumgaqo ocetywayo ngokusekelwe kwingxelo yoluntu.Ukongeza, oogqirha abaye baseka ubudlelwane kunye nezigulane nge-telemedicine okanye ngaphambi kwe-11 kaNovemba ka-2023 banokuqhubeka nokumisela amayeza alawulwayo kwezi zigulana ngaphandle kovavanyo lwezonyango lomntu kwaye nokuba ngaba ugqirha ukwisimo sokubhaliswa kwe-DEA yesigulane ngaphambi kukaNovemba. .11, 2024.
Ukukhutshwa kweLayisenisi yeMpilo yeTelebehavioral Ngexesha le-COVID-19 PHE, uninzi lwababoneleli bezempilo banokubonelela ngeenkonzo zempilo zomnxeba phakathi kwelizwe ngokukhutshwa kwelayisenisi ekhutshwe ngurhulumente.Ukwandisa ukusetyenziswa kwe-telemedicine, amazwe angaququzelela ubonelelo lwe-telemedicine yangaphakathi ngokuphatheka kwelayisensi.Ukuphatheka kwephepha-mvume kubhekiselele kubuchule bonyango obunikwe ilayisensi kwilizwe elinye ukuba basebenzise amayeza kwelinye ilizwe kunye nemiqobo encinci kunye nezithintelo ngokudluliselwa, ukuqinisekiswa, okanye ukukhutshwa kwelayisensi.Ukwandisa ukukwazi ukugqithisela iilayisensi kwandisa ufikelelo kwiinkonzo zonyango kwaye kunceda ukuphucula ukuqhubeka kokhathalelo lwezigulane.
Phakathi kwezinye izibonelelo, ukuphatheka kwelayisenisi kuvumela amazwe ukuba agcine amandla olawulo, ukuvumela ababoneleli bezempilo ukuba bakhonze izigulane ezininzi, ukuvumela izigulane ukuba zifumane ukhathalelo kuthungelwano olubanzi lwababoneleli bezempilo, kunye nokunceda amazwe aphucule ukufikelela kuluntu lokhathalelo lwamaphandle kunye noluphantsi- abantu abanengeniso..Izivumelwano zelayisensi zizivumelwano phakathi kwamazwe ayenza lula inkqubo kwaye avumele ababoneleli ngenkonzo ukuba bangenise isicelo esisodwa sokuziqhelanisa kumazwe athatha inxaxheba.Izivumelwano zeelayisenisi zinokunciphisa umthwalo kwaye zinciphise amaxesha okulinda ukuba ababoneleli bezempilo baziqhelanise norhulumente, bagcine ulongamelo lolawulo lukarhulumente, kwaye bagcine imirhumo yomboneleli wezempilo kwiibhodi zeelayisensi zikarhulumente.Amaxwebhu elayisensi aluncedo kuzo zombini iinkonzo zomntu kunye ne-telemedicine.Iikhontrakthi ezikhoyo zelayisenisi zibandakanya: iSivumelwano esiPhakathi kwi-Audiology kunye ne-Speech Pathology, iSivumelwano seNgcebiso, iSivumelwano soNyango oluNgxamisekileyo, iSivumelwano seLayisenisi yezoNyango, iSivumelwano seLayisenisi yoMongikazi, iSivumelwano soNyango loMsebenzi, iSivumelwano soNyango loMzimba, kunye nokwandiswa kweSivumelwano soNyango lwezeNgqondo, kunye nokwandiswa koBuchule beNgqondo. eminye imisebenzi.
Ingxaki yezempilo yokuziphatha kunye nokunqongophala kwababoneleli bezempilo yengqondo, kubandakanywa unyango lokuphazamiseka kokusetyenziswa kweziyobisi, kubonisa imfuneko yokwandisa iinzame zokufumana iilayisensi kuwo wonke amazwe.Maninzi amathuba okuba amazwe asebenzise izixhobo zomdibaniso ukuxhasa ukwandiswa kwetelemedicine ngokusebenzisa ilayisensi yamazwe ngamazwe:
I-HHS iphinde yaphinda kathathu inkxaso yayo nge-HRSA ukuya kwi-Federation of State Medical Councils kunye ne-Association of State and Provincial Psychological Councils, ethe yadala i-Interstate Medical Licensing Treaty, i-Provider Bridge, i-Psychological Inter-Jurisdictional Treaty, kunye neZibonelelo zokuLayiselwa kweLayisensi yeZifundo ezininzi, ngokulandelelanayo, ngeLayisensi. ISibonelelo sokuDlulisa.Inkqubo.
Ukongeza, izixhobo ezitsha zelayisenisi ziqulethe ulwazi lwamva nje malunga nokukhutshwa kweelayisenisi phakathi kwamazwe, izivumelwano zelayisensi, kunye nokunikezelwa kweempepha-mvume kubasebenzi bezempilo abaziphatha kakuhle.Esi sibonelelo sibonelela ngesikhokelo esihlaziyiweyo malunga nendlela yokwenziwa ngokusemthethweni nangokuziphatha ngaphandle korhulumente kwaye ikhuthaza ukwamkelwa kweemodeli zelayisensi ezandisa ukufikelela kukhathalelo lwempilo.
I-Broadband Access Uqhagamshelwano lwe-intanethi ye-Broadband ludlala indima ephambili ekuncedeni uluntu olunemivuzo ephantsi kunye nabantu abasebenzisa iinkonzo ze-telemedicine.Ukwandisa ukufikelela kwi-broadband kumakhaya nakwimimandla, iCongress yapasisa uMthetho we-2021 we-Consolidated Appropriations ukuba yabele i-3.2 yeebhiliyoni zeedola kwi-Federal Communications Commission (FCC) ukudala iNkqubo yeNzuzo yeBroadband eNgxamisekileyo (iNkqubo ye-EBB) ukunceda amakhaya anengeniso ephantsi ahlawule ukufikelela kwi-broadband kunye izixhobo zenethiwekhi.
Ngomhla we-15 kweyeNkanga, ngo-2021 uMthetho woTyalo-mali kwiZibonelelo kunye neMisebenzi (IIJA) ubonelela nge-65 yeebhiliyoni zeerandi kwinkxaso-mali yebroadband, apho i-48.2 yeebhiliyoni zeerandi iya kulawulwa liSebe lezoNxibelelwano lweSizwe kunye noLawulo loLwazi (i-NTIA) yeSebe lezoRhwebo kwiGunya loQhagamshelwano elisandula ukuyilwa I-intanethi.kwaye ukhule.I-IIJA ikwabonelele i-FCC nge-14.2 yeebhiliyoni zeerandi ukuze iphucule kwaye yandise (inkqubo ye-EBB) iNkqubo yoQhagamshelwano olufikelelekayo (ACP) kunye ne-2 yeebhiliyoni zeedola kwi-USDA ukuseka ookopolotyeni ukubonelela ngebroadband.
Ezi zicwangciso zebroadband ziya kunceda ekuphuculeni ukufikelela kwezigulane kwiinkonzo ze-intanethi kunye nezixhobo ezifunekayo kwiinkonzo ze-telehealth, ukunciphisa ukungafani kunye nomthwalo wemali ekufikeleleni kwiinkonzo zevidiyo kunye nezempilo ezinikwe iteknoloji.