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Njengoba uMnyango Wezempilo Nezinkonzo Zabantu (i-HHS noma uMnyango) uqhubeka nenqubo yokusuka kuzinqubomgomo eziphuthumayo ze-COVID-19, uMnyango ufuna ukucacisa izimo zesikhathi esizayo ze-telehealth kanye nokulawulwa kude ukuze uqinisekise ukuthi iziguli zingakwazi ukuqhubeka nokuthola nokuthola usizo ezilutholayo. isidingo.Ngezansi ishidi lamaqiniso elichaza lokho okuzoshintsha ezigulini nakubahlinzeki bezempilo lapho uNobhala we-HHS ememezela Isimo Esiphuthumayo Sezempilo Yomphakathi (PHE) se-COVID-19 ngokuhambisana neSigaba 319 soMthetho Wenkonzo Yezempilo Yomphakathi (bheka ngezansi) ), okuzohlala kungashintshiwe. njenge "COVID".-19 PHE”).I-PHE iyaphela.ICongress yaphasisa umthetho we-Omnibus Appropriations Act ka-2023, welula izinguquko eziningi zohlelo lwezempilo abantu abethembele kuzo ngesikhathi se-PHE COVID-19 kuze kube sekupheleni kuka-2024. ngaphezu kwalokho, i-Health Resources and Services Administration (HRSA) isebenzisa iwebhusayithi ye-HHS ethi www.Telehealth.HHS.gov, ezoqhubeka nokusebenza njengensiza yeziguli, abahlinzeki bezempilo kanye nezifunda ukuze uthole ulwazi lwe-telemedicine olufana nezindlela ezihamba phambili ze-telemedicine, izibuyekezo zenqubomgomo. kanye nezimbuyiselo, amalayisense aphakathi kwezifundazwe, ukufinyelela kwe-broadband, amathuba okuxhasa ngemali, kanye nemicimbi.
I-Medicare kanye ne-Telehealth Ngesikhathi se-PHE, abantu abane-Medicare banokufinyelela okubanzi ezinsizakalweni zezingcingo, okubandakanya emakhaya abo, ngaphandle kwemikhawulo esebenzayo yendawo noma yendawo ngenxa yoMthetho Wokuhlela Izakhiwo okhipha Izithasiselo kuMthetho Wokulungiselela Izabelo kanye Nempendulo YeTelemedicine 2020 kanye neCoronavirus.Usizo, Usizo kanye Nomthetho Wokuphepha Kwezomnotho.I-Telemedicine ihlanganisa izinsiza ezilethwa ngezinhlelo zokuxhumana ezifana namakhompuyutha futhi ivumela abahlinzeki bezempilo ukuthi banikeze ukunakekelwa ezigulini bekude kunokuba bazibonele mathupha ehhovisi.Umthetho Wokulinganiswa Okuhlanganisiwe ka-2023 unweba izinguquko eziningi ze-Medicare telemedicine kuze kube nguDisemba 31, 2024, njengokuthi:
Ngaphezu kwalokho, ngemva komhla zingama-31 kuZibandlela 2024, lapho lokhu kuvumelana nezimo kuphelelwa yisikhathi, ama-ACO athile angase anikeze izinsizakalo ze-telehealth, okuvumela odokotela ababambe iqhaza be-ACO nabanye odokotela ukuba banakekele iziguli ngaphandle kokuvakasha komuntu siqu, kungakhathaliseki ukuthi bahlalaphi.Uma umhlinzeki wezempilo ehlanganyela ku-ACO, abantu kufanele bahlole nabo ukuze bathole ukuthi yiziphi izinsizakalo ze-telehealth ezingase zitholakale.I-Medicare Advantage Plans kumele ihlanganise izinsiza ze-telehealth ezimbozwe yi-Medicare futhi ingase inikeze izinsizakalo zezempilo ezengeziwe.Abantu ababhalise ohlelweni lwe-Medicare Advantage kufanele bahlole ukusabalala kwe-telehealth ngohlelo lwabo.
Amazwe ane-Medicaid, CHIP, kanye ne-Telehealth anokuguquguquka okukhulu ekuhlinzekeni nge-Medicaid kanye nezinsizakalo Zohlelo Lomshuwalense Wezempilo Wezingane (CHIP) ezihlinzekwa nge-telehealth.Kanjalo, ukuguquguquka kwe-telemedicine kuyahlukahluka ngokwezifunda, kanti okunye kuboshelwe ekupheleni kwe-COVID-19 PHE, okunye kuxhumene nesimemezelo se-PHE sombuso nezinye izimo eziphuthumayo, kanti ezinye zahlinzekwa izinhlelo zezwe ze-Medicaid ne-CHIP kudala ngaphambi kwalolu bhubhane.Ngemuva kokuqedwa kohlelo lwe-PHE lukahulumeni, imithetho ye-Medicaid ne-CHIP yocingo izoqhubeka nokuhluka ngokwezifundazwe.I-Centers for Medicare and Medicaid Services (CMS) ikhuthaza izifundazwe ukuthi ziqhubeke nokukhokhela izinsizakalo ze-Medicaid ne-CHIP ezihlinzekwa ngocingo.Ukusiza izifundazwe ekuqhubekeni, ekwamukeleni, noma ekwandiseni ukuhlinzekwa kwezempilo ngocingo kanye nezinqubomgomo zokukhokha, i-CMS ikhiphe i-State Medicaid ne-CHIP Telehealth Toolkit, kanye nedokhumenti eyengeziwe echaza izihloko zenqubomgomo okumele izifundazwe zikhulume ngayo ukuze kuthuthukiswe ukutholwa kwe-telehealth okujwayelekile: https:// www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
Umshwalense Wezempilo Ozimele kanye ne-Telemedicine Njengoba kwenzeka njengamanje ngesikhathi se-PHE COVID-19, uma i-PHE COVID-19 iphela, ukufakwa kwe-telemedicine nezinye izinsizakalo zokunakekelwa okukude kuzohluka ngohlelo lomshwalense wangasese.Uma kuziwa ku-telemedicine nezinye izinsizakalo zokunakekela ezikude, izinkampani zomshwalense ezizimele zingafaka isicelo sokwabelana ngezindleko, ukugunyazwa kwangaphambili, noma ezinye izinhlobo zokuphathwa kwezokwelapha kwalezo zinsizakalo.Ukuze uthole ulwazi olwengeziwe mayelana nendlela yomshwalense ku-telemedicine, iziguli kufanele zithinte inombolo yazo yesevisi yamakhasimende yomshwalense etholakala ngemuva kwekhadi labo lomshwalense.
Ngesikhathi se-PHE COVID-19, okokuqala ngqa, abahlinzeki bezokunakekelwa kwempilo abangaphansi kwe-HIPAA Privacy, Security, and Breach Notice Rule (HIPAA Rule) bafuna ukuxhumana neziguli kanye nokuhlinzeka ngezinsizakalo zezempilo besebenzisa ubuchwepheshe bokuxhumana obukude obungaseshelufu. okungakaqondwa ngokugcwele.I-HIPAA Ithobela Idinga.IHhovisi le-HHS of Civil Rights (OCR) limemezele ukuthi kusukela ngoMashi 17, 2020, lizosebenzisa ukuqonda kwalo futhi ngeke likhiphe izinhlawulo kubahlinzeki bezempilo abangathobeli imithetho ye-HIPAA.Abahlinzeki abasebenzisa noma ibuphi ubuchwepheshe bokuqapha berimothi bangabusebenzisa ngaphandle kwengozi yokuthi i-OCR ijeziswe ngokungathobeli imithetho ye-HIPAA.Lokhu kuqonda kusebenza kumasevisi e-telemedicine ahlinzekwa nganoma yisiphi isizathu, kungakhathaliseki ukuthi amasevisi e-telemedicine ahlobene noma cha ahlobene nokuxilonga nokwelashwa kwesimo sezokwelapha esihlobene ne-COVID-19.
Ngomhla ziyi-11 kuMbasa, 2023, i-OCR yamemezela ukuthi ngenxa yokuphelelwa yisikhathi kwe-PHE COVID-19, lesi Saziso Sokuphoqelela sizophelelwa yisikhathi ngoMeyi 11, 2023 ngo-11:59 pm.I-OCR izoqhubeka nokusekela ukusetshenziswa kwe-telemedicine ngemva kwe-PHE ngokunikeza abahlinzeki bezempilo abahlanganisiwe isikhathi sokuguqulwa kwezinsuku ezingu-90 ukwenza noma yiziphi izinguquko ezidingekayo ekusebenzeni kwabo ukuze banikeze i-telemedicine ngendlela eyimfihlo nevikelekile ngokuhambisana nezidingo zemithetho yezokwelapha ye-HIPAA. .Phakathi nalesi sikhathi sezinguquko, i-OCR izoqhubeka nokuphoqelela ukuqonda kwayo futhi ngeke ijezise abahlinzeki bokunakekelwa kwezempilo abahlanganisiwe ngenxa yokwehluleka ukuhambisana nemithetho ye-HIPAA Telemedicine Fair Practice.Isikhathi soshintsho sizoqala ngomhla ka-Meyi 12, 2023 futhi siphele ngo-Agasti 9, 2023 ngo-23:59.
Ukuze uthole ulwazi olwengeziwe, sicela uvakashele iwebhusayithi ye-OCR ukuze uthole izaziso zokuphelelwa yisikhathi zezaziso ezithile zokuphoqelela ezikhishwe ngenxa yesimo esiphuthumayo sezempilo somphakathi se-COVID-19.
I-Telebehavioral Health Ezinhlelweni Zokwelapha Nge-OpioidSelokhu kwethulwa i-PHE, i-HHS Substance Abuse and Mental Health Services Authority (SAMHSA) ikhiphe isiqondiso sokuguquguquka esilawulayo sezinhlelo zokwelapha i-opioid (OTPs) ukusiza ukubhekana nemiphumela yezempilo yokuqhelelana komphakathi ku-OTP neziguli zayo. ..
Ukuyekisa Ukuhlolwa Kwezokwelapha Komuntu Siqu: I-SAMHSA iyeka imfuneko ye-OTP yokuhlolwa kwezokwelapha okusendaweni yanoma isiphi isiguli esizothola i-OTP buprenorphine, inqobo nje uma udokotela wohlelo, udokotela wokunakekela okuyinhloko, noma uchwepheshe wezempilo ogunyaziwe eqashwe Uhlelo Lwesinqumo Lodokotela.Ukuhlolwa okwanele kwesimo sesiguli kungenziwa kusetshenziswa i-telemedicine.I-SAMHSA imemezele ukuthi lokhu kuvumelana nezimo kuzonwetshwa kuze kube nguMeyi 11, 2024. Ukunwetshwa kuzoqala ukusebenza ngomhla ka-May 11, 2023, futhi i-SAMHSA ihlongoza ukwenza lokhu kuvumelana nezimo unomphela njengengxenye yeSaziso sayo Sokwenziwa Kwemithetho Ehlongozwayo, esizoshicilelwa ngoDisemba. 2022.
Imithamo Yasekhaya: NgoMashi 2020, i-SAMHSA yakhipha ukuyekwa kwe-OTP, lapho izifundazwe zingadinga “ukukhululwa okuvamile kuzo zonke iziguli ezizinzile ku-OTP ukuze zithole kufika ezinsukwini ezingama-28 zemithamo yasekhaya yama-opioid.Imithi Yezinkinga Zokusetshenziswa Kwezidakamizwa.Amazwe futhi "angadinga kufikela kuzinsuku eziyi-14 zomuthi wasekhaya ezigulini ezingaqinile kodwa i-OTP enquma ukuthi zingaphatha ngokuphephile leli zinga lemithi yasekhaya."
Eminyakeni emithathu selokhu kwanikezwa lokhu kudedela, izifundazwe, ama-OTP, nabanye ababambiqhaza baye babika ukuthi kubangele ukwanda kokuzibandakanya kwesiguli ekwelashweni, ukwanda kokwaneliseka kwesiguli ngokunakekelwa, kanye nezigameko ezimbalwa uma kuqhathaniswa zokusebenzisa kabi izidakamizwa noma ukuphambukisa.I-SAMHSA iphethe ngokuthi kunobufakazi obanele bokuthi lokhu kukhululwa kuqinisa futhi kukhuthaze ukusetshenziswa kwezinsizakalo ze-OTP lapho kubhekene nokwanda okuphawulekayo kokufa okuhlobene ne-fentanyl overdose.Ngo-Ephreli 2023, i-SAMHSA yabuyekeza ngokuphelele isiqondiso, ibuyekeza imibandela esebenza ezilungiselelweni ze-OTP zokusetshenziswa okungagadiwe kwe-methadone.
Lesi siqondiso esisha sika-April 2023 esibuyekeziwe sizoqala ukusebenza ngemva kokuphelelwa yisikhathi kwe-PHE futhi sizohlala sisebenza unyaka owodwa ngemva kokuphela kwe-PHE noma kuze kube yilapho i-HHS ikhipha umthetho wokugcina ochibiyela 42 CFR Ingxenye 8. Isaziso Sokumisa Okuhlongozwayo Esiphakamisa Izichibiyelo Ingxenye 8 ye-42 CFR (87 FR 77330), enesihloko esithi “Imithi Yokwelapha I-Opioid Use Disorders”, i-SAMHSA esebenzela ukuyiphothula.
Isiqondiso esibuyekeziwe sango-April 2023 sikhulula imfuneko yokuthatha imithi yasekhaya ngaphandle kokugadwa ngaphansi kokungu-42 CFR § 8.12(i) ngaphansi kwezimo ezingezansi.Ikakhulukazi, i-TRP ingase isebenzise lokhu kuyekwa ukuze inikeze imithamo engagadiwe ye-methadone ekhaya ngokuvumelana nezikhathi zokwelashwa ezilandelayo:
Ngaphambilini i-SAMHSA imemezele ukuthi lokhu kuvumelana nezimo kuzonwetshwa kuze kube nguMeyi 11, 2024. Amazwe kuzodingeka abhalise ngokuqinisekisayo imvume yawo kulokhu kukhululwa ukuze ama-OTP Wezifundazwe akusebenzise.Izifundazwe noma izikhungo zokwelapha i-opioid zikahulumeni ezigunyazwe ukuthi zisebenzele umbuso zingabhalisa imvume yazo kulokhu kukhululwa ngokuthumela ifomu lemvume elibhaliwe ebhokisini leposi le-Division of Pharmacological Therapeutics nganoma yisiphi isikhathi ngemva kokushicilelwa kwalo mhlahlandlela.Ukuqinisekisa ukuguquguquka okushelelayo kulesi siqondiso kusukela ekuguquguqukeni okukhishwe ngesikhathi sesimo esiphuthumayo sezempilo yomphakathi se-COVID-19, izifunda zikhuthazwa ukuthi zenze kanjalo ngaphambi kukaMeyi 10, 2023. umbuso usenganikeza imvume ebhaliwe.
I-SAMHSA iphinde iphakamise ukwenza lokhu kuvumelana nezimo kube unomphela njengengxenye yeSaziso sayo sikaDisemba 2022 Sokwenziwa Kwemithetho Ehlongozwayo.Njengoba ukuyekelwa kunikezwe, izifunda, ama-OTP kanye nabanye ababambiqhaza baye babika ukuthi lokhu kuguquguquka kuye kwandisa ukwaneliseka kwesiguli ngokwelashwa kanye nokuthuthukiswa kokuzibandakanya kwesiguli.Ukusekelwa kwalokhu kuvumelana nezimo kube kuhle kakhulu, ngemibiko evela ezikhungweni zokwelapha i-opioid kanye nama-OTP ngamanye aphakamisa ukuthi isilinganiso sikhuthaza futhi sithuthukise ukunakekelwa kuyilapho kunciphisa ukucwaswa okuhlobene nokusetshenziswa kwe-opioid (OUD).
I-Drug Enforcement Administration (DEA) kanye nemithetho ye-PHE Kusukela ngoMashi 2020, i-HHS ne-DEA ivumela odokotela ukuthi banqume izinto ezilawulwayo zeSheduli II-V (“Izinto Ezilawulwayo”) ngokusekelwe ekuvakasheni kwezempilo ngaphandle kokuhlolwa kokuqala kwezempilo esizeni.Ngaphezu kwalokho, i-DEA iyisusile imfuneko yokuthi udokotela abhaliswe ne-DEA esimweni sesiguli uma udokotela efanelekile ukunikeza izidakamizwa ezilawulwayo nge-telemedicine esifundazweni lapho udokotela ebhaliswe khona ne-DEA nase-United States.Isimo sesiguli.Bebonke, babizwa ngokuthi “Ukuguquguquka Kwemithi Elawulwa Nge-Telemedicine”.
NgoMashi 2023, i-DEA ifuna ukuphawula ngezaziso ezimbili ezihlongozwayo zokuthuthukiswa kwemithetho yokuguquguquka kwezidakamizwa ezilawulwayo.Lezi ziphakamiso zenzelwe ukukhuthaza ukufinyelela okukhulu emithini elawulwayo, okuhlanganisa nabantu abangene ekwelashweni ngokuguquguquka.I-DEA, ngokubambisana ne-SAMHSA, ihlela ukukhipha umthetho wokugcina ngoNovemba 11, 2023.
Ekuphetheni kwe-PHE, i-DEA kanye ne-SAMHSA bakhiphe umthetho wesikhashana owelula ukuguquguquka kwe-telemedicine ezintweni ezilawulwayo kuze kube umhla ka-11 Novemba 2023, ngenkathi icubungula izinguquko emthethweni ohlongozwayo ngokusekelwe empendulweni yomphakathi.Ngaphezu kwalokho, odokotela abasungule ubudlelwano neziguli nge-telemedicine ngomhla ka-Novemba 11, 2023 noma ngaphambi kwalokho bangaqhubeka nokunikeza lezi ziguli imithi elawulwayo ngaphandle kokuhlolwa komuntu mathupha futhi kungakhathaliseki ukuthi udokotela usesikhungweni sesiguli sokubhaliswa kwe-DEA ngaphambi kukaNovemba. .11, 2024.
Ukunikezwa Kwelayisense Yezempilo Nge-Telebehavioral Ngesikhathi se-COVID-19 PHE, abahlinzeki bezempilo abaningi bangahlinzeka ngezinsizakalo zezempilo ezimaphakathi ngokudedelwa kwelayisensi ekhishwe nguhulumeni.Ukuze kwandiswe ukusetshenziswa kwe-telemedicine, izifunda zingenza lula ukuhlinzekwa kwe-interstate telemedicine ngokuphatheka kwelayisensi.Ukuphatheka kwelayisense kusho ikhono likachwepheshe wezokwelapha onelayisense esifundeni esisodwa ukwenza imithi kwesinye isimo enezithiyo nemikhawulo emincane ngokudluliswa, ukuqinisekiswa, noma ukukhishwa kwelayisensi.Ukwandisa amandla okudlulisa amalayisensi kunweba ukufinyelela kumasevisi okunakekelwa kwezempilo futhi kusize ukuthuthukisa ukuqhubeka kokunakekelwa kweziguli.
Phakathi kwezinye izinzuzo, ukuphatheka kwelayisensi kuvumela izifunda ukuthi zigcine amandla okulawula, okuvumela abahlinzeki bezempilo ukuthi basize iziguli ezengeziwe, okuvumela iziguli ukuthi zithole ukunakekelwa kwenethiwekhi ebanzi yabahlinzeki bezempilo, nokusiza izifundazwe ukuba zithuthukise ukufinyelela emiphakathini yokunakekelwa kwezindawo zasemakhaya neziphansi- abantu abaholayo..Izivumelwano zamalayisense ziyizivumelwano phakathi kwezifunda ezenza inqubo ibe lula futhi zivumele abahlinzeki besevisi ukuthi bathumele isicelo esisodwa ukuze bazijwayeze ezifundazweni ezibamba iqhaza.Izivumelwano zamalayisense zingadambisa umthwalo futhi zinciphise izikhathi zokulinda ukuze abahlinzeki bezokunakekelwa kwempilo bazilolonge ngaphandle kwezwe, bagcine ukugada kwemithetho yombuso, futhi bonge izinkokhelo zomhlinzeki wezokunakekelwa kwempilo zamabhodi amalayisensi kahulumeni.Amadokhumenti elayisensi awusizo kukho kokubili izinsiza zomuntu siqu kanye ne-telemedicine.Izinkontileka zamalayisense ezikhona zifaka phakathi: Isivumelwano Samazwe Ngaphakathi Se-Audiology kanye Ne-Speech Pathology, ISivumelwano Sokwelulekwa, Isivumelwano Sokunakekelwa Kwezokwelashwa Esiphuthumayo, Isivumelwano Selayisensi Yezokwelapha Ephakathi, ISivumelwano Selayisense Yabahlengikazi, ISivumelwano Sokwelapha Emsebenzini, ISivumelwano Sokwelapha Ngomzimba, kanye neNhlangano Yezobulungiswa Yezengqondo eminye imisebenzi.
Inkinga yezempilo yokuziphatha kanye nokushoda kwabahlinzeki bezempilo yengqondo, okuhlanganisa nokwelashwa kwezinkinga zokusetshenziswa kwezidakamizwa, kukhomba isidingo sokwandisa imizamo yokunikeza amalayisensi kuzo zonke izifundazwe.Kunamathuba amaningi okuthi izifunda zisebenzise izinsiza zikahulumeni ukusekela ukunwetshwa kwe-telemedicine ngokusebenzisa amalayisense aphakathi kwezifundazwe:
I-HHS iphinde kathathu ukwesekwa kwayo nge-HRSA ku-Federation of State Medical Councils kanye ne-Association of State and Provincial Psychological Councils, eyakha i-Interstate Medical Licensing Treaty, Provider Bridge, Psychological Inter-Jurisdictional Treaty, kanye Nezinsiza Zokuthola Layisense Ezihlukahlukene, ngokulandelana, ngelayisensi. Isibonelelo Sokudlulisa.Uhlelo.
Ngaphezu kwalokho, izinsiza ezintsha zokulayisensa ziqukethe ulwazi lwakamuva mayelana nokunikezwa kwelayisense phakathi kwezifundazwe, izivumelwano zamalayisense, nokulayisensa kochwepheshe bezempilo bokuziphatha.Le nsiza ihlinzeka ngeziqondiso zakamuva zokuthi kwenziwa kanjani ngokusemthethweni nangokuziphatha ngaphandle kombuso futhi ikhuthaza ukwamukelwa kwamamodeli amalayisense anweba ukufinyelela ekunakekelweni kwezempilo.
Ukuxhumana kwe-inthanethi kwe-Broadband Access Broadband kudlala indima ebalulekile ekusizeni imiphakathi ehola kancane kanye nabantu ngabanye ukuthi basebenzise izinsiza ze-telemedicine.Ukuze kwandiswe ukufinyelela kwe-broadband ezindlini nasezifundeni, iCongress yaphasisa uMthetho Wokusetshenziswa Kwezimali Ezihlanganisiwe wango-2021 ukuze yabele i-Federal Communications Commission (FCC) engu-$3.2 billion ukuze idale Uhlelo Lwezinzuzo Ze-Broadband Ephuthumayo (Uhlelo lwe-EBB) ukusiza amakhaya aneholo eliphansi ukuthi akhokhele ukufinyelela kwe-broadband futhi. amadivaysi enethiwekhi.
Novemba 15, 2021 Umthetho Wokutshalwa Kwengqalasizinda Nemisebenzi (IIJA) uhlinzeka ngezimali eziyizigidi eziyizinkulungwane ezingama-65 zamarandi, lapho amabhiliyoni angama-48.2 azophathwa Uphiko Lukazwelonke Lwezokuxhumana Nokuphathwa Kolwazi (i-NTIA) loMnyango Wezohwebo ku-Connectivity Authority esanda kwakhiwa. I-inthanethi.futhi ukhule.I-IIJA iphinde yanikeza i-FCC ngamaRandi ayizigidi eziyizinkulungwane ezingu-14.2 ukuze ithuthukise futhi yandise (uhlelo lwe-EBB) Uhlelo Lokuxhumanisa Okufinyelelekayo (ACP) kanye namaRandi ayizigidi eziyizinkulungwane ezimbili ku-USDA ukuze kusungulwe imifelandawonye ezohlinzeka nge-broadband.
Lezi zinhlelo ze-broadband zizosiza ukuthuthukisa ukufinyelela kweziguli ezinsizakalweni ze-inthanethi namadivayisi adingekayo ezinsizeni zezempilo ngocingo, ukunciphisa ukungalingani kanye nemithwalo yezimali ekufinyeleleni izinsiza zevidiyo nezempilo ezinikwe amandla ubuchwepheshe.