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Ha Lefapha la Bophelo bo Botle le Litšebeletso tsa Botho (HHS kapa Lefapha) le ntse le tsoela pele ka ts'ebetso ea phetoho ho tsoa ho maano a tšohanyetso a COVID-19, Lefapha le batla ho hlakisa maemo a tlang a mmuso a telehealth le taolo e hole ho netefatsa hore bakuli ba ka tsoela pele ho fumana le ho fumana thuso eo ba e fumanang. tlhokeho.Ka tlase ke leqephe la lintlha tse hlalosang se tla fetoha ho bakuli le bafani ba tlhokomelo ea bophelo ha Mongoli oa HHS a phatlalatsa Boemo ba Tšohanyetso ba Bophelo bo Botle ba Sechaba (PHE) bakeng sa COVID-19 ho latela Karolo ea 319 ea Molao oa Ts'ebeletso ea Bophelo bo Botle (sheba ka tlase) ), e tla lula e sa fetohe. joalo ka "COVID".-19 PHE”).PHE e qetella.Congress e fetisitse Molao oa Litokisetso oa Omnibus oa 2023, o atolosetsa menyetla e mengata ea merero ea bophelo bo botle eo batho ba neng ba itšetlehile ka eona nakong ea PHE COVID-19 ho fihlela bofelong ba 2024. HHS ho arolelana tataiso e eketsehileng bakeng sa lintlafatso le linako tse amanang le ho boloka maemo ana. Ho phaella moo, Health Resources and Services Administration (HRSA) e sebelisa sebaka sa marang-rang sa HHS www.Telehealth.HHS.gov, se tla tsoelapele ho sebetsa e le sesebelisoa bakeng sa bakuli, bafani ba tlhokomelo ea bophelo le linaha bakeng sa tlhahisoleseding ea telemedicine e kang mekhoa e metle ea telemedicine, lintlafatso tsa maano. le ho buseletsoa, ​​lilaesense tsa linaha, phihlello ea marang-rang, menyetla ea lichelete, le liketsahalo.
Medicare le Telehealth Nakong ea PHE, batho ba nang le Medicare ba na le phihlello e pharalletseng ea lits'ebeletso tsa thelefono, ho kenyeletsoa malapeng a bona, ntle le lithibelo tsa tikoloho kapa tsa sebaka ka kakaretso ka lebaka la Molao oa Clerk of Appropriations Act o fanang ka Tlatsetso ea Molao oa Boitokisetso le Karabelo ea Likhau tsa Telemedicine 2020 le Coronavirus.Molao oa Thuso, Liphallelo le Tšireletso ea Moruo.Telemedicine e kenyelletsa lits'ebeletso tse fanoang ka lits'ebetso tsa likhokahano tse kang likhomphutha mme e lumella bafani ba tlhokomelo ea bophelo ho fana ka tlhokomelo ho bakuli ba le hole ho e-na le ka seqo ofising.The Consolidated Appropriations Act ea 2023 e atolosa maemo a mangata a Medicare telemedicine ho fihlela ka la 31 Tšitoe 2024, joalo ka:
Ho phaella moo, ka mor'a December 31, 2024, ha maemo ana a fetoha, li-ACO tse ling li ka fana ka litšebeletso tsa thelefono, ho lumella lingaka tse nkang karolo tsa ACO le lingaka tse ling ho hlokomela bakuli ntle le ho etela motho ka mong, ho sa tsotellehe hore na ba lula hokae.Haeba mofani oa tlhokomelo ea bophelo a kenya letsoho ACO, batho ba lokela ho buisana le bona ho fumana hore na litšebeletso tsa thelefono li ka ba teng.Merero ea Medicare Advantage e tlameha ho koahela lits'ebeletso tsa thelefono tse koahetsoeng ke Medicare mme e ka fana ka lits'ebeletso tse ling tsa thelefono.Batho ba ngolisitseng morerong oa Medicare Advantage ba lokela ho hlahloba litaba tsa bona tsa telehealth ka moralo oa bona.
Linaha tse nang le Medicaid, CHIP, le Telehealth li na le menyetla e mengata ea ho fana ka litšebeletso tsa Medicaid le tsa Children's Health Insurance Program (CHIP) tse fanoang ka thelefono.Ka hona, maemo a telemedicine a fapana ho ea ka mmuso, 'me a mang a tlameletsoe qetellong ea COVID-19 PHE, a mang a hokahane le phatlalatso ea PHE ea mmuso le maemo a mang a tšohanyetso,' me a mang a fanoe ke mananeo a mmuso a Medicaid le CHIP khale pele ho seoa sena.Kamora ho felisoa ha leano la federal PHE, melao ea Medicaid le CHIP ea telehealth e tla tsoela pele ho fapana ho ea ka linaha.Litsi tsa Medicare le Medicaid Services (CMS) li khothaletsa linaha ho tsoela pele ho lefella litšebeletso tsa Medicaid le CHIP tse fanoang ka thelefono.Ho thusa linaha ho tsoelapele, ho amohela, kapa ho holisa lits'ebetso tsa mehala le maano a ho lefa, CMS e lokolotse State Medicaid le CHIP Telehealth Toolkit, hammoho le tokomane ea tlatsetso e hlalosang lihlooho tsa leano tseo linaha li lokelang ho sebetsana le tsona ho khothaletsa kamohelo e kholo ea thelefono: https:// www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
Inshorense ea Bophelo bo Botle le Telemedicine Joalo ka ha ho le joalo nakong ea PHE COVID-19, hang ha PHE COVID-19 e fela, tšireletso ea telemedicine le lits'ebeletso tse ling tsa tlhokomelo e hole li tla fapana ho latela moralo oa inshorense oa poraefete.Ha ho tluoa ho telemedicine le lits'ebeletso tse ling tsa tlhokomelo e hole, lik'hamphani tsa inshorense tse ikemetseng li ka kopa ho arolelana litšenyehelo, tumello ea pele, kapa mefuta e meng ea tsamaiso ea bongaka ea lits'ebeletso tse joalo.Bakeng sa tlhahisoleseding e eketsehileng mabapi le mokhoa oa inshorense oa telemedicine, bakuli ba lokela ho ikopanya le nomoro ea tšebeletso ea bareki ea inshorense e ka morao ea karete ea bona ea inshorense.
Nakong ea PHE COVID-19, khetlo la pele, bafani ba tsa bophelo bo botle ba ipapisitseng le Lekunutu la HIPAA, Ts'ireletso, le Tlolo ea Tsebiso ea Molao (HIPAA Rule) ba batla ho buisana le bakuli le ho fana ka lits'ebeletso tsa mehala ba sebelisa mahlale a hole a puisano a ka bang teng. ha e so utloisisoe ka botlalo.Ho Hlokahala Tumellano ea HIPAA.Ofisi ea HHS ea Litokelo tsa Botho (OCR) e phatlalalitse hore ho tloha ka la 17 Hlakubele 2020, e tla sebelisa boikhethelo ba eona mme e ke ke ea beha likotlo ho bafani ba tlhokomelo ea bophelo ba sa lumellaneng le melao ea HIPAA.Bafani ba sebelisang thekenoloji leha e le efe ea ho shebella e hōle ba ka e sebelisa ntle le kotsi ea hore OCR e fuoe kotlo bakeng sa ho se ikobele melao ea HIPAA.Maikutlo ana a sebetsa ho litšebeletso tsa telemedicine tse fanoang ka mabaka afe kapa afe, ebang litšebeletso tsa telemedicine li amana kapa che li amana le tlhahlobo le kalafo ea boemo ba bongaka bo amanang le COVID-19.
Ka la 11 Mmesa 2023, OCR e phatlalalitse hore ka lebaka la ho felloa ke nako ha PHE COVID-19, Tsebiso ena ea Ts'ebetso e tla felloa ke nako ka la 11 Motšeanong 2023 ka 11:59 bosiu.OCR e tla tsoelapele ho tšehetsa tšebeliso ea telemedicine ka mor'a PHE ka ho fa bafani ba tlhokomelo ea bophelo bo botle nako ea phetoho ea matsatsi a 90 ho etsa liphetoho leha e le life tse hlokahalang ts'ebetsong ea bona ho fana ka telemedicine ka mokhoa oa lekunutu le o sireletsehileng ho latela litlhoko tsa melao ea bongaka ea HIPAA. .Nakong ena ea phetoho, OCR e tla tsoela pele ho sebelisa bohlale ba eona 'me e ke ke ea otla bafani ba tlhokomelo ea bophelo bo koahetsoeng ka lebaka la ho hlōleha ho latela Melao ea Boikoetliso ba HIPAA Telemedicine Fair Practice.Nako ea phetoho e tla qala ka la 12 Motšeanong 2023 'me e fele ka la 9 Phato 2023 ka 23:59.
Ho fumana lintlha tse ling, ka kopo etela sebaka sa marang-rang sa OCR bakeng sa litsebiso tsa ho felloa ke nako bakeng sa litsebiso tse itseng tsa ts'ebetso tse fanoeng ka lebaka la maemo a tšohanyetso a bophelo ba sechaba a COVID-19.
Bophelo bo Botle ba Telebehavioral ho Mananeo a Phekolo ea OpioidHo tloha ha ho qala PHE, HHS Substance Abuse and Mental Health Services Authority (SAMHSA) e lokolotse tataiso ea taolo ea maemo bakeng sa mananeo a mangata a kalafo ea opioid (OTPs) ho thusa ho sebetsana le litlamorao tsa bophelo bo botle ba ho arohana sechabeng ho OTP le bakuli ba eona. ..
Monyetla oa Tlhahlobo ea Bongaka: SAMHSA e tlohela tlhoko ea OTP bakeng sa tlhahlobo ea bongaka sebakeng sa mokuli bakeng sa mokuli leha e le ofe ea tla fumana OTP buprenorphine, ha feela ngaka ea lenaneo, ngaka ea tlhokomelo ea mantlha, kapa setsebi sa tlhokomelo ea bophelo se lumelletsoeng se behiloe leihlo ke Lenaneo la Qeto la Ngaka.Tekolo e lekaneng ea boemo ba mokuli e ka etsoa ho sebelisoa telemedicine.SAMHSA e phatlalalitse hore phetoho ena e tla atolosoa ho fihlela ka la 11 Motšeanong, 2024. Katoloso e tla qala ka la 11 Motšeanong, 2023, 'me SAMHSA e boetse e sisinya ho etsa hore phetoho ena e be ea ka ho sa feleng e le karolo ea Tsebiso ea eona ea Proposed Rulemaking, e tla hatisoa ka December. 2022.
Methati ea Lehae: Ka Hlakubele 2020, SAMHSA e ile ea fana ka tumello ea OTP, moo linaha li ka hlokang "tokoloho e akaretsang bakeng sa bakuli bohle ba tsitsitseng ba OTP ho amohela ho fihla ho matsatsi a 28 a litekanyetso tsa lapeng tsa opioids.Meriana ea Mathata a Tšebeliso ea Lithethefatsi.Linaha li ka boela tsa "hloka matsatsi a ka bang 14 a meriana ea lapeng bakeng sa bakuli ba sa tsitsang empa bao OTP e lekanyetsang hore ba ka sebetsana le boemo bona ba meriana ea lapeng ka mokhoa o sireletsehileng."
Lilemong tse tharo ho tloha ha tumello ena e fanoe, e re, li-OTP, le ba bang ba amehang ba tlalehile hore ho entse hore ho be le ho eketseha ha mokuli kalafong, ho eketsa khotsofalo ea mokuli ka tlhokomelo, le liketsahalo tse fokolang tsa tšebeliso e mpe ea lithethefatsi kapa tšitiso.SAMHSA e ile ea etsa qeto ea hore ho na le bopaki bo lekaneng ba hore ho lokolloa hona ho matlafatsa le ho khothalletsa tšebeliso ea litšebeletso tsa OTP ha ho e-na le keketseho e kholo ea lefu le amanang le fentanyl overdose.Ka Mmesa 2023, SAMHSA e ile ea nchafatsa tataiso ka botlalo, ea nchafatsa mekhoa e sebetsang ho lipehelo tsa OTP bakeng sa tšebeliso e sa laoleheng ea methadone.
Tataiso ena e ncha e ntlafalitsoeng ea April 2023 e tla sebetsa ka mor'a ho fela ha PHE 'me e tla lula e sebetsa selemo se le seng ka mor'a bofelo ba PHE kapa ho fihlela HHS e fana ka molao oa ho qetela o fetolang 42 CFR Karolo ea 8. Tsebiso ea Phatlalatso e Reriloeng ea ho Phahamisa Liphetoho ho. Karolo ea 8 ea 42 CFR (87 FR 77330), e nang le sehlooho se reng "Meriana ea Phekolo ea Mathata a ho Sebelisa Opioid", eo SAMHSA e sebetsang ho e phethela.
Tataiso e ntlafalitsoeng ea Mmesa 2023 ha e lokolle tlhoko ea ho noa meriana ea hae ntle le tlhokomelo tlas'a 42 CFR § 8.12(i) tlasa maemo a ka tlase.Haholo-holo, TRP e ka sebelisa tlhahiso ena ho fana ka litekanyetso tse sa laoleheng tsa methadone lapeng ho latela linako tse latelang tsa kalafo:
SAMHSA e tsebisitse pejana hore phetoho ena e tla atoloswa ho fihlela ka la 11 Motsheanong, 2024. Linaha li tla hloka ho ngodisa tumello ya tsona bakeng sa tokollo ena e le hore di-OTP tsa Naha di kgone ho e sebedisa.Linaha kapa mekhatlo ea naha ea phekolo ea opioid e lumelletsoeng ho sebetsa molemong oa naha e ka ngolisa tumello ea bona ea ho lokolloa hona ka ho romella foromo ea tumello e ngotsoeng lebokoseng la poso la Division of Pharmacological Therapeutics ka nako leha e le efe ka mor'a hore tataiso ena e phatlalatsoe.Ho etsa bonnete ba phetoho e bonolo ho tataiso ena ho tloha ho tenyetseheng e lokollotsoeng nakong ea tšohanyetso ea bophelo bo botle ba sechaba ea COVID-19, linaha li khothaletsoa ho etsa joalo pele ho la 10 Mots'eanong 2023. Haeba mmuso o ne o so ka o sebelisa tokollo ea la 16 Hlakubele 2020. mmuso o ntse o ka fana ka tumello e ngotsoeng.
SAMHSA e boetse e etsa tlhahiso ea ho etsa hore phetoho ena e be ea ka ho sa feleng e le karolo ea Tsebiso ea eona ea Tšitoe ea 2022 ea Phatlalatso e Reriloeng.Ho tloha ha tumello e fanoe, e re, li-OTP le ba bang ba amehang ba tlalehile hore ho feto-fetoha ha maemo ho ekelitse khotsofalo ea mokuli ka phekolo le ho ntlafatsa ho kopanela ha mokuli.Tšehetso ea ho feto-fetoha ha maemo e bile e ntle haholo, ka litlaleho tse tsoang mekhatlong ea phekolo ea opioid ea mmuso le li-OTP ka bomong li fana ka maikutlo a hore tekanyo e khothalletsa le ho ntlafatsa tlhokomelo ha e ntse e fokotsa sekhobo se amanang le lefu la tšebeliso ea opioid (OUD).
Drug Enforcement Administration (DEA) le melaoana ea PHE Ho tloha ka Hlakubele 2020, HHS le DEA li lumella lingaka ho fana ka lintho tse laoloang ke Shejule II-V (“Lintho Tse Laoloang”) ho ipapisitsoe le ketelo ea thelefono ntle le tlhahlobo ea mantlha ea bongaka setšeng.Ho feta moo, DEA e tlositse tlhokahalo ea hore ngaka e ngolisoe le DEA sebakeng sa mokuli haeba ngaka e tšoaneleha ho fana ka meriana e laoloang ka telemedicine seterekeng seo ngaka e ngolisitsoeng ho DEA le United States.Boemo ba mokuli.Ka kakaretso, li bitsoa "Meriana e Laoloang Telemedicine Flexibility".
Ka Hlakubele 2023, DEA e batla maikutlo mabapi le litemoso tse peli tse reriloeng tsa ntlafatso ea melao bakeng sa maemo a laoloang a thelefono ea lithethefatsi.Litlhahiso tsena li etselitsoe ho khothaletsa phihlello e kholo ho meriana e laoloang, ho kenyeletsoa le batho ba keneng kalafo ka mokhoa o bonolo.DEA, ka tšebelisano le SAMHSA, e rera ho fana ka molao oa ho qetela ka la 11 Pulungoana 2023.
Qetellong ea PHE, DEA le SAMHSA li fane ka molao oa nakoana o atolosang ho tenyetseha ha telemedicine bakeng sa lintho tse laoloang ho fihlela la 11 Pulungoana 2023, ha ho ntse ho nahanoa ka liphetoho molaong o reriloeng ho ipapisitsoe le maikutlo a sechaba.Ho feta moo, lingaka tse thehileng likamano le bakuli ka telemedicine ka la 11 Pulungoana 2023 kapa pele ho moo li ka tsoelapele ho fana ka meriana e laoloang ho bakuli bana ntle le tlhahlobo ea bongaka ea motho le ho sa tsotelehe hore na ngaka e ngolisong ea boemo ba mokuli DEA pele ho Pulungoana. .La 11, 2024.
Lilaesense tsa Bophelo bo Botle ba Telebehavioral Nakong ea COVID-19 PHE, bafani ba bangata ba tlhokomelo ea bophelo bo botle ba ka fana ka lits'ebeletso tsa mehala tsa mehala ka ho tlohela laesense e fanoeng ke mmuso.Ho eketsa ts'ebeliso ea telemedicine, linaha li ka thusa ho fana ka telemedicine ea lipakeng ka ho tsamaisa laesense.License portability e bolela bokhoni ba setsebi sa bongaka se nang le lengolo la tumello naheng e 'ngoe ho sebetsa bongaka naheng e' ngoe ntle le litšitiso tse nyane le lithibelo ka phetisetso, netefatso, kapa ho fana ka laesense.Ho eketsa bokhoni ba ho fetisetsa mangolo a tumello ho eketsa phihlello ea lits'ebeletso tsa bophelo bo botle 'me ho thusa ho ntlafatsa tsoelopele ea tlhokomelo ho bakuli.
Har'a melemo e meng, ho ba le lilaesense ho lumella linaha ho boloka matla a taolo, ho lumella ba fanang ka tlhokomelo ea bophelo ho thusa bakuli ba bangata, ho lumella bakuli ho fumana tlhokomelo ho tsoa ho marang-rang a pharaletseng a bafani ba tlhokomelo ea bophelo, le ho thusa linaha ho ntlafatsa phihlello ea metseng ea tlhokomelo bakeng sa batho ba mahaeng le ba tlase. batho ba kenang chelete..Litumellano tsa laesense ke litumellano lipakeng tsa linaha tse nolofatsang ts'ebetso le ho lumella bafani ba litšebeletso ho fana ka kopo e le 'ngoe ea ho itloaetsa linaheng tse nkang karolo.Litumellano tsa laesense li ka imolla moroalo le ho fokotsa nako ea ho leta bakeng sa bafani ba tlhokomelo ea bophelo ho itloaetsa ho tsoa mmusong, ho boloka taolo ea taolo ea mmuso, le ho boloka litefiso tsa mofani oa tlhokomelo ea bophelo bakeng sa liboto tsa tumello ea mmuso.Litokomane tsa laesense li na le thuso bakeng sa lits'ebeletso tsa motho ka mong le tsa telemedicine.Likonteraka tse ntseng li le teng tsa laesense li kenyelletsa: Tumellano ea Phatlalatso ea Audiology le Pathology ea Puo, Tumellano ea Keletso, Tumellano ea Tlhokomelo ea Bongaka ea Tšohanyetso, Tumellano ea Lilaesense ea Bongaka, Tumellano ea Laesense ea Mooki, Tumellano ea Therapy Therapy, Physical Therapy Treaty, le Psychology e ka holisang ho kena lipakeng. mesebetsi e meng.
Mathata a bophelo bo botle ba boitšoaro le khaello ea ba fanang ka tlhokomelo ea bophelo bo botle ba kelello, ho kenyeletsoa le kalafo bakeng sa mathata a ts'ebeliso ea lithethefatsi, li supa tlhoko ea ho eketseha ha boiteko ba ho fana ka mangolo a tumello ho pholletsa le linaha.Ho na le menyetla e mengata ea hore linaha li sebelise lisebelisoa tsa federal ho ts'ehetsa katoloso ea telemedicine ka ho fana ka laesense ea linaha:
HHS e ekelitse tšehetso ea eona hararo ka HRSA ho Federation of State Medical Councils le Association of State and Provincial Psychological Councils, e thehileng Interstate Medical Licensing Treaty, Provider Bridge, Psychological Inter-Jurisdictional Treaty, le Multidisciplinary Licensing Resources, ka ho latellana, ka License. Phetisetso Grant.Lenaneo.
Ho feta moo, lisebelisoa tse ncha tsa laesense li na le tlhaiso-leseling ea morao-rao mabapi le ho fana ka lilaesense lipakeng tsa linaha, litumellano tsa laesense, le ho fana ka laesense bakeng sa litsebi tsa bophelo bo botle ba boitšoaro.Mohloli ona o fana ka tataiso ea morao-rao mabapi le mokhoa oa ho itloaetsa ka molao le ka mekhoa e metle ntle le naha le ho khothalletsa ho amoheloa ha mekhoa ea lilaesense e atolosang phihlelo ea tlhokomelo ea bophelo.
Mahokelo a Marang-rang a Broadband Access a bapala karolo ea bohlokoa ho thuseng sechaba se nang le meputso e tlase le batho ka bomong ho sebelisa litšebeletso tsa telemedicine.Ho holisa phihlello ea Broadband malapeng le literekeng, Congress e fetisitse Molao oa 2021 oa Consolidated Appropriations Act ho abela Federal Communications Commission (FCC) $ 3.2 billion ho theha Lenaneo la Melemo ea Emergency Broadband (Lenaneo la EBB) ho thusa malapa a nang le meputso e tlase ho lefa bakeng sa phihlello ea Broadband le. lisebelisoa tsa marang-rang.
La 15 Pulungoana 2021 The Infrastructure Investment Investment and Jobs Act (IIJA) e fana ka liranta tse bilione tse 65 tsa lichelete tsa Broadband, tseo ho tsona $48.2 bilione e tla laoloa ke Tsamaiso ea Naha ea Khokahano le Tlhahisoleseding (NTIA) ea Lefapha la Khoebo ho Bolaoli bo sa tsoa thehoa ba Khokahano ho Marang-rang.le ho hola.IIJA e boetse e fane ka FCC ka $14.2 bilione ho ntlafatsa le ho atolosa (lenaneo la EBB) Lenaneo la Khokahano e Affordable (ACP) le $2 bilione ho USDA ho theha likoporasi ho fana ka marang-rang.
Merero ena ea Broadband e tla thusa ho ntlafatsa phihlello ea bakuli lits'ebeletso tsa marang-rang le lisebelisoa tse hlokahalang bakeng sa lits'ebeletso tsa thelefono, ho fokotsa liphapang le meroalo ea lichelete ho fihlella lits'ebeletso tsa video le tsa bophelo bo botle tse nolofalitsoeng ke theknoloji.