Pogwiritsa ntchito tsamba lovomerezeka la .gov Tsamba la .gov ndi la bungwe lovomerezeka la boma la US.
Tsamba lotetezedwa la .gov lomwe limagwiritsa ntchito HTTPS (padlock) kapena https:// blocking zikutanthauza kuti mwalumikizidwa ndi tsamba la .gov motetezeka.Gawani zinthu zodziwikiratu pamawebusayiti ovomerezeka okha, otetezedwa.
Takulandilani pakukhazikitsanso kamangidwe ka HHS.gov ka US Web Design System.Zomwe zili mkati ndikuyenda kumakhalabe komweko, koma mawonekedwe osinthidwa amafikirako komanso osavuta kugwiritsa ntchito mafoni.
Pamene Dipatimenti ya Zaumoyo ndi Ntchito Za Anthu (HHS kapena Dipatimenti) ikupitiriza kusintha ndondomeko zadzidzidzi za COVID-19, dipatimentiyi ikufuna kufotokozera tsogolo la federal telehealth ndi zowongolera zakutali kuti odwala apitilize kulandira ndi kulandira chithandizo. chosowa.Pansipa pali pepala lofotokoza zomwe zidzasinthe kwa odwala ndi othandizira azaumoyo pomwe Mlembi wa HHS alengeza za Public Health Emergency (PHE) ya COVID-19 motsatira Gawo 319 la Public Health Service Act (onani m'munsimu) ), zomwe sizisintha. ngati "COVID".-19 PHE”).PHE yatha.Congress idapereka lamulo la Omnibus Appropriations Act la 2023, kukulitsa zosinthika zambiri zamadongosolo azaumoyo omwe anthu adalira pa PHE COVID-19 mpaka kumapeto kwa 2024. Kuwonjezera apo, Health Resources and Services Administration (HRSA) imagwiritsa ntchito webusaiti ya HHS www.Telehealth.HHS.gov, yomwe idzapitirizabe kukhala chithandizo kwa odwala, opereka chithandizo chamankhwala ndi mayiko kuti adziwe zambiri za telemedicine monga njira zabwino za telemedicine, zosintha za ndondomeko. ndi kubwezeredwa, zilolezo zapakati pamayiko, mwayi wopezeka ndi burodibandi, mwayi wandalama, ndi zochitika.
Medicare ndi Telehealth Munthawi ya PHE, anthu omwe ali ndi Medicare ali ndi mwayi wopeza chithandizo chamankhwala, kuphatikiza m'nyumba zawo, popanda zoletsa zamalo kapena malo chifukwa Clerk of Appropriations Act yopereka Zowonjezera ku Appropriations Preparedness and Response Act for Telemedicine 2020 ndi Coronavirus.Lamulo la Thandizo, Thandizo ndi Chitetezo pazachuma.Telemedicine imaphatikizapo ntchito zomwe zimaperekedwa kudzera m'njira zolumikizirana ndi matelefoni monga makompyuta ndipo zimalola othandizira azaumoyo kuti azipereka chisamaliro kwa odwala kutali osati pamasom'pamaso ku ofesi.The Consolidated Appropriations Act ya 2023 imakulitsa zosinthika zambiri za Medicare telemedicine mpaka Disembala 31, 2024, monga:
Kuphatikiza apo, pambuyo pa Disembala 31, 2024, zosinthazi zikatha, ma ACO ena atha kupereka chithandizo chamankhwala, kulola madotolo omwe atenga nawo gawo a ACO ndi asing'anga ena kuti azisamalira odwala popanda kuwayendera, mosasamala kanthu komwe amakhala.Ngati wothandizira zaumoyo akugwira nawo ntchito ku ACO, anthu ayenera kufufuza nawo kuti adziwe zomwe chithandizo cha telefoni chingakhalepo.Mapulani a Medicare Advantage ayenera kuphimba chithandizo cha telefoni cha Medicare ndipo angapereke zina zowonjezera pa telefoni.Anthu omwe adalembetsa nawo dongosolo la Medicare Advantage akuyenera kuyang'ana momwe amawonera telehealth ndi mapulani awo.
Mayiko omwe ali ndi Medicaid, CHIP, ndi Telehealth ali ndi kusinthasintha kwakukulu pakufalitsa chithandizo cha Medicaid ndi Children's Health Insurance Programme (CHIP) chomwe chimaperekedwa kudzera pa telehealth.Mwakutero, kusinthasintha kwa telemedicine kumasiyanasiyana malinga ndi boma, pomwe ena amakhala kumapeto kwa COVID-19 PHE, ena omangika ku chilengezo cha boma cha PHE ndi zochitika zina zadzidzidzi, ndipo zina zidaperekedwa ndi mapulogalamu aboma a Medicaid ndi CHIP kalekale mliriwu usanachitike.Pambuyo pa kutha kwa dongosolo la federal PHE, malamulo a telehealth a Medicaid ndi CHIP apitirizabe kusiyana ndi boma.Centers for Medicare and Medicaid Services (CMS) imalimbikitsa mayiko kuti apitirize kulipira chithandizo cha Medicaid ndi CHIP choperekedwa kudzera pa telefoni.Pofuna kuthandiza mayiko kuti apitilize, kutengera, kapena kukulitsa njira zopezera chithandizo chamankhwala patelefoni ndi njira zolipirira, CMS yatulutsa State Medicaid ndi CHIP Telehealth Toolkit, komanso chikalata chowonjezera chofotokoza mfundo zomwe mayiko akuyenera kuthana nazo kuti alimbikitse kukhazikitsidwa kwa telehealth: https:// www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf;
Inshuwaransi Yaumoyo Payekha ndi Telemedicine Monga momwe zilili pano pa PHE COVID-19, PHE COVID-19 ikatha, chithandizo cha telemedicine ndi ntchito zina zosamalira anthu akutali zimasiyana ndi inshuwaransi yachinsinsi.Zikafika pa telemedicine ndi ntchito zina zosamalira anthu akutali, makampani a inshuwaransi azinsinsi atha kugwiritsa ntchito kugawana mtengo, chilolezo choyambirira, kapena njira zina zoyendetsera ntchito zachipatala.Kuti mumve zambiri za njira ya inshuwaransi pa telemedicine, odwala ayenera kulumikizana ndi nambala yamakasitomala ya inshuwaransi yomwe ili kumbuyo kwa kirediti kadi yawo ya inshuwaransi.
Munthawi ya PHE COVID-19, kwa nthawi yoyamba, opereka chithandizo chamankhwala omwe amatsatira za HIPAA Zazinsinsi, Chitetezo, ndi Kuphwanya Notice Rule (HIPAA Rule) akufuna kulumikizana ndi odwala ndikupereka chithandizo cha telefoni pogwiritsa ntchito matekinoloje olankhulirana akutali omwe atha. osamveka bwino.Kugwirizana kwa HIPAA Kufunika.HHS Office of Civil Rights (OCR) yalengeza kuti kuyambira pa Marichi 17, 2020, ichita mwanzeru ndipo sidzapereka chindapusa kwa ogwira ntchito yazaumoyo omwe satsatira malamulo a HIPAA.Othandizira omwe amagwiritsa ntchito ukadaulo uliwonse wowunikira atha kuzigwiritsa ntchito popanda chiwopsezo cha OCR kulangidwa chifukwa chosatsatira malamulo a HIPAA.Kuwona uku kumagwira ntchito pazachipatala zoperekedwa pazifukwa zilizonse, kaya chithandizo cha telemedicine chikukhudzana ndi kuzindikira ndi kuchiza matenda okhudzana ndi COVID-19.
Pa Epulo 11, 2023, OCR idalengeza kuti chifukwa cha kutha kwa PHE COVID-19, Chidziwitso Chotsatirachi chidzatha pa Meyi 11, 2023 nthawi ya 11:59 pm.OCR idzapitiriza kuthandizira kugwiritsa ntchito telemedicine pambuyo pa PHE popereka opereka chithandizo chamankhwala ophimbidwa ndi nthawi ya kusintha kwa masiku a 90 kuti asinthe zofunikira pa ntchito zawo kuti apereke telemedicine mwachinsinsi komanso motetezeka malinga ndi zofunikira za malamulo a zachipatala a HIPAA. .Panthawi yosinthikayi, OCR idzapitirizabe kulimbikitsa nzeru zake ndipo sichidzalanga opereka chithandizo chamankhwala chifukwa cholephera kutsatira malamulo a HIPAA Telemedicine Fair Practice Rules.Nthawi yosinthira idzayamba pa Meyi 12, 2023 ndikutha pa Ogasiti 9, 2023 nthawi ya 23:59.
Kuti mumve zambiri, chonde pitani patsamba la OCR kuti mupeze zidziwitso zakutha ntchito kwa zidziwitso zina zokakamira zomwe zaperekedwa chifukwa cha ngozi yadzidzidzi ya COVID-19.
Telebehavioral Health in Opioid Treatment ProgramsChiyambireni kukhazikitsidwa kwa PHE, bungwe la HHS Substance Abuse and Mental Health Services Authority (SAMHSA) yatulutsa malangizo osinthika pamapulogalamu angapo amankhwala a opioid (OTPs) kuti athandizire kuthana ndi zovuta zokhudzana ndi chikhalidwe cha anthu ku OTP ndi odwala ake. ..
Kusiya Kuyezetsa Zamankhwala Kwaumwini: SAMHSA imasiya kufunikira kwa OTP kwa kuyezetsa kwachipatala pamalopo kwa wodwala aliyense amene adzalandira OTP buprenorphine, malinga ngati dokotala wa pulogalamuyo, dokotala wamkulu wachipatala, kapena katswiri wovomerezeka wa zaumoyo akuyang'aniridwa ndi Dongosolo Lachigamulo la Dokotala.Kuunika kokwanira kwa wodwalayo kutha kuchitidwa pogwiritsa ntchito telemedicine.SAMHSA yalengeza kuti kusinthasintha kumeneku kudzakulitsidwa mpaka pa Meyi 11, 2024. Kuwonjezaku kudzachitika pa Meyi 11, 2023, ndipo SAMHSA ikufunanso kuti kusinthasintha uku kukhale kokhazikika ngati gawo la Notice of Proposed Rulemaking, yomwe idzasindikizidwa mu Disembala. 2022.
Mlingo wakunyumba: Mu Marichi 2020, SAMHSA idapereka chilolezo cha OTP, pomwe mayiko angafunike "kusaperekedwa kwa odwala onse okhazikika mu OTP kuti alandire mpaka masiku 28 amankhwala opioid akunyumba.Mankhwala Osokoneza Bongo.Mayiko angafunikenso "kutengera masiku 14 amankhwala akunyumba kwa odwala omwe sakhazikika koma omwe OTP yawatsimikizira kuti atha kulandira mankhwala apanyumba motetezeka."
M'zaka zitatu kuchokera pamene chiwongolerochi chinaperekedwa, akuti, OTPs, ndi anthu ena ogwira nawo ntchito adanena kuti zachititsa kuti odwala azitenga nawo mbali pa chithandizo chamankhwala, kuwonjezeka kwachisangalalo kwa odwala ndi chisamaliro, ndi zochitika zochepa za kugwiritsa ntchito mankhwala osokoneza bongo kapena kusokoneza.SAMHSA inatsimikiza kuti pali umboni wokwanira wakuti kumasulidwa uku kumalimbitsa ndi kulimbikitsa kugwiritsa ntchito ntchito za OTP pamaso pa kuwonjezeka kwakukulu kwa imfa za fentanyl zokhudzana ndi overdose.Mu Epulo 2023, SAMHSA idasinthiratu malangizowo, ndikukonzanso zomwe zikugwiritsidwa ntchito ku OTP kugwiritsa ntchito methadone mosayang'aniridwa.
Malangizo atsopanowa a Epulo 2023 ayamba kugwira ntchito pambuyo poti PHE itatha ndipo ikhala ikugwira ntchito kwa chaka chimodzi pambuyo pa kutha kwa PHE kapena mpaka HHS ipereka lamulo lomaliza losintha 42 CFR Gawo 8. Gawo 8 la 42 CFR (87 FR 77330), lotchedwa "Makhwala Ochizira Opioid Use Disorders", omwe SAMHSA ikugwira ntchito yomaliza.
Maupangiri osinthidwa a Epulo 2023 samalola kuti munthu azimwa mankhwala kunyumba popanda kuyang'aniridwa ndi 42 CFR § 8.12(i) malinga ndi zomwe zili pansipa.Makamaka, a TRP angagwiritse ntchito chiwongolerochi kuti apereke Mlingo wosayang'aniridwa wa methadone kunyumba molingana ndi nthawi zotsatirazi:
SAMHSA idalengeza kale kuti kusinthasintha uku kudzawonjezedwa mpaka pa Meyi 11, 2024. Mayiko adzafunika kulembetsa motsimikiza kuti avomereza kukhululukidwaku kuti ma OTP a Boma agwiritse ntchito.Mayiko kapena mabungwe aboma opereka chithandizo kwa opioid ololedwa kuchitapo kanthu m'malo mwa boma atha kulembetsa chilolezo chawo kuti asakhululukidwe potumiza fomu yololeza yolembedwa ku bokosi la makalata la Division of Pharmacological Therapeutics pa nthawi iliyonse pambuyo pofalitsa malangizowa.Pofuna kuwonetsetsa kuti chitsogozochi chikuyenda bwino kuchokera ku kusinthika komwe kunatulutsidwa panthawi ya ngozi ya COVID-19, mayiko akulimbikitsidwa kutero pasanafike pa Meyi 10, 2023. boma likhoza kuperekabe chilolezo cholembedwa.
SAMHSA ikulingaliranso kuti izi zitheke ngati gawo la Chidziwitso cha Proposed Rulemaking chake cha Disembala 2022.Popeza kuti kuchotsedwako kwaperekedwa, akuti, OTPs ndi ena ogwira nawo ntchito adanena kuti kusinthasintha kumeneku kwawonjezera kukhutira kwa odwala ndi chithandizo ndi kupititsa patsogolo kuyanjana kwa odwala.Thandizo la kusinthasintha kumeneku lakhala labwino kwambiri, ndi malipoti ochokera ku mabungwe a boma a opioid ndi OTPs payekha akusonyeza kuti muyeso umalimbikitsa ndi kupititsa patsogolo chisamaliro pamene amachepetsa kusalana kokhudzana ndi vuto la kugwiritsa ntchito opioid (OUD).
Drug Enforcement Administration (DEA) ndi malamulo a PHE Pofika pa Marichi 2020, HHS ndi DEA amalola akatswiri kuti apereke zinthu zoyendetsedwa ndi Ndandanda II-V (“Zinthu Zolamulidwa”) potengera ulendo wa patelefoni popanda kuyezetsa koyambirira kwachipatala.Kuonjezera apo, DEA yachotsa zofunikira kuti dokotala alembetsedwe ndi DEA m'boma la wodwalayo ngati dokotala ali woyenera kupereka mankhwala olamulidwa kudzera pa telemedicine m'boma limene dokotalayo amalembetsa ndi DEA komanso ku United States.Mkhalidwe wodwala.Pamodzi, iwo amatchedwa "Controlled Medication Telemedicine Flexibility".
Mu Marichi 2023, a DEA ikufuna ndemanga pazidziwitso ziwiri zachitukuko za malamulo owongolera kusinthasintha kwamankhwala osokoneza bongo.Malingaliro awa adapangidwa kuti apititse patsogolo mwayi wopezeka ndi mankhwala oyendetsedwa bwino, kuphatikiza kwa anthu omwe alowa nawo chithandizo momasuka.DEA, mogwirizana ndi SAMHSA, ikukonzekera kupereka lamulo lomaliza pa Novembara 11, 2023.
Pamapeto a PHE, bungwe la DEA ndi SAMHSA linapereka lamulo lanthawi yochepa lowonjezera kusinthasintha kwa telemedicine kwa zinthu zolamuliridwa mpaka pa Novembara 11, 2023, poganizira zosintha malamulo omwe akufuna kutengera malingaliro a anthu.Kuphatikiza apo, asing'anga omwe adakhazikitsa maubwenzi ndi odwala kudzera pa telemedicine pa Novembala 11, 2023 kapena isanafike, atha kupitiliza kupereka mankhwala olamulidwa kwa odwalawa popanda kuyezetsa magazi mwamunthu payekha komanso mosasamala kanthu kuti dotoloyo ali pa kulembetsa kwa DEA kwa wodwalayo Novembala isanafike. .11, 2024.
Chilolezo cha Telebehavioral Health Munthawi ya COVID-19 PHE, othandizira azaumoyo ambiri atha kupereka chithandizo chamankhwala chapakati pamayiko kudzera mu chilolezo choperekedwa ndi boma.Kuti achulukitse kugwiritsa ntchito telemedicine, mayiko amatha kuthandizira kuperekedwa kwa interstate telemedicine kudzera pakunyamula chilolezo.Licence portability imatanthawuza kuthekera kwa dokotala yemwe ali ndi chilolezo kudera lina kukachita zamankhwala kudera lina popanda zopinga zochepa ndi zoletsa kudzera pakusamutsa, kutsimikizira, kapena kupereka laisensi.Kuchulukitsa luso losamutsa zilolezo kumakulitsa mwayi wopezeka pazithandizo zachipatala ndikuthandizira kupititsa patsogolo chisamaliro cha odwala.
Mwa zina, kupezeka kwa ziphaso kumalola mayiko kukhalabe ndi mphamvu zowongolera, kulola othandizira azaumoyo kuthandiza odwala ambiri, kulola odwala kulandira chithandizo kuchokera kumagulu ambiri azachipatala, komanso kuthandiza mayiko kupititsa patsogolo mwayi wopeza chithandizo kumadera akumidzi ndi otsika - anthu opeza ndalama..Mapangano a ziphaso ndi mapangano pakati pa mayiko omwe amathandizira kuti ntchitoyi ikhale yosavuta komanso imalola opereka chithandizo kuti apereke pulogalamu imodzi yoyeserera m'maiko omwe akutenga nawo gawo.Mapangano a zilolezo atha kuchepetsa mtolowo ndikuchepetsa nthawi yodikirira kuti ogwira ntchito zachipatala azigwira ntchito kunja kwa boma, kuyang'anira kayendetsedwe ka boma, ndikusunga chindapusa chaopereka chithandizo chamankhwala ku mabungwe opereka ziphaso aboma.Zolemba zamalayisensi ndizothandiza pazantchito zaumwini komanso za telemedicine.Mapangano omwe alipo amaphatikizirapo: Mgwirizano wapakati pa Audiology and Speech Pathology, Counselling Treaty, Emergency Medical Care Treaty, Interstate Medical Licensing Treaty, Nurse Licensing Treaty, Occupational Therapy Treaty, Physical Therapy Treaty, ndi Inter-Psychology yomwe ingathe kukulirakulira. ntchito zina.
Vuto laumoyo wamakhalidwe komanso kuchepa kwa othandizira azaumoyo, kuphatikiza chithandizo chamankhwala osokoneza bongo, zikuwonetsa kufunikira kowonjezera zoyeserera m'maiko onse.Pali mwayi wambiri woti mayiko agwiritse ntchito chuma cha federal kuti athandizire kukulitsa kwa telemedicine kudzera mu zilolezo zapakati:
HHS idachulukitsa katatu thandizo lake kudzera mu HRSA kupita ku Federation of State Medical Councils ndi Association of State and Provincial Psychological Councils, yomwe idapanga Interstate Medical Licensing Treaty, Provider Bridge, Psychological Inter-Jurisdictional Treaty, ndi Multidisciplinary Licensing Resources, motsatana, kudzera mu License. Transfer Grant.Pulogalamu.
Kuphatikiza apo, zida zatsopano zoperekera malaisensi zili ndi zidziwitso zaposachedwa kwambiri zololeza zilolezo zapakati pa mayiko, mapangano a ziphaso, komanso kupereka zilolezo kwa akatswiri azaumoyo.Chidziwitsochi chimapereka chitsogozo chamakono cha momwe angagwiritsire ntchito mwalamulo ndi mwamakhalidwe kunja kwa boma ndikulimbikitsa kukhazikitsidwa kwa zitsanzo zamalayisensi zomwe zimakulitsa mwayi wopeza chithandizo chamankhwala.
Malumikizidwe a intaneti a Broadband Access Broadband amatenga gawo lalikulu pothandiza anthu omwe amapeza ndalama zochepa komanso anthu pawokha kugwiritsa ntchito ma telemedicine.Kuti awonjezere mwayi wopezeka m'nyumba ndi m'maboma, Congress idapereka lamulo la 2021 Consolidated Appropriations Act kuti lipereke $3.2 biliyoni ku Federal Communications Commission (FCC) kuti ipange Emergency Broadband Benefits Program (EBB Program) kuti ithandize mabanja omwe amapeza ndalama zochepa kuti azilipira mwayi wofikira pa intaneti komanso zida zama network.
November 15, 2021 Infrastructure Investment and Jobs Act (IIJA) ikupereka $ 65 biliyoni mu ndalama za Broadband, zomwe $ 48.2 biliyoni zidzayendetsedwa ndi National Telecommunications and Information Administration (NTIA) ya Dipatimenti ya Zamalonda mu Connectivity Authority yomwe yangopangidwa kumene ku Intaneti.ndi kukula.IIJA inapatsanso FCC ndalama zokwana madola 14.2 biliyoni kuti ikweze ndi kukulitsa (pulogalamu ya EBB) Pulogalamu Yogwirizanitsa Yothandizira (ACP) ndi $ 2 biliyoni ku USDA kuti ikhazikitse ma cooperative kuti apereke burodi.
Mapulani a Broadband awa athandiza kupititsa patsogolo mwayi kwa odwala ku chithandizo cha intaneti ndi zida zofunikira pazachipatala, kuchepetsa kusiyana ndi mavuto azachuma kuti athe kupeza mavidiyo ndi ntchito zaumoyo zothandizidwa ndiukadaulo.