CMS Telehealth Credentialing Rule

The Centers for Medicare and Medicaid Services has implemented new rules that make it easier for hospitals to establish medical credentials for telehealth professionals.

These new rules, which go into effect July 5, 2011, will revise the Medicare Conditions of Participation to allow hospitals and CMS-designated Critical Access Hospitals (CAH) to provide medical credentials to telehealth providers by relying on the review of those providers by another hospital in a separate location, a process termed "privileging by proxy."

The new rules allow a hospital (an originating site, in CMS terminology) to grant practice privileges to telehealth providers at a second hospital (termed a distant site) by accepting the distant-site hospital's credentialing and privileging approvals for those providers.

In addition, the new rules allow sites other than hospitals, such as physician offices and ambulatory centers, which provide telehealth services, to receive privileging by proxy approvals for telehealth services, as long as those services meet the hospital’s conditions of practice.

These new regulations have important implications for telehealth services in California. They will promote the use of telehealth to improve access to care, reduce costs, and increase the availability and quality of services in medically underserved communities, both urban and rural. Reducing administrative burdens on hospitals for the credentialing of telehealth practitioners will encourage hospitals to utilize telehealth services.

The regulations are vitally important to California's 352 hospitals, which includes 34 rural hospitals and 28 CAHs, and to many of the state's 264 Rural Health Clinics.

CCHP collaborated with the California Association of Rural Health Clinics, California Rural Indian Health Board, and California State Rural Health Association, in supporting the rule change.  The collaborating organizations sent a comment letter to CMS in July, 2010.

Why Was the Rule Change Necessary?

To participate in the Medicare or Medicaid programs, a hospital must be certified as complying with CMS's Conditions of Participation. CMS certifies hospitals in two ways—through a survey conducted by a state agency on behalf of CMS, or by a CMS-granted "deeming authority" to a hospital accrediting organization, such as The Joint Commission (TJC).

In the past, TJC-accredited hospitals were deemed to have met CMS's Medicare requirements. This included TJC rules that accredited hospitals could use the privileging by proxy process to credential telehealth providers.

However, TJC's deeming authority was revoked with the passage of the Medicare Improvements for Patients and Providers Act of 2008. The statute required TJC to reapply for CMS certification. In addition, CMS had determined that TJC's privileging by proxy process was inconsistent with CMS's hospital and CAH Conditions of Participation requirements.

This rule change reinstated the privileging by proxy process.

A 2010 CCHP report provides background on provider credentialing under Medicare and accreditation programs, prior to the release of the proposed rule change.