CMS SOM App. A, Tag A-0342

an agreement with a distant-site hospital, the governing body of the hospital whose patients

are receiving the telemedicine services may choose, in lieu of the requirements in

paragraphs (a)(1) and (a)(2) of this section, to have its medical staff rely upon the

credentialing and privileging decisions made by the distant-site hospital when making

recommendations on privileges for the individual distant-site physicians and practitioners

providing such services, if the hospital’s governing body ensures, through its written

agreement with the distant-site hospital, that all of the following provisions are met:

(i) The distant-site hospital providing the telemedicine services is a Medicare-participating hospital.

(ii) The individual distant-site physician or practitioner is privileged at the distant-site

hospital providing the telemedicine services, which provides a current list of the distant-site

physician’s or practitioner’s privileges at the distant-site hospital.

(iii) The individual distant-site physician or practitioner holds a license issued or

recognized by the State in which the hospital whose patients are receiving the telemedicine

services is located.

(iv) With respect to a distant-site physician or practitioner, who holds current

privileges at the hospital whose patients are receiving the telemedicine services, the hospital

has evidence of an internal review of the distant-site physician’s or practitioner’s

performance of these privileges and sends the distant-site hospital such performance

information for use in the periodic appraisal of the distant-site physician or practitioner.

At a minimum, this information must include all adverse events that result from the

telemedicine services provided by the distant-site physician or practitioner to the hospital’s

patients and all complaints the hospital has received about the distant-site physician or

practitioner.

Interpretive guidelines §482.22(a)(3)

The hospital’s governing body has the option, when considering granting privileges to

telemedicine physicians and practitioners, to have the hospital’s medical staff rely upon the

credentialing and privileging decisions of the distant-site hospital for these physicians and

practitioners. This process would be in lieu of the traditional process required under

§482.22(a)(1) and §482.22(a)(2), whereby the hospital’s medical staff conducts its own review

of each telemedicine physician’s or practitioner’s credentials and makes a recommendation

based on that individualized review.

In order to exercise this alternative credentialing and privileging option, the hospital’s governing

body must ensure through its written agreement with the distant-site hospital that all of the

following requirements are met:

• The distant-site hospital participates in the Medicare program. If the distant-site

hospital’s participation in Medicare is terminated, either voluntarily or involuntarily, at

any time during the agreement, then, as of the effective date of the termination, the

hospital may no longer receive telemedicine services under the agreement;

• The distant-site hospital provides to the hospital a list of all its physicians and

practitioners covered by the agreement, including their privileges at the distant-site

hospital. The list may not include any physician or practitioner who does not hold

privileges at the distant-site hospital. The list must be current, so the agreement must

address how the distant-site hospital will keep the list current;

• Each physician or practitioner who provides telemedicine services to the hospital’s

patients under the agreement holds a license issued or recognized by the State where the

hospital (not the distant-site hospital) is located. States may have varying requirements

as to whether they will recognize an out-of-state license for purposes of practicing within

their State, and they may also vary as to whether they establish different standards for

telemedicine services. The licensure requirements governing in the State where the

hospital whose patients are receiving the telemedicine services is located must be

satisfied, whatever they may be; and

• The hospital has evidence that it reviews the telemedicine services provided to its patients

and provides feedback based on this review to the distant-site hospital for the latter’s use

in its periodic appraisal of each physician and practitioner providing telemedicine

services under the agreement. At a minimum, the hospital must review and send

information to the distant-site hospital on all adverse events that result from a physician

or practitioner’s provision of telemedicine services under the agreement and on all

complaints it has received about a telemedicine physician or practitioner covered by the

agreement.

Survey Procedures §482.22(a)(3)

• If the hospital provides telemedicine services to its patients under an agreement with a

distant-site hospital, ask whether the hospital’s governing body has exercised the option

to have the medical staff rely upon the credentialing and privileging decisions of the

distant-site hospital in making privileging recommendations on telemedicine physicians

and practitioners. If yes, ask to see:

• The written agreement with the distant-site hospital. Does the agreement address the

required elements concerning the distant-site hospital’s Medicare participation,

licensure of telemedicine physicians and practitioners, current list of telemedicine

physicians and practitioners with privileges, and review by the hospital of the

telemedicine physicians’ and practitioners’ services and provision of information

based on its review to the distant-site hospital?

• The list provided by the distant-site hospital of the telemedicine physicians and

practitioners, including their current privileges and pertinent licensure information.

Evidence that the hospital reviews the services provided by the telemedicine physicians and

practitioners, including any adverse events and complaints, and provides feedback to the distant-site hospital.