The state of Arkansas has received failing marks from the American Telemedicine Association for some of their rules regarding telehealth. The two most troublesome involve how patient relationships are established and the originating site requirements. Last week, the state legislature took an important step in improving its regulations regarding patient relationships, but failed to act regarding originating sites.
Like many other states, Arkansas has a telemedicine parity law that requires private insurers to reimburse physicians for encounters conducted “using real-time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination.” However, the Arkansas statute was the only one in the country to require that a patient-provider relationship first be established with an in-person visit. This rule severely limits the ways that telemedicine can be used to care for patients.
Last week, the Legislative Subcommittee gave its final approval to amend Arkansas’ prior practice standards for telemedicine by revising the text of Regulation No. 2(8)(A) and (B). These amendments allow a doctor to establish a valid relationship with a patient, without the need for an in-person exam. The revised regulation will become effective August 26.
A second proposed rule concerning telemedicine known as Regulation No. 38 was also on the agenda of the Subcommittee but ultimately was withdrawn. Regulation No. 38 defines what qualifies as an “originating site” for telemedicine very narrowly. Patients must be at a medical facility, such as a doctor’s office or hospital, not at home, for a telemedicine visit to qualify for reimbursement. (There is an exception for end of life care.) This restriction undermines much of telemedicine’s potential to reduce cost and save time for patients. The committee is scheduled to hold a public hearing on Regulation 38 in October.
The situation in Arkansas is a good reminder that telehealth parity laws alone are not enough to ensure a progressive approach to telemedicine adoption. It’s good news that the in-person requirement will soon be a thing of the past. It is also a positive sign that the legislature is working through the originating site issue with an eye toward expanding the definition. We’ll let you know if they follow through.