Last month, The American Telemedicine Association (ATA) released a couple of informative reports on state policies. One looked at legislation related to coverage and reimbursement, while the other focused on physician practice standers and licensure. The reports include state-specific grades based on several criteria.
Good News Related to Coverage and Reimbursement
The Coverage and Reimbursement report is an analysis of telemedicine adoption in every state, including Washington D.C. We are delighted to report that at present, all state Medicaid agencies offer at least some type of coverage for telemedicine. In fact, there is a trend toward offering coverage for new types of care including dental services, counseling, and substance abuse treatment. In addition, the reach of telemedicine is moving beyond traditional provider’s offices to include care received at homes and in schools. In 2005, only 24 states allowed some kind of coverage for telemedicine. In 2017, they all do to one degree or another.
States legislators across the country have been busy with bills related to telehealth. Seven states have enacted policies that expand coverage and reimbursement of telemedicine services since the last report in 2016. They include West Virginia, Utah, Rhode Island, Idaho, Hawaii, Florida, and Connecticut. Three states, Delaware, South Carolina and Washington D.C. have bucked the trend and instead either reduced telemedicine coverage or enacted policies that restrict coverage.
“There is promising news overall for patients, providers, and businesses using telemedicine and other digital health platforms,” said Latoya Thomas, Director of the State Policy Resource Center, ATA. “These reports show that insurers, state lawmakers, and Medicaid agencies see telemedicine, and other digital health platforms, as affordable and convenient solutions to bridge the provider shortage gap and enhance access to quality health care services.”
There are Improvements Regarding Physician Standards and Licensure as Well
State laws and medical board standards are scrutinized in the Physician Standards and Licensure report. Like its coverage counterpart, this report also shows an increase in the adoption of telemedicine. The general trend is to provide healthcare providers new opportunities to practice across state lines. The report points to Louisiana, Arkansas, and Florida as having made significant gains.
To get an idea about what is happening on the state level, let’s take a closer look at the specific changes taking place in Utah and Texas.
Utah Gets Closer to Expanding the Use of Telemedicine
Utah HB 154, which amends the Medical Assistance Act, the Public Employees’ Benefit and Insurance Program Act, and the Insurance Code to provide coverage, and coverage transparency, for certain telehealth services, passed the House with bi-partisan support. But controversy still remained.
Members of the Utah Senate were concerned about a provision within the bill that prohibited the use of telemedicine for the prescription of abortion-inducing medications. Concern that the restriction would cause the bill to fail or to be deemed unconstitutional prompted its removal from the bill. Sen. Brian Shiozawa prompted a legislative panel Tuesday to strip out the prohibitive wording on abortion. “We need this telehealth bill,” Shiozawa, R-Cottonwood Heights, told the Salt Lake Tribune. This move “is not pro-choice or pro-life, I want to take that off the table.” The bill is expected to proceed to passage. The potential remains for a second bill, specific to abortion coverage to be introduced.
Signs of Progress in Texas
Texas has long held the lowest rank in the ATA’s report of any state. There are signs that Texas’ restrictive approach to telemedicine may be beginning to shift. The Houston Chronicle reports that State Sen. Charles Schwertner, R-Georgetown plans to introduce legislation that would eliminate the requirement that providers meet with patients in person before using telemedicine. In 2011 the state medical board told providers that they could lose their licenses if they did not meet with a patient prior to conducting an online encounter. Texas is one of the last states to require this in-person meeting to establish the doctor-patient relationship.
“I think we will have a bill very soon,” Schwertner told The Chronicle.
“This is significant, and will be a winner for everyone,” said Nora Belcher, executive director of the Texas e-Healthcare Alliance. “This is going to get us a fair and open market for telemedicine in Texas.”
Under the draft bill, a valid practitioner-patient relationship would be considered to exist between a telemedicine provider and a patient whom he or she had not previously treated in person if the telemedicine practitioner met certain requirements. The remote visit would either have to be a synchronous audio-video (video conferencing) encounter, or it could involve “store-and-forward” technology along with an audio-only interaction if the provider used information from the patient’s medical record such as photo or video images. In both cases, the provider must meet the same standard of care that would be required for in-person visits.
Additionally, current law requires that a healthcare professional be present when a patient initiates a video consult. (Much like the most common approach used by Medicare.) This means it is typically done from a medical office, not the patient’s home. But the proposed new bill would require the Texas Medical Board to drop that “telepresenter” requirement, opening up the use of telemedicine significantly in the state.
“As federal and state lawmakers reevaluate the current health policy environment, they cannot ignore telemedicine’s potential as a valuable and cost saving tool,” said Gary Capistrant, ATA’s Chief Policy Officer. We expect to see continued progress toward a more progressive approach to telemedicine on both the coverage and reimbursement and the physician practices and licensing fronts. The recent reports from the ATA show great forward momentum.