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Educate yourself on state telemedicine regulations

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The emergence of telehealth in recent decades and the increased adoption by private practices, hospitals, and larger health systems has triggered an explosion in telemedicine-related legislation. In January 2015 alone, over 100 telehealth-related bills were introduced.

State medical board regulations

Many state medical boards are implementing telemedicine-related standards for practitioners within that state. The idea is that practitioners delivering care through telemedicine need to be held to the same standards as when they are delivering in-person care. Given the recent releases of telehealth standards by the Federation of State Medical Boards (FSMB) and the American Medical Association (AMA), it’s expected that many more states will begin implementing legislation regulating telemedicine standards of care. The FSMB has issued a document outlining state-by-state regulatory and administrative requirements for the practice of telemedicine.


Cross-state licensing

Cross-state licensing specifically refers to allowing practitioners to provide telemedicine care to a patient in a neighboring state in which he or she is not licensed. This reciprocity would allow physicians to practice across state lines without obtaining a full license in each state where patients are located. Besides reciprocity, several other models for cross state licensing exist. Licensure by endorsement is a common practice where state boards grant licenses to health professionals licensed in other states with equivalent standards. These licenses may require additional qualifications or documentation before the endorsement is granted. Mutual recognition is a system by which the licensing authorities enter into an agreement to legally accept the policies and processes of a licensee’s home state. Generally organized as a multi-state pact, these state boards work together to enforce a “harmonization of standards” for professional conduct deemed essential for healthcare delivery.


Online prescribing

Many states have enacted online prescribing regulations, specifically ones that involve scheduled drugs or those used for chronic pain management. Some states also mandate an in-person physical exam in order to legally prescribe medications to a patient over telemedicine. It’s important to be familiar with your state’s regulations on prescribing medications over telehealth. We’ve provided a link to the Federation of State Medical Boards “Internet Prescribing Language: State-by-State Overview.”


Physician-patient relationship

States vary on the what it legally means to establish a patient-physician relationship. While some require an in-person physical exam to establish this relationship, others allow for the relationship to be established through certain forms of telemedicine, like real-time videoconferencing.


Patient informed consent

Check your state’s health professional board regulations to see what kind of informed consent you need in order to provide telehealth care to patients. In some states, a written informed consent is required, while others don’t require it at all.

State reimbursement regulations

Private payer reimbursement

Currently, 30 states have mandated private payer reimbursement for delivering care over telemedicine, and many more have similar pending legislation. Visit our private payer reimbursement page to learn more about state mandates. Many in the industry would argue that these state reimbursement mandates are crucial to moving telemedicine forward.


Medicaid reimbursement

Ultimately under the umbrella of the Centers for Medicare & Medicaid Services (CMS), Medicaid is often held to the same standards as Medicare in regards to the regulation of telemedicine. However, Medicaid rules are determined on a per-state basis and can be less restrictive when it comes to telehealth reimbursement. You can learn more on our dedicated Medicaid reimbursement page.

Here’s an overview of where the nation stands as of 2016:

  • 48 state Medicaid programs reimburse for some form of live video telehealth
  • 12 state Medicaid programs offer some reimbursement for store-and-forward, not counting states that only reimburse for tele-radiology
  • 19 state Medicaid programs offer reimbursement for remote patient monitoring
  • 7 state Medicaid programs (Alaska, Hawaii, Illinois, Minnesota, Mississippi, Missouri and Washington) reimburse for all three
  • 30 states will reimburse either a transmission fee, facility fee, or both

Other state regulatory considerations

Credentialing and privileging of telemedicine providers

Healthcare organizations use a pre-determined process for the credentialing and privileging of every provider who practices medicine within that organization. The Centers for Medicare and Medicaid Services (CMS) released a final rule in 2011 that allows hospitals and critical access hospitals (CAHs) to utilize new processes for the credentialing and privileging of telehealth providers. Most states and hospitals have now adopted AMA guidelines, which recommend the elimination of dual privileging for both distant and originating site institutions; Privileging need only come from originating site hospitals, which reduces administrative encumbrance and allows more freedom for providers to access their patients. Hospitals are now exchanging simplified agreements which help ensure the appropriate rendering of telehealth services.


Malpractice liability

Malpractice liability in telehealth has become an increasing concern to professionals in the healthcare industry. While there are no publicly available studies on telehealth and the frequency of malpractice, medical malpractice carriers will undoubtedly need to make this a priority in years to come. Just last year, the American Telemedicine Association (ATA) partnered with HUB Healthcare Solutions, an insurance broker and healthcare service consulting firm, which focuses on specific risks faced by individuals, institutions and corporations in telemedicine.

Telemedicine compliance made simple

Our experienced regulatory team walks you through the entire process.