State law

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There are a number of areas important for telehealth that are controlled by state law and regulation, such as health and other insurance law, professional licensure and Medicaid programs.

Contents

Recent news, pending action

September 6, 2014 -- The American Telemedicine Association releases 50 State Telemedicine Gaps Analysis – Coverage & Reimbursement and 50 State Telemedicine Gaps Analysis – Physician Practice Standards & Licensure.

Legislative Action

2014 Update - Twenty-one states have already introduced bills which aim to improve access to telemedicine services. View the ATA State Policy Matrix.

Telemedicine Mandate (14 states)

Medicaid Coverage

  • Louisiana - HB 903
  • Maryland - SB 198 (Signed into law) and HB 802
  • Ohio - HB 123 (Signed into law) and SB 166

Dental

Mental/Behavioral Health

Informed Consent

Physician Practice Guidelines

Laws, regulations

Telehealth opportunities

The following are a variety of leading edge ways for state and local action to utilize telehealth improve access and outcomes, leverage scarce health professionals, and constrain health costs:

Medicaid coverage and reimbursement (In addition to statewide benefits, states can also use waivers for specialized or localized applications.)

• Require primary care case managers to accommodate telehealth ways to provide covered services
• Cover telemental health screening and counseling
• Maximize video conferencing to reduce spending for patient transport and trauma for patients
• Add remote patient monitoring to home and community-based service programs to enable people needing chronic care to continue living at home
• Accommodate “store-and-forward” uses, such as allowing a rural clinic to transmit a medical image with a specialist for consultation or diagnosis. Newer uses are wound management and diabetic retinopathy screening.
• Use automated devices and reminders to achieve better medication compliance

Insurance plan coverage – In the past year, Arizona, Mississippi, Missouri, Montana, New Mexico, and the District of Columbia joined the list of states to specify for all state-regulated health benefit plans that if a specific service is covered then a telehealth way of delivering the service is covered. Arizona passed a partial parity law limits coverage to rural areas and applies only to certain health care services.

Medical licensure – Encourage licensing boards to adopt ways (interstate compacts, reciprocity, clearinghouses, special licensing, etc.) to facilitate patient and provider access to out-of-state specialists and other scarce professionals, such as the Nurse Licensure Compact

Network development – Fund and facilitate wide telehealth networks to augment comprehensive service delivery focused on—

• Specific medical conditions, such as stroke (such as Georgia’s REACH), traumatic brain injury and fetal monitoring and neonatal care (such as Arkansas’ ANGELS)
• Specific settings, such as school-based clinics and correctional facilities

Telepharmacy – Allow a pharmacist to use telehealth technologies and pharmacy technicians to serve multiple rural dispensing locations (as North Dakota does)

Medicaid

9 states and the District of Columbia have laws mandating the coverage and reimbursement for telemedicine-provided services under their Medicaid programs:

ATA has developed a series of state policy best practices for different clinical applications of telehealth:

Private insurance

Telehealth Parity Map 2014.png

The following 21 states and DC, covering over 130 million Americans, have adopted mandates for the coverage of telemedicine, with the year of enactment indicated:

Timeline for State Parity Legislation and Laws

In 2014, bills have already been introduced in Connecticut, Florida, Illinois, Iowa, Massachusetts, Nebraska, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee (ENACTED), Washington, and West Virginia.

In 2013, bills bill were introduced in Arizona (ENACTED)**, Connecticut, Florida, Illinois, Massachusetts, Mississippi (ENACTED), Missouri (ENACTED), Montana (ENACTED), New Mexico (ENACTED), New York, Pennsylvania, South Carolina, Tennessee, Washington and the District of Columbia (ENACTED).

**Arizona law does not permit state-wide coverage. Coverage is limited to rural areas and applies only to certain health care services.

In 2012, bills were introduced in Arizona, Connecticut, Maryland (ENACTED), Michigan (ENACTED), Rhode Island, South Carolina, and Vermont (ENACTED).

In 2011, bills were introduced in Florida, New Jersey, New Mexico, Ohio, and Pennsylvania.

In general, the state laws say-- A health benefit plan may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be covered were it provided in-person. Coverage for health care services provided through telemedicine must be determined in a manner consistent with coverage for health care services provided in-person.

Resources

AHRQ State Snapshots provide State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement[16].

Listing of State Offices of Rural Health (SORH)

Listing of State Health Information Exchange contacts

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