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.
Recent news, pending action
September 6, 2014 -- The American Telemedicine Association releases 50-State Gaps Reports:
- 50 State Telemedicine Gaps Analysis – Coverage & Reimbursement
- 50 State Telemedicine Gaps Analysis – Physician Practice Standards & Licensure.
2015 Update - View the ATA State Policy Matrix.
- State Telehealth Laws and Reimbursement Policies, Center for Connected Health Policy, November 2013
- Report on State Prescribing Laws: Implications for e-Prescribing August 2009
- Report on State Medical Record Access Laws August 2009
- Report on State Law Requirements for Patient Permission to Disclose Health Information August 2009
- Releasing Clinical Laboratory Test Results: Report on Survey of State Laws August 2009
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 2 years, Arizona, Mississippi, Missouri, Montana, New Mexico, New York, Tennessee 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 which 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
9 states and the District of Columbia have laws mandating the coverage and reimbursement for telemedicine-provided services under their Medicaid programs:
- District of Columbia
ATA has developed a series of state policy best practices for different clinical applications of telehealth:
- ATA Best Practice - Telemental and Behavioral Health
- State Medicaid Best Practice - Store-and-forward Telemedicine
- State Medicaid Best Practice - Remote Patient Monitoring and Home Video Visits
- State Medicaid Best Practice - School-based Telehealth
- State Medicaid Best Practice - Managed Care and Telehealth
- State Medicaid Best Practice - Telestroke
- State Medicaid Best Practice - Telerehabilitation
- State Medicaid Best Practice - Telehealth for High-risk Pregnancy
The following 22 states and DC, covering over 130 million Americans, have adopted mandates for the coverage of telemedicine, with the year of enactment indicated:
- Arizona (2013) 
- California (1996) 
- Colorado (2001)
- District of Columbia (2013) 
- Georgia (2006)
- Hawaii (1999)
- Kentucky (2000)
- Louisiana (1995)
- Maine (2009)
- Maryland (2012)
- Michigan (2012)
- Mississippi (2013) 
- Missouri (2013) 
- Montana (2013) 
- New Hampshire (2009)
- New Mexico (2013) 
- New York (2014) 
- Oklahoma (1997)
- Oregon (2009)
- Tennessee (2014)
- Texas (1997)
- Vermont (2012)
- Virginia (2010)
Timeline for State Parity Legislation and Laws
In 2014, bills were introduced in Alaska, Connecticut, Florida, Illinois, Iowa, Massachusetts, Nebraska, New Jersey, New York (ENACTED), 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 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.