Steady wins the race applies to telehealth’s entry into the mainstream of healthcare. The Department of Health and Human Services (HHS) reports that 61% of the nation’s healthcare institutions are employing some sort of telemedicine service, and more and more states are working to come up with viable guidelines for enacting telehealth laws and reimbursement policies. As of 2017, 48 of our 50 states had come up with substantive changes to how telehealth is delivered to those living in remote areas, the exceptions being Massachusetts and Connecticut.
In March, 2018, Iowa became the latest state to require insurers to treat telehealth services the same as those rendered in person, joining Arkansas, Maine, Indiana, Hawaii and Louisiana who in 2017 allowed physician/patient evaluations and relationships to be carried out via real time audio and visual telehealth technologies. Other examples of progressive state changes to Telehealth include:
- New Jersey’s newly enacted telehealth law that uses the loose definition,”healthcare provider,” allowing for a wider range of healthcare modalities, thus paving the way for medical professionals other than physicians.
- West Virginia’s recent bill that expands access to behavioral medications after a telehealth appointment.
- New York’s new telepsychiatry-specific law clarifying which mental health services can be delivered through telemedicine.
Speaking of mental health, Epstein Becker & Green (a national law firm that focuses on healthcare and life sciences) reported in the appendix of their 50 State Survey of Telemental/Telebehavioral Health, that 31 states, plus the District of Columbia, have enacted private payment laws addressing issues such as how physician/patient relationships are established and how remote prescribing is carried out.
Another catalyst for expanded remote care came on the scene in April 2017 when the Interstate Medical Licensure Compact (“Compact”) went into effect. This milestone was an agreement between 24 states and one territory. Thirty one medical and osteopathic boards in those states created an expedited process for their licensed physicians to practice in multiple compact member states. The idea behind this agreement was to encourage states to institute regulatory frameworks that will increase interstate delivery of telehealth services and, in the process, increase payer coverage to states that currently do not have access to telemedicine.
But perhaps the most concrete and immediate promise for telehealth reimbursement to providers comes from the Centers for Medicare and Medicaid. The agency has been widely criticized for its restrictive guidelines on reimbursing providers for telehealth services delivered in rural areas, including limiting the type of authorized services and where they can be delivered. However, in a May 2018 press release CMS unveiled their new rural healthcare strategy. The plan focuses on how to best serve the 60 million plus Americans living in rural communities, while avoiding “unintended consequences of policy and program implementation.” Having come to the conclusion that advancing and modernizing telemedicine is the best way to accomplish this goal, they will be reducing “some of the barriers to telehealth such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.”
As in all areas, consumer demand will be the driving force toward government regulation, and rightly so. This demand has already resulted in a number of states enacting expanded or new parity laws requiring insurers to cover telehealth visits in increasing types of settings. Payers in states without parity laws are finding that they need to keep up on changes in legislation and must prepare for the day when every state mandates reimbursement for telehealth services. Advances such as those mentioned above contribute to the need for building a secure and user friendly platform to facilitate the delivery of telemedicine services and telehealth technologies into health care systems. As a provider of a HIPAA-compliant video platform designed to allow telehealth providers to set up their own secure videoconferencing system, we invite you to contact us so you’ll be ready for that day.