States Differ Greatly in Telemedicine Policies, Support

Ken Terry

May 07, 2015

The American Telemedicine Association (ATA) details state gaps in telemedicine coverage and reimbursement in a new report, released Monday. An accompanying report compares state medical licensing policies related to telemedicine.

The ATA issued earlier reports on these topics in September 2014.

On the basis of 13 indicators, the new coverage and reimbursement report gave top ratings to the District of Columbia (DC), Maine, New Hampshire, New Mexico, Tennessee, and Virginia. Connecticut and Rhode Island had the lowest ratings.

Twenty-four states have telemedicine parity laws for private insurance, meaning that health plans must cover telemedicine, the report shows. But only 16 states and DC authorize statewide coverage, without any provider or technology restrictions.

Forty-eight state Medicaid programs have some type of telemedicine coverage, according to the report, but many programs restrict that coverage. Connecticut, Hawaii, Idaho, Rhode Island, and West Virginia scored the lowest in this area.

Twenty-four states have some type of telehealth coverage under state employee health plans. But 29 states have partial or no coverage in these plans.

In their Medicaid regulations, the report notes, states are slowly moving away from requiring telemedicine visits to occur in particular healthcare settings. Twenty-four states and the DC do not specify a patient setting as a condition for a telemedicine payment. Twenty-five states recognize the home as an originating site, and 16 states recognize schools and/or school-based health centers as originating sites.

The report noted, "States are increasingly using telemedicine to fill provider shortage gaps and ensure access to specialty care." Fifteen states and DC, for example, don't specify the type of healthcare provider allowed to provide telemedicine.

Licensure and Standards

The second ATA report looks at state professional licensure portability and practice standards for providers who use telemedicine. These "conflicting and disparate requirements" remain a big barrier, according to the report.

Comparing state laws and medical board standards, the ATA found that 22 states had the highest "composite grade" supporting telemedicine use. Twenty-six states and DC fell in the middle, with room for improvement. Texas and Alabama were at the bottom. Texas's low ranking is not surprising, considering that the Texas Medical Board recently ruled that physicians could not prescribe medications in telemedicine consults to patients they'd never encountered before.

Most states do not require the presence of a health professional during a telemedicine encounter, the report shows. Alaska, Hawaii, and Louisiana were ranked the lowest in this respect.

However, no state achieved a top score for its licensure policies. "This means that every state imposes a policy that makes practicing medicine across state lines difficult, regardless of whether or not telemedicine is used," the report said.

The Federation of State Medical Boards last year adopted an interstate compact for physician licensure that is designed to make it easier to practice medicine (including telemedicine) in multiple states. To date, bills supporting this compact have been introduced in 15 states, and legislative chambers in three states — South Dakota, Utah, and Wyoming — have passed such measures.

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