- An analysis of state telehealth and Medicaid reimbursement policies finds a wide range of connected health practices across the country – so varied, in fact, that states can’t even agree on a definition for telehealth.
The fourth annual report, prepared by the Center for Connected Health Policy, finds a national landscape that’s just as confusing as ever, with some states moving forward while others are falling back. The result, CCHP officials say, is a “confusing environment for telehealth participants to navigate, particularly when a health system provides healthcare services in multiple states.”
On a side note, the American Telemedicine Association, which released its own annual report cards on each state’s telemedicine policies earlier this year, also decried the lack of strong progress, and noted that some states are more accepting of new care platforms than others.
The frustration in the CCHP report may best be seen in the definitions of telehealth and telemedicine, a topic that has been sitting on the sidelines for years (HIMSS, for example, switches between the two terms in its mHealth Roadmap). Alabama, Rhode Island and New Jersey offer no legal definition for either term, the report says, while other see telemedicine as focused on the delivery of clinical services and telehealth as a more encompassing platform.
In many cases, the report says, states define telehealth or telemedicine by restricting what the platform can do – such as enabling “live” or “interactive” visits between a doctor and patient but excluding remote patient monitoring and store-and-forward technology. The most common restriction excludes telephone, e-mail and fax services from telehealth or telemedicine (a debate best exemplified in Teladoc’s ongoing battle with the Texas Board of Medicine to offer phone-based service in that state).
In other issues, the CCHP report notes that Massachusetts, Rhode Island and Utah don’t currently offer Medicaid reimbursement for telehealth, while other states vary greatly on what is reimbursed and what isn’t. The most common permitted service is live video, with all but the three states noted above offering some kind of reimbursement.
“The spectrum ranges from a Medicaid program in a state like Connecticut, which will only reimburse for case management behavioral health services for clients under the age of 18, to states like California, which reimburses for live video across a wide variety of medical specialties,” the report states. States also place restrictions on type of services, providers and locations.
Conversely, the report notes, only nine states define and reimburse for store-and-forward services – with many limiting reimbursement to “real time” delivery platforms. Only 16 states reimburse for remote patient monitoring, the report notes, and while six states have added that platform since 2013, none have done so in the past year.
Finally, the report noted that 29 states include some form of informed consent in their telehealth guidelines, though it can vary from all telehealth encounters to specific specialties to the Medicaid program. And nine states issue special licenses or certificates for the practice of telehealth, while 12 states have joined the Federation of State Medical Boards’ Interstate Medical Licensure Compact, which maintains each state’s licensing duties but clarifies the process for telehealth providers seeking to practice in multiple states.
In all, the report states, 44 states introduced more than 150 telehealth-related pieces of legislation during the 2016 legislative calendar, and new bills are being proposed or passed on an almost-weekly basis.