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Arkansas Still Struggling with Telehealth Regulations

While the video visit has been OK'd by state regulators, the debate continues on the definition of 'originating site' and 'store-and-forward' telehealth.

By Eric Wicklund

- Arkansas is moving toward legislation that would enable healthcare providers to treat first-time patients via telehealth – though those patients would still have to be sitting in a healthcare facility to take advantage of the service.

The Arkansas Legislative Council’s Rules and Regulations Subcommittee has signed off on an amendment to Regulation 2.8 of the state’s Medical Code, permitting a physician licensed in the state to use real-time audio-visual technology to establish a relationship with a first-time patient. The amendment will go into effect in 10 days.

Arkansas is one of only a few states still to mandate an in-person visit prior to a telehealth relationship. News reports out of Texas, whose medical board has been fighting to keep that regulation on the books, say telehealth advocates and state officials are working on a compromise that would allow doctors to use audio-visual technology to establish a relationship with new patients.

The news wasn’t all good in Arkansas, however.

The subcommittee did not vote on a separate proposal known as Regulation 38, which establishes guidelines for the use of telehealth technology. Among those guidelines are definitions of “store and forward technology” and the “originating site” for a telehealth encounter.

The board’s decision clears the way for providers to connect with patients via virtual visits, but only when the patient is receiving treatment in a health facility. As such, it would prevent Arkansans from accessing telehealth from their home, office and other location.

In addition, the current terminology excludes the online patient questionnaire as a form of store-and-forward technology, a staple for several of the larger telehealth vendors.

Both issues, hotly contested in recent meetings of the Arkansas State Medical Board and a public hearing earlier this year, will now be on the agenda for the board’s October meeting.

The ongoing debate places Arkansas squarely in the crosshairs of telehealth advocates, including the American Telemedicine Association and ERISA, who say the state is one of the most restrictive in the nation. But it’s not the only state wrestling with the concept. Several states and the Centers for Medicare & Medicaid Services have struggled to define an “originating site,” with Medicare limiting how providers can be reimbursed based on where the patient is located.

Some states have also debated whether to include the online patient questionnaire as a form of store-and-forward technology – a key aspect of asynchronous telehealth platforms and companies like Teladoc, which does a majority of its business by phone and has so far been prevented from doing business in Arkansas.

Telehealth proponents – including representatives for Teladoc and several of the state’s largest employers – have argued that state medical officials are going overboard in their efforts to regulate the technology. By restricting a patient’s access to telehealth or a health facility and banning the questionnaire, they say, residents can’t use a telehealth platform when and where it’s most convenient for them. This would also block businesses such as Wal-Mart, America’s Car Mart and the Arkansas Trucking Association from offering telehealth to their employees.

Following the Aug. 16 meeting, the medical board’s lawyer said Regulation 38 would be back on the table in October.

“A version will be passed by the Medical Board,” Kevin O’Dwyer told reporters after the meeting. “I don’t know what version. Whether it will have ‘store and forward’ or not … that I don’t know.”

Dig Deeper:

New Report Paints a Frustrating Picture for Telehealth Advancement

AMA Approves Ethical Guidelines for Telemedicine


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