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Policy News

How Telehealth Implementation Policies Vary Across the States

By Vera Gruessner

- Telehealth implementation policies differ in the wide array of states across the nation depending upon each individual region’s laws. Legislation such as telemedicine payment parity laws and telehealth implementation policies differ in each state while every year brings more rulings and modifications for technology and medical device adoption throughout the healthcare industry.

Telemedicine and Remote Monitoring

Some of the key aspects of telehealth implementation policies that states have adopted include deciding on definitions, reimbursement regulations, and physician licensing requirements, according to the Center for Connected Health Policy’s report called State Telehealth Laws and Medicaid Program Policies. For example, there are differences between how certain states define telemedicine versus telehealth.

While each state differs on aspects of their telehealth implementation policies, there are general trends that may be affecting telemedicine adoption throughout the country. For example, live video Medicaid reimbursement is paid at much higher rates than that of remote monitoring.

Currently, 16 states offer some form of Medicaid reimbursement for remote patient monitoring while 44 state Medicaid programs offer payment for live video use. Alabama, Maine, Colorado, Alaska, Indiana, New York, Texas, and Utah are a handful of the states that offer Medicaid reimbursement for remote patient monitoring services.

There are three states that lack a definitive, written reimbursement policy for telehealth and this includes Iowa, Massachusetts, and Rhode Island. The District of Columbia also falls into this category.

“A few states have adopted the Medicare policy in which reimbursable services are restricted to those provided in rural or underserved areas, or there are unusual requirements in order to ensure there is some distance between the patient and distant site provider,” the report stated.

The American Telemedicine Association released another analysis on the variations between state telehealth implementation policies called State Telemedicine Gaps Analysis – Physician Practice Standards & Licensure. Two of the biggest issues that this report discusses is telemedicine licensing requirements for physicians and general practice standards in the telehealth field.

There has been a mix of both improvements and slowdowns when it comes to state-based telehealth implementation policies as the field has blossomed and revolutionized patient care, especially in rural areas of the country.

This particular analysis report finds that Alabama, Arkansas, and Texas create the most complex and stringent clinical practice rulings for telehealth providers when stacked up against in-person healthcare practices.

“Health care providers have seen a considerable amount of state policy activity to improve coverage and reimbursement of telemedicine-provided services by various payers,” the report stated.

“However, despite improvements to address the payment challenges, health care providers are encountering conflicting and sometimes confusing policies from their own colleagues. Within the past year, over 25 states have considered proposals, with varied results, to revise health professional standards and licensure requirements when using telemedicine. Some states are creating new laws that impact access to care via telemedicine, while others are amending existing policies with greater implications.”

Practice standards are more specific in telemedicine than in-person visits among a few state medical boards, according to the report. For instance, many require an in-person physical exam as well as a patient-physician relationship to be created face-to-face instead of in the virtual setting.

Some other potential barriers the report finds include in-person exams following a telemedicine visit and patient-informed consent. Additionally, any telehealth providers who would like to offer their services across state lines often find that their licensing requirements forbid these actions.

“Every state imposes a policy that makes practicing medicine across state lines difficult regardless of whether or not telemedicine is used. Michigan, North Dakota, Pennsylvania, and South Dakota are the only states that do not allow some type of licensure exemption for physician-to-physician out-of-state consultation,” the report concluded.


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