Offering a convenient and cost-effective way to extend health care to the millions who need it most, telemedicine has made giant strides in recent years. As state legislators and health care providers more fully realize its potential, states have laid the foundation to speed its growth by passing legislation that creates a more hospitable climate for telemedicine within their states. One of the most recent such advances comes from New Jersey, where a key state Senate committee recently cleared legislation that will give telemedicine a much-needed boost in the Garden State.
Noting that telemedicine is “expanding the universe of care for millions of Americans,” Senator Joseph Vitale, one of the bill’s sponsors, said that this new legislation offers “an opportunity to get this working the right way” in New Jersey. Vitale is chairman of the state Senate Health, Human Services, and Senior Citizens Committee.
Provisions of NJ Bill
According to Vitale, the proposed New Jersey legislation would require:
- Insurers to reimburse for telemedicine services at the same rate as in-person visits,
- The State Board of Medical Examiners to write and put into effect specific guidelines for the practice of telemedicine within the state, and
- Physicians to meet in person with patients before prescribing medications that are potentially addictive.
If the proposed legislation is enacted, New Jersey would join the more than 25 states that require telemedicine services be given the same treatment as in-person health care services under the law. Such laws are known as telemedicine parity statutes. And New Jersey is not the only state where telemedicine parity legislation is in the works. Also working on such legislation in the latter half of 2016 are state lawmakers in Illinois, Iowa, Massachusetts, North Carolina, Ohio, and Pennsylvania.
Yet another sponsor of the pending New Jersey legislation, Senator Diane Allen pointed out that access to telemedicine services is “especially vital” for certain types of patients. Interviewed for an article posted at NJ.com, Allen said such groups include homebound senior citizens, patients suffering from chronic illnesses, and people who live far from doctors and medical centers or who would otherwise find it difficult to travel for health care.
“No one should have to choose between paying for groceries and traveling to see a doctor,” said Allen. “By legalizing telemedicine, we can bring the cost of healthcare down and expand access to a variety of health services for millions of new patients.”
Not everybody in New Jersey welcomed all the specifics of this most recent legislative development. Wardell Sanders, president of the New Jersey Association of Health Plans, decried the provision that requires that telemedicine services be reimbursed at the same rate as in-person appointments. “We would argue there should be flexibility to allow for different pay structures,” he told NJ.com.
A Nonprofit Association
Sanders’ organization is a nonprofit association that represents both commercial and Medicaid health insurance plans that collectively cover nearly 7 million state residents. He pointed out that only seven of the 31 states that have passed telemedicine legislation mandate reimbursement for telemedicine services “to the same extent as for in-person treatments and consultations.”
In response to Sanders’ criticism, Vitale argued strongly against creating lower levels of reimbursement for telemedicine services than those paid for in-person services. He said to do so would sabotage one of the key goals of the state’s new legislation, namely the promotion of the use of virtual medicine. If payment for virtual services were less than that for comparable in-person services, said Vitale, it would remove the incentive for the state’s doctors to increase their use of telemedicine services.
Helps Those with Developmental Delays
In testimony before Vitale’s committee, Karen Olanrewaju, program director for Sunny Days Early Childhood Developmental Services in Manalapan, said telemedicine could be particularly beneficial for infants and toddlers with developmental delays. She noted that therapists affiliated with the state’s Early Intervention program have been experimenting with the technology, which provides a “secure platform” for interactions between patients and professionals.
By putting to use the unique features of telemedicine technology, said Olanrewaju, “we can eliminate the concerns about the spread of infection, travel issues, and significant practitioner shortages in certain regions of the state.”
Among the most formidable stumbling blocks to the nationwide expansion of telemedicine services has been the crazy-quilt of regulations from state to state. While the vast majority of states have taken steps to create a more hospitable environment for the growth of telemedicine, the laws vary between state jurisdictions, sometimes only slightly but in other cases more significantly.
2016 Progress Report
In an August 2016 analysis of telehealth laws and regulations across all 50 states and the District of Columbia, the Center for Connected Health Policy noted that “no two states are alike in how telehealth is treated despite some similarities in the language used.” While some states have incorporated telemedicine-related policies into law, others address such issues only within their Medicaid program guidelines. CCHP said it had even discovered policy inconsistencies within a single state. In its report, the center said that “this variability creates a confusing environment for those who use (or intend to use) telehealth, especially health systems that provide health care services in several states.”
Among the findings in CCHP’s 2016 report are the following:
- Medicaid programs in 48 states and the District of Columbia are reimbursing for live video telemedicine consultations (as of August 2016).
- Medicaid programs in 12 states offer some degree of reimbursement for the use of store-and-forward technology, not counting states that reimburse only for teleradiology. Store-and-forward technology involves the acquisition of clinical information, in the form of data, image, sound, or video, that is then forwarded to another medical professional for clinical evaluation.
- Medicaid programs in 19 states reimburse for remote patient monitoring. Similar programs are scheduled to take effect in three other states at a future date.
- Medicaid programs in 30 states offer a transmission or facility fee when telemedicine is used.
- Twenty-nine states require that telemedicine-specific informed consent be obtained from the patient under state statute, administrative code, and/or Medicaid policy.
- Thirty-four states and the District of Columbia have enacted laws that govern private-payer telehealth reimbursement policies.
- Nine states have some form of geographic requirements that restrict telemedicine reimbursement to rural or underserved areas, or require a certain amount of distance between an originating and remote site.
- Half of all states limit reimbursement to a specific list of facilities. Ten of those states have added such lists to their policies within the nine months prior to August 2016.
- Nine state medical boards issue licenses specific to the practice of telemedicine, while 17 other states have signed on to the Interstate Medical Licensure Compact, which expedites the licensing process across state lines.
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