By Duane Morris Government Strategies, (Originally published 2/1/17; updated 4/7/17)
On December 14, 2016, former President Barack Obama signed the Expanding Capacity for Health Outcomes (ECHO) Act, expanding the implementation of healthcare technology. The law, which was sponsored by Sen. Orrin Hatch (R-UT), requires the Department of Health and Human Services to report on technology-enabled learning procedures and models that help specialists work with primary care providers. The law is geared toward disseminating best healthcare practices with telehealth serving as a key platform.
Framed off an initiative that begun at the University of New Mexico’s Health Science Center, the ECHO Act supports the expansion of healthcare technology that can connect undeserved communities with specialty healthcare services. It also educates primary care providers and nurses in an effort to increase the availability of specialty care. ECHO creates “hubs” that deliver specialized education and feedback to other healthcare professionals located at the local level. ECHO addresses disparities in healthcare access, rising costs, systemic inefficiencies and the slow diffusion of best practices. While the law does not expound upon telehealth services, it does underscore the need to improve technology-based services.
Besides the ECHO Act, several other pieces of telehealth legislation have been introduced into the House and Senate. The Reaching Underserved Rural Areas to Lead Telehealth Act of 2015, sponsored by Sen. Roger Wicker, (R-MS), directs the FCC to remove regulations on Medicaid reimbursements non-rural hospitals receive from the Healthcare Connect fund, which provides funding for healthcare facilities internet service. The Telehealth Innovation and Improvement Act of 2015, sponsored by Sen. Cory Gardner (R-CO), would require the Center for Medicare and Medicaid Innovation to test the impacts of a telehealth delivery system. In 2015, Rep. Doris Matsui (D-CA) introduced the Telehealth Modernization Act of 2015 to help create a federal standard for telehealth procedures. However, all three bills never moved passed their congressional committees.
As federal lawmakers seek a telehealth regulatory policy, 47 states and the District of Columbia have established some sort of Medicaid reimbursement policy for telehealth (Massachusetts, Rhode Island and Utah do not have a policy). Meanwhile, 29 states and the District of Columbia have telehealth mandates for private insurers.
The Federation of State Medical Boards said telehealth was the primary healthcare regulatory issue in 2016, but comparing state laws for telehealth remains difficult because requirements, polices and licenses vary. Moreover, 150 pieces of telehealth legislation were introduced in 44 statehouses in 2016, while 42 states proposed more than 200 pieces of legislation related to telehealth in 2015.
In an effort to increase interstate collaboration and provide a uniform framework for telehealth, several states have introduced licensing compacts that allow out-of-state healthcare providers to treat patients. While not specifically designed for telehealth, the compacts create a roadmap for a strong regulatory policy. Nine states have implemented policies specific to telehealth, while nine other states have created mandates for Medicaid reimbursement for store and forward telemedicine.
As federal and state legislatures try to smooth out details, several issues remain. Concerns about doctors writing prescriptions for patients via telehealth linger. Specifically, whether a proper patient-doctor relationship can support an adequate diagnosis and prescription over an electronic platform. Doctors also have concerns over malpractice and what that means in a telehealth market. If telehealth continues to gain popularity, a legal framework over consent for doctors and patients interacting via the internet is paramount.
Last year, the Department of Health and Human Services created the National Quality Forum Telehealth Multistakeholder Committee to help measure and quantify telehealth-delivered care, before identifying best practices. Meanwhile, other organizations, like the American Heart Association, is advocating Medicare to cover telehealth services for cardiovascular disease.
“As the conversation surrounding Healthcare in the US evolves—especially following the AHCA debate last month–telehealth will almost certainly remain a top issue in 2017 as more consumers look to it as a low cost alternative to the doctor’s office” says Brett Goldman, DMGS Manager of Special Projects.
Telehealth: New Jersey
In September 2016, the New Jersey Senate Health Committee approved bipartisan telemedicine legislation (S. 291) sponsored by Sen. Joe Vitale (D-Middlesex), but the state assembly awaits a vote on the bill’s companion legislation.
The legislation has several provisions:
- Ensures health insurance companies provide coverage and payment for telemedicine services at the same rate as provided in person.
- Doctors must meet with a patient in-person before receiving a written prescription for potentially addictive substances.
- The State Board of Medical Examiners will write and adopt specific rules for practicing telemedicine.
The bill also allows out-of-state providers to treat New Jersey residents via telemedicine, while ensuring New Jersey’s Medicaid and NJ Family Care plans reimburse for telehealth at the same rate as in-person care. Some physician’s organizations, like the New Jersey Association of Health, say the proposed legislation offers little flexibility in payment structures. The bill’s supporters say eliminating uniform payment will only deter doctors from using telemedicine.
The bill does exclude audio, email and text message communications from approved telehealth platforms, meaning most telehealth in New Jersey will primarily rely on FaceTime and other video interfacing technology.
While legislators shape the state’s telemedicine framework, the New Jersey Department of Health announced a $290,000 grant in January for a telehealth company providing care for military veterans seeking behavioral healthcare but experiencing transportation challenges. The grant aims to help veterans suffering from depression, anxiety, post-traumatic stress and other psychiatric disorders, but have trouble traveling to a Veteran’s Affairs clinic.
In April, Plushcare, a San Francisco-based telehealth services provider operating in 17 states, announced it would begin providing services to New Jersey residents. Plushcare, which specializes in sinus infections, pink eye, STD’s and other ailments, started in San Francisco in 2014 before expanding to Ohio, Pennsylvania and New York. The company has partnered with roughly 50 primary care specialists, including several in New Jersey, for patients requiring a doctor’s visit.
However, with the state’s telemedicine law pending, New Jersey residents and physicians don’t have any protections in place, which has hindered telehealth’s delivery. According to a survey of physicians released in March by SERMO, a social network for doctors with more than 600,000 worldwide, only 15 percent of U.S. physicians rated their state’s telehealth programs favorably. A significant number of the survey’s participants were from New York, New Jersey, Ohio and California. Unfortunately, of the 1,651 U.S. physicians surveyed, 59 percent ranked New Jersey’s telehealth implementation as “poor” to “very poor,” while Ohio and California received relatively high approval marks. New York managed slightly better than New Jersey.
State Legislative Overview
States Enacting Interstate Medical Licensures
Alabama, Arizona, Colorado, Idaho, Illinois, Iowa, Kansas, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, West Virginia, Wisconsin and Wyoming.
States with Telehealth Specific Licenses
Alabama, Louisiana, Maine, New Mexico, Ohio, Oklahoma, Oregon, Tennessee and Texas
Medicaid Reimbursement for live Video
47 states have some sort of Medicaid reimbursement for telehealth video, but three do not, Massachusetts, Rhode Island and Utah.
Store and Forward Medicaid Reimbursement
Alaska, Arizona, California, Illinois, Minnesota, Mississippi, New Mexico, Virginia and Washington
Danny Restivo, DMGS Pittsburgh, Contributed to This Report