If you’ve ever consulted with a doctor through Skype or other videoconferencing system, or received continuing education via a webinar, you’ve participated in the expanding area of telehealth. As defined by the Health Resources and Services Administration (HRSA) telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.” The technologies used for telehealth range from videoconferencing and the internet, to store-and-forward imaging and streaming media, to the use of landline phones and cell phones.
The impact of telehealth on our health system could be far reaching. Telehealth is viewed as a way to improve access to health services for patients in rural areas, reduce healthcare costs (e.g., in 2013 the U.S. Department of Veterans Affairs reported that home telehealth services saved $1,999 per patient per year), and ensure disease control surveillance through methods such as video directly observed therapy (VDOT) systems. In many ways the applications for telehealth are outpacing the laws and policies governing our health system. Luckily there are online legal resources that cover state laws addressing the different telehealth policy areas.
First, the Center for Connected Health Policy (CCHP) has an online compilation of current and pending state telehealth laws and policies as well as an annual report. While the CCHP resources focus mainly on Medicaid policies, they also include state laws and policies that require private insurers to pay for telehealth services. The second legal resource is the Telehealth and Primary Care Provider Laws Map provided as part of LawAtlas by the Public Health Law Research Program (PHLR). This resource provides information about state laws and policies impacting the use of telehealth to deliver primary care and the reimbursement for such services. Telehealth topic and policy areas that are addressed by the CCHP and PHLR resources include: the definition of telehealth; reimbursement for various telehealth services (e.g., live video, store-and-forward, remote patient monitoring, transmission and/or facility fees); consent issues; service location and practice setting issues; online prescribing; physician oversight requirements; types of providers who may provide telehealth services; and cross-state licensure.
While the laws and policies evolve, state and federal policymakers continue to play an important role in telehealth’s emergence and recent activities at the federal and state levels are both pushing and restricting the limits of telehealth. Earlier this year at the federal level, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) released a draft of the Federal Health IT Strategic Plan 2015-2020. The plan sets out the federal government’s health information technology goals and encourages the use of telehealth as a strategy for expanding the adoption of health information technology and strengthening health care delivery.
Meanwhile in Texas, the Texas Medical Board recently adopted new rules to curb the ever expanding use of telehealth by requiring an in-person physical exam before a teleconsultation with a healthcare provider can occur. The board cited patient safety as a key reason for its decision. Opponents to the new rules point out that other states allow teleconsultations without in-person exams and argue that the rules limit the access to health services in rural Texas and prohibit businesses from reducing employee healthcare costs. The debate over telehealth in Texas is far from over. Teladoc, a Dallas-based provider of telemedicine services, has filed suit in the U.S. District Court in Austin challenging the board’s action.
This blog post was prepared by Andy Baker-White, J.D., M.P.H., associate director for the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.