Increased use of telehealth prompts heightened legislative activity

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

In 2015, more than 200 bills were introduced in 42 states addressing telehealth. The use of telehealth services is expected to grow from 250,000 patients in 2013 to 3.2 million in 2018. These are just some of the findings contained in an extensive report on telehealth by the National Conference of State Legislatures (NCSL).  

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Released in December, the report lists a number of telehealth’s potential benefits, including ameliorating health care work force shortages and maldistributions and reducing health care costs and disparities. It then goes on to explore a number of policy considerations that this advancing and promising technology raises.

The NCSL report groups these issues into three main categories: coverage and reimbursement, interstate licensure, and safety and security. These are the issues being examined and addressed by state and federal legislatures.

Next: Coverage and reimbursement

Coverage and reimbursement

At the federal level, coverage and reimbursement for telehealth varies. Under Medicare, reimbursement is limited, according to the report, and allowed for only certain modalities, services, and locations. For example, the site where the patient receives treatment must be a rural location or one outside of a metropolitan statistical area as defined by federal regulations. Two pending federal bills introduced in 2015 cited by the NCSL would expand telehealth services under Medicare: The Medicare Telehealth Parity Act (HR 2948) and The Telehealth Enhancement Act (HR 2066). Coverage and reimbursement varies under Medicaid, as states have greater control over reimbursement and coverage policies, but currently 49 states and the District of Columbia do have some coverage for telehealth. (Rhode Island is the only state that currently provides no coverage.)

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Laws governing telehealth coverage and reimbursement for private insurance likewise vary. Where reimbursement is required, some states require that the reimbursement is “equivalent to” that for in-person services, while some require that it be “on the same basis as” in-person services. According to the NCSL report, by 2017, 32 states and the District of Columbia will have some form of telehealth parity laws.

Licensure

Licensure is another important issue states must address, according to the report. The advent of telehealth means that a physician licensed in one state can treat a patient in another state, but licensure is determined by where the patient is treated. The report lists a number of ways states have addressed this issue, including the granting of temporary medical licenses, telehealth- specific licenses, and reciprocity agreements with neighboring states.

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Another option is to join a licensure compact such as the Federation of State Medical Boards’ Interstate Licensure Compact, which is a system that allows a physician to apply for licensure to practice among the compact states. The NCSL report lists 11 states that have joined this compact, including Alabama, Illinois, Minnesota, and Utah; Wisconsin has since become the twelfth state to enter the compact.

Next: Safety and security

Safety and security

Safety and security issues, the last main grouping explored in the report, include those surrounding patient-provider relationships, informed consent, and data security compliant with the federal Health Insurance Portability and Accountability Act. In examining these issues, the report states that the standard of care applies to health care providers regardless of the means of delivery, and thus, the standard of care and best practices should similarly govern safety in telehealth. It goes on to note that the standard of care is likely to evolve as teleheath is further employed.

The report concludes that telehealth is a rapidly growing field with the potential to assist states with a number of health care issues and that “[s]tate leaders are grappling with how to capitalize on this potential while safe-guarding state investments in telehealth and ensuring patient outcomes and safety.”

Telehealth has made inroads in urology and will be the subject of a presentation by two expert urologists-Eugene Rhee, MD, of Kaiser Permanente San Diego, and Aaron Spitz, MD, of Orange County Urology Associates in Laguna Hills, CA-at the 2016 Urology Joint Advocacy Conference. The JAC is co-sponsored by the AACU and AUA, and takes place at The Willard InterContinental in Washington, Feb. 28-March 1, 2016.

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