Telehealth: Should states set their own rules?

By Eric Wicklund
09:14 AM

Telehealth advocates have long argued that the platform won't become an accepted form of healthcare delivery until doctors are reimbursed for using it. But do we need a national policy, or can we expect state governments to lead the way?

One look at the telehealth policies in the Northeast isn't so promising.

During a recent webinar by American Well, Kofi Jones, the Boston-based telehealth provider's vice president of public and government affairs, highlighted the policies in place in the six New England states and New York. The process took a significant chunk out of the hour-long webinar, and pointed to the difficulties that healthcare providers face in delivering care not only across state lines, but in their own backyard.

One of the problem states? Massachusetts, home of some of the more progressive health systems in the nation, but with no policy for Medicaid reimbursement for telehealth or commercial health plan reimbursements and a 12-year-old definition for online prescribing.

"It's been a unique challenge being a national telehealth policy expert and sitting in a state that has none of the telehealth policies we need," Jones lamented.

To be fair, Jones and Kathryn Audette, director of state government relations for Boston Children's Hospital, said the commonwealth is moving in the right direction. Audette noted a recent bill, HB 267, "An Act Advancing and Expanding Access to Telemedicine Services," has succeeded in galvanizing a broad array of healthcare and legislative supporters. Whether it gains enough support to pass remain to be seen.

Massachusetts is actually one of four states with no laws on the books requiring Medicaid to reimburse for telehealth services (Iowa, Rhode Island and New Hampshire are the others). On the opposite side of the coin, 29 states and the District of Columbia do mandate commercial reimbursement and six of them and DC go even further, mandating parity – reimbursement at the same rate as an in-person visit. On the national platform, Medicare offers some reimbursement, though there are restrictions on where care is delivered, and Jones said the program's standards for telehealth haven't been amended in 15 years.

As for the Northeast, Jones said each state is following its own path. Maine offers a "robust guidance" for defining telehealth and "fairly decent reimbursement" guidelines for commercial payers, she said, while the state's Medicaid rules mandate a dedicated need and a social or geographic reason for requiring telehealth, guidelines that require a lot of work to prove.

Jones said Connecticut enacted "very permissive" guidelines this year, mandating parity for commercial payers but more restrictive rules for Medicaid. New Hampshire also has new rules on the books this year, she said, improving on the definition of telehealth while setting specific guidelines for both commercial payers and Medicaid that aren't entirely positive, but aren't overly burdensome either.

Of Rhode Island, Jones said state officials were ahead of the times when they enacted telehealth definitions, but the state has done nothing on reimbursement – a fact she calls "disappointing." Vermont, meanwhile, is one of the front-runners, with progressive standards of care and parity in reimbursement for both commercial payers and Medicaid.

Then there's New York. "The medical board really has not done a tremendous amount of thinking on this issue," Jones said. They have not reworked any telehealth definitions in a decade, and while reimbursement guidelines for commercial payers were recently enacted, they're "very confusing," and the reimbursement guidelines for Medicaid need work.

That each state in the Northeast has its own vastly different standards and reimbursement rules for telehealth illustrates the rough landscape for the industry nationwide. No state wants to give up its regulatory authority, Jones said, and few are in agreement on how to define telehealth – medical boards in seven states, she said, "have done no thinking at all" on the subject.

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