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State Legislatures Examining the Benefits and Challenges of Expanding Telemedicine

December 14, 2015
by Heather Landi
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Barriers to widespread telehealth adoption include a number of policy-related issues such as coverage and reimbursement as well as licensures, and state policymakers need to collaborate with stakeholders to address these issues, according to a report from the National Conference of State Legislatures.

The adoption and expansion of telehealth across the nation poses various challenges, which, in turn, present policy questions for state leaders. The report focused on three primary policy issues related to telehealth – reimbursement for telehealth, licensures for telehealth providers and patient privacy, safety and security. The report is the result of a NCSL partnership project on telehealth in which state legislators, legislative staff and privacy industry representatives met for one year to discuss telehealth issues with the goal of providing options for state policymakers.

“Telehealth can help achieve the goals of the triple aim—improving care, bettering health and lowering costs—by improving access to appropriate, lower-cost services, such as timely primary or specialty care, or through lower-cost settings, including clinics, homes or workplaces,” the report stated.

With regard to coverage and reimbursement, the report highlighted that differences in payment and coverage for telehealth services in the public and private sector, as well as different policies across states continues to be a barrier to widespread telehealth use.

The NCSL report also identified provider licensure portability as a key issue and one that many states are already examining in order to expand telehealth access. State policymakers have addressed telehealth across state lines in various ways, including reciprocity with other states and interstate compacts.

The NCSL report offered a number of recommendations for state policymakers to address the three policy issues and collaboration with stakeholders within the industry was a key point within the recommendations.

With regard to coverage and reimbursement policy, the NCSL report recommends state legislators examine existing policies related to telehealth reimbursement and coverage in their states. The report authors encouraged legislators to ask questions such as: “Which providers can be reimbursed? For which services and telehealth modalities? Where must a provider or patient be located to ensure payment or coverage? What  other policies affect coverage and reimbursement?”

State policymakers also were encouraged to consider existing definitions of telehealth and to explore other states’ definitions while also weighing the benefits and potential obstacles to promoting consistent language across state lines to help standardize telehealth. And, state policymakers should consider Medicaid and state employee reimbursement policies and consider expanding covered services. At the same time, state leaders should consult with stakeholders and evaluate the benefits of telehealth expansion within the context of other state needs.

To address licensure issues, the NCSL report recommends that state policymakers consult with stakeholders, including provider boards, providers, payers and consumers, and then consider legislation related to licensure and workforce issues in telehealth as well as language in legislation to help provide appropriate guidance to boards.

The report also recommended assessing the role of licensure in existing or new payment and delivery reforms. “When creating legislation, consider language that includes or can apply to all provider types, including those who may provide telehealth services in the future,” the report authors wrote.

With regard to barriers related to safety and security, NCSL recommended that lawmakers balance the constraints being place on telehealth with the need to safeguard patient privacy, safety and security when examining existing or considering new legislation. State policymakers should also examine how to collect data from telehealth tools to evaluate the healthcare services delivered.

And, the NCSL recommends that state lawmakers study existing statues to evaluate where clarity might be needed and consult with stakeholders about changes and considerations.

And the report offered some overall recommendations as a framework for state policymakers to explore expanding telehealth:

  • Guide policy discussions that center on telehealth’s ability to extend existing health and long-term care services with technology, versus describing telehealth as a new service.
  • Conduct a needs assessment to find out where telehealth services are already being used and where investing in telehealth may be most effective. Identify model programs that may be replicable in your state, whether programs at private hospital system or universities.
  • Convene a variety of stakeholders from all sectors and perspectives to help ensure the best information is available when considering policy decisions. Consider all types of healthcare providers (e.g. physicians, nurse practitioners, physician’s assistants, psychiatrists, etc.), state boards, community health centers, hospitals and payers, as well as consumers, patients and family caregivers.

 

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