The current state of telehealth regulations and legislation is a big jumble, like my aunt’s crazy quilt. You know the kind – where the pattern makes no sense. For telehealth, just a few basics tell the “story”:
Currently, only California, Texas, and Vermont have established laws to mandate that both public and private payers cover telehealth services. States with pending legislation to cover public and private payers include Arkansas, the District of Columbia, Iowa, New Jersey, Ohio, Rhode Island, and Washington.
- Arkansas – As of January 26, 2015, SB 133 was referred to Senate Committee on Public Health, Welfare and Labor and would require telehealth parity under Medicaid, private insurance and state employee health plans.
- District of Columbia – As of April 2104, B. 20-248 and B 249 have been referred to Business, Consumer and Regulatory Affairs Committee, and would require private payer insurance companies and D.C. Medicaid to pay for services delivered through telemedicine.
- Iowa – As of February 19, 2015, HF 218 was passed to subcommittee and would require private payer reimbursement under the medical assistance program. As of March 2, 2015, HF 404 was in the House Committee on Human Resources, and would require reimbursement by insurance plans and the state’s Medicaid program.
- New Jersey – As of October 31, 2015, the Pension and Health Benefits Commission has recommend to not enact AB 3675, which would require health insurers to provide coverage for telemedicine.
- Ohio – As of February 11, 2015, SB 32 was referred to Senate Committee on Rules and Reference, and would require Private insurance and Medicaid parity.
- Rhode Island – As of February 12, 2015, HB 5422 was introduced and referred to House Committee on Corporations, and would require health insurance policies, plans or contracts to include provisions for the reimbursement of telemedicine services. As of February 2, 2015, HB 5177 was recommended held for further study, and would provide telemedicine parity for private insurance and Medicaid.
- Washington – As of February 16, 2015, SB 5175 was referred to Health Care and Wellness Committee, and would require reimbursement of telemedicine services.
There are a group of states where legislation exists requiring state Medicaid plans to cover telehealth – forty-seven state Medicaid programs have some type of coverage for telemedicine. And, there is pending legislation related to Medicaid in a number of states – including Missouri and Texas.
- Missouri – As of February 10, 2015, public hearing for HB 319 was completed. This bill would establish providers and originating sites that qualify to provide telehealth services in their Medicaid program. As of February 18, 2015, HB 965 was being read a second time, and would require reimbursement for home telemonitoring under Medicaid.
- Texas – As of March 2, 2015, SB 550 is scheduled for a public hearing, and would clarify telehealth and Medicaid telemedicine reimbursement provisions.
And, examples of other pending legislation related to telehealth include:
- Florida – As of January 22, SB 478 was pre-filed. This bill seeks to, among other things, define the term “telemedicine services”, and require telemedicine services to be covered by specified Medicaid programs in the same manner as services provided to a recipient in person.
- Minnesota – As of February 25, HF 1246 has been introduced and referred to Committee on Health and Human Services Reform. The bill seeks to require coverage of telemedicine through the medical assistance plan.
- New York – As of January 7, AB 810 was introduced and referred to the Assembly Committee on Health. This bill seeks to establish the Rural Home Health Flexibility Program, which among other things will operate long term home health care programs, which will qualify for home telehealth reimbursement.
In total, 36 states have introduced 100 different telehealth bills in the first two months of this year (see 36 States Introduce 100 Telemedicine Related Bills). For more on these pending legislative initiatives, check out 2015 State Telemedicine Legislation Tracking from The American Telemedicine Association; and National Telehealth Policy Resource Center from The Center for Connected Health Policy.
The impact of telehealth on the strategies of health and human service organizations is uneven – for good reason. For telehealth to be most disruptive, three factors in a market need to be in place:
- The majority of the high-spending population needs to be in managed care financing and delivery models.
- Value-based payment arrangements (ACOs, medical homes, bundled rates, etc.) with provider organizations needs to be used within those managed care models.
- Regulatory and legislative environments need to support telehealth.
Where these three factors are in motion, the service delivery markets will be most disrupted – with both strategic challenges and strategic opportunities for existing players. We will keep you posted on all three. In the meantime, for some of our best resources on telehealth, check out:
- Telemedicine Could Save U.S. Employers $6 Billion Annually If Percentage Of Employers Offering Health Plans That Cover Telehealth Increases To 37%
- The Uphill Climb To Virtual Care
- Telehealth & The World Of Behavioral Health Care: How New Tech Is Changing Service Delivery, Performance & Operations
- Preparing For The Telehealth Tipping Point
- Telehealth Services in the United States Department of Veterans Affairs
- Where Are We With Telehealth? Does The Snapshot Tell The Story?
- Planning & Technology: How To Build A Sustainable Model For Telehealth In Your Organization
- Competitive Advantage Via Telehealth
- Building A Sustainable Telehealth Program
- Building A Sustainable Telehealth Program: Learning From The Experiences Of Executives Who’ve Been There
- 12% Of Veterans Served Via Telehealth In Fiscal Year 2014
- Health Care Professionals Report Disparities In Private Payer Reimbursement Policies For Telemedicine Vs. In-Office Visits
And for more, don’t miss our pre-institute seminar, How To Build A Successful Technology Plan: From Innovation & Strategy, To Budgeting & Selection, at The OPEN MINDS Technology & Informatics Institute.