Telehealth progress at the federal and state levels

The use of telemedicine (or telehealth) technology is increasing rapidly across the U.S. healthcare industry. Telemedicine is being practiced in workplaces, schools and prisons, and by major pharmacy chains.

The arguments in favor of telemedicine (better, more accessible care and reduced costs, among others) have been acknowledged for some time. However, legislation that supports broader integration of telemedicine into today’s healthcare system has been lagging.

Over the past year, there has been some legislative movement at the federal and state levels. Several bills are being debated in the U.S. Senate and House, and state efforts to increase cross-jurisdictional access and licensure are progressing. The following is a short list of key bills and what they might mean for healthcare providers.

Proposed federal legislation

One of the primary barriers to expanding the practice of telehealth is the issue of access. The TELE-MED Act (S. 1778 and H.R. 3081) is designed to reduce barriers to interstate care by allowing Medicare participating physicians to treat Medicare patients in all 50 states with a single medical license. It must be understood that it is not a federally imposed change to existing state laws that require physicians to be licensed in the states in order to provide care for non-Medicare patients. The act allows telemedicine care only to be practiced by Medicare-eligible physicians for Medicare patients.

A second piece of federal legislation is the Medicare Telehealth Parity Act (H.R. 2948). The act lays out a phased expansion of telehealth services that includes removing geographic barriers under current law and expanding the list of telehealth-eligible providers to include respiratory therapists, physical therapists, occupational therapists, speech language pathologists, and audiologists. 

The act expands access to telestroke services regardless of patient loction, allows remote monitoring of patients with chronic conditions, allows the beneficiary’s home to serve as a site of care for certain services, and removes some of the reimbursement roadblocks that have limited access to innovative remote patient monitoring.

The Telehealth Enhancement Act (H.R. 2066) is designed to promote and strengthen Medicare and other federal telecommunications programs through expanded telemedicine coverage. The proposed act adds to the list of currently qualified sites, and includes urban critical access hospitals, sole community hospitals, home telehealth sites, and any originating site in current law for the treatment of acute stroke. The proposed act also provides positive incentives for Medicare’s Hospital Readmissions Reduction Program, by providing hospitals with an additional payment for the shared savings achieved from better-than-expected performance in reducing hospital readmissions.

Next: A coordinated state effort

A coordinated state effort

Licensing of physicians in multiple states has been a major barrier to the cost-effective adoption of telemedicine. In addition to federal Medicare-focused legislation, the states are seeking their own solutions to the problem of cross-jurisdictional access.

The most important of these initiatives is the Interstate Medical Licensure Compact. Following the Federation of State Medical Board’s completion of the model compact in September 2014 and its endorsement by 30 state medical boards, it has been enacted in 11 states. Eight more states have introduced the compact during their most recent legislative sessions.

The compact does not eliminate the need for providers to obtain a license in every state in which he or she intends to practice telemedicine, nor does it remove control of standards of care and other regulatory issues from the states. It does, however, provide for an expedited process for obtaining full, unrestricted licenses to practice medicine in each relevant state.

While the progress of telemedicine legislation may, at times, appear slow, healthcare providers and systems should stay abreast of these and other legislative and regulatory developments across the United States so that they may take effective action should these and related bills become law.

Nadia de la Houssaye is a partner with Jones Walker LLP in Lafayette, Louisiana, and is the head of the firm's telemedicine section.