Last Modified: 06/04/2015
VIII. Licensure, Reimbursement, Legislation
In preparation for pursuing coverage of tele-audiology at the state level, it is important to understand general procedures as well as talking points in support of telehealth and talking points for rebutting common arguments opposing tele health coverage. The ATA State Policy Toolkit: Improving Access to Covered Services for Telemedicine [PDF] is a great resource.
Licensure rules are relatively straightforward: As with any service delivery by a health provider, in order to conduct remote diagnostic evaluations, an audiologists must be licensed in the state where the infant is. For most of the members involved in this learning community, inter-state licensure was not required since they were serving infants in remote regions of their own state. However, audiologists in Colorado were required to be licensed in Guam.
Reported by the American Telemedicine Association news “two pending bipartisan bills which would expand the "one state license" practice to other federal interstate telehealth programs. With these bills, a healthcare professional would need only one state license to serve patients in any location who are covered by a federal health program.
- H.R. 2001 for the Department of Veterans Affairs with the VETS Act (Veterans E-Health & Telemedicine Support Act)
- H.R. 3077 for Medicare with the TELE-MED Act (TELEmedicine for MEDicare Act)”
Although these bills address services typically provided to an adult population, they would set serious precedence for interstate licensure to support pediatric services as well.
- The American Speech Language Hearing Association (ASHA) provides a link to state telepractice regulations as well as model regulations to guide improvement of state policies.
Reimbursement is not straightforward. Rules vary state to state and by private versus public payment sources. However, reimbursement barriers slowly are devolving. Commentary by Paul Cerrato writes how “Barriers to telemedicine slowly crumble”.
The Northwest Regional Telehealth Resource Center has a useful article discussing how one state was able to get a telehealth parity law passed.
Learn the steps [PDF]
- The Center for Connected Health Policy helps you stay informed about telehealth-related laws, regulations, and Medicaid programs. They cover current and pending rules and regulations for the U.S. and all fifty states. Find up-to-date state-specific information at their website.
- A summary of “Telemedicine legislation: Who is keeping count?,” written by Herb Rogove, gives an overview several federal legislations that could effect the telemedicine/telehealth community:
- H.R. 6719 TeleHealth Promotion Act: “the goal of this bill was to prevent readmission and help with interstate licensing”.
- H.R. 3077 TELE-MED (TELEmedicne for MEDicare) Act of 2013 “the goal of this bill is to amend Title XVIII of the Social Security Act to permit certain Medicare [specialists] licensed in one state to provide telemedicine services to certain Medicare beneficiaries in a different state”.
- H.R. 3306 Telehealth Enhancement Act of 2013: “with the goal of promoting and expanding the application of telehealth under Medicare and other federal healthcare programs, and for other purposes:
- Eliminate restrictions on telehealth reimbursement for Medicare patients;
- Adjust Medicare home health payments to account for remote patient monitoring;
- Expand telehealth coverage to all critical access and sole community hospitals;
- Cover home-based video services for hospice care, home dialysis and homebound Medicare beneficiaries;
- Allow state Medicaid programs to set up high-risk pregnancy networks;
- Encourage ACOs to use telehealth”.
- The American Telemedicine Association (ATA) news identifies proposed telehealth expansions in Medicare. Starting in 2014 telehealth services will see some of the following changes in Medicare and Medicaid services as written by ATA:
- “Expanding the geographic areas where telehealth service can be provided into the fringes of metropolitan areas
- Adding coverage for transitional care management services (CPT codes 99495 and 99496) and making explicit that coverage includes the Evaluation and Management portion of these services
- Adding coverage for chronic care services (CPT codes 99487-99489) for patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
- Slightly increasing the fee for originating (patient) sites to $24.63 from $24.43”
- More information about the official proposed telehealth expansions in Medicare [PDF] can be found at the office of the federal register under the telehealth section pages 536-557 and chronic car management pages 589-632.
- ATA's State Telemedicine Gaps Analysis Coverage & Reimbursement [PDF]
State Telehealth Laws and Reimbursement Policies report [PDF] “offers policymakers, health advocates, health care professionals and others with an interest in telehealth a summary guide of the most recent information available about how each of the 50 states (and the District of Columbia) defines, governs, and regulates the use of “telehealth” or “telemedicine” technologies in the delivery of health care services” (CCHP).
Medicaid Policies and Reimbursement
State Medicaid Best Practice, Telerehabilitation (January 2014) [PDF] is an excellent document highlighting states with Medicaid reimbursement for telerehabilitation.
50 State Telehealth Medicaid Policy Report
The Center for Connected Health Policy (CCHP) has released an analysis of state telehealth laws and Medicaid reimbursement policies. The report focuses on eleven key areas of telehealth that continually get brought up in the discussions about reimbursements, licensing, and definitions in state’s Medicaid programs.
Specific policy areas related to telehealth surveyed and addressed by CCHP:
- Definition of the term telemedicine/telehealth
- Reimbursement for Live Video
- Reimbursement for Store and Forward
- Reimbursement for Remote Patient Monitoring (RPM)
- Reimbursement for Email/Phone/FAX
- Consent issues
- Location of service provided
- Reimbursement for transmission/facility fees
- Online Prescribing
- Private payer laws