State Specific Issues
The practice of medicine has become progressively more complex in the last decade as increasing regulation and payer restrictions/policies have encroached on the physician patient relationship. Nowhere is this more clear than at the cutting edge application of technology and healthcare delivery. Telemedicine is no different. Within each state there may be multiple hurdles to overcome, boards to interact with, specific technology requirements, and payer specific requirements. It is advisable that all of these bodies be consulted prior to beginning the practice of telemedicine in order to ensure proper care, fair reimbursement, avoidance of unforeseen medicolegal issues, and to provide best care for our patients. This brief will attempt to provide a guideline for approaching this process but will not address specific issues with practicing across state lines. That will be covered in another section. This section will attempt to cover regulatory issues, not reimbursement nor technology requirements at the state level.
Specific State Resources
Many states have both a state medical board and a state board of pharmacy and approval or licensure from both may be required. The Federation of State Medical Boards has a comprehensive list of known requirements by state statutes and is a good place to begin. FSMB also has a MODEL POLICY FOR THE APPROPRIATE USE OF TELEMEDICINE TECHNOLOGIES IN THE PRACTICE OF MEDICINE available on the website. Do not forget that CMS also has specific definitions and requirements for the use of telemedicine which can be found at www.cms.gov and www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf.
As not all states have a separate state pharmacy board involved in regulation of prescription writing it is advisable for you to seek out your individual state requirements by contacting these boards in your state. For example, at the time of publication, the state of Kansas has no specific laws regarding telemedicine. Guam requires only that physicians be licensed somewhere in the United States. Many states, including Texas require that the physician be licensed in the state where the patient is located. Some states like Maryland grant reciprocity to patients residing in adjoining states (see www.fsmb.org). See additional information regarding the interstate medical license compact in the section titled Providing Care Across State Lines.
Some states have also adopted a separate license for the practice of telemedicine. It is also notable that the laws and regulations regarding practice of telemedicine are evolving rapidly such as in Montana, Oregon, and Alabama.
Many state medical societies or licensing boards have already provided resources and step by step guidelines to adopt the practice and telemedicine and you may wish to encourage your states organizations to do the same. An excellent example is the state of Pennsylvania’s website. Other excellent examples are put forth by the Texas Medical Association.
Many excellent infographics and information/requirement summaries can be obtained at the Center for Connected Health Policy.
A very important issue is that many states require informed consent for the practice of telemedicine. Requirements for informed consent vary by state and should be cleared by your state medical board.
Payer Specific Resources
Individual payers will also have requirements that may be more stringent than state board requirements. This may not have a direct effect on what you can and cannot do as part of a telemedicine visit, but it will highly influence reimbursement for services rendered. It is advisable to contact each of your payers for their specific policies and coding requirements. At the time of writing there is no single source that amalgamates these requirements. Some payers such as United Health already offer their members access to virtual visits. There are also some commercial entities that exist who will facilitate this process for a part of your fee. As none of these entities have been vetted or endorsed by the AAAAI, they are not listed here.
These links are for research only. They are not endorsed by the American Academy of Allergy, Asthma & Immunology (AAAAI).