Page 35 - Network Magazine Summer 2019
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conducted through telemedicine. Other states allow the physician-patient relationship to be established entirely through telemedicine interaction. Each state has its own laws regarding patient consent for treatment, and some states do not require it at all. Traditionally, written consent is required, and some states maintain this requirement for telemedicine care. Other states have adopted the written consent to an interactive online form that en- sures patients read and check each pertinent line item. Lastly, cross-state licensing, which allows practitioners to provide telemedicine care to a patient in a neighboring state in which the practitioner is not licensed, requires the cooperation of state medical boards to form work- ing models. These models include reciprocity, licensure by endorsement, and mutual recognition. Reciprocity is the simplest model allowing practitioners to utilize their existing license in another state.
Licensure by endorsement involves state boards granting licenses to practitioners who hold valid licenses in states with similar standards. Some endorsement states require the practitioner to attain additional qualifications. Mutual recognition involves the organization of a multi-state pact that forms a legal agreement to ac- cept the policy and processes of each participant-state with efforts made to promote the “harmoniza- tion of standards.” Each of these issues has required significant consideration by policymakers to ensure that the quality of patient care does not decline as a result of telemedicine.
State-mandated reimbursement programs are vital to the survival of telemedicine. In each state, both private payer reimbursement and Medicaid & Medicare reimbursement require legislation. Private carriers almost universally ex- clude "asynchronous" telemedicine. They also have strin- gent requirements regarding the technological platforms utilized for the "appointment." Third-party platforms, such as Skype are not permitted. Only platforms that are specifically designed for telemedicine are allowed. This ensures patient privacy and prevents connectivity-related issues. Reimbursement levels are also controlled by the state with most requiring the same level of reimbursement for telemedicine as for in-person visits. Medicaid has the same reimbursement protocols as Medicare for telemedi- cine. The only variation is that Medicaid offers lower re- imbursement levels for certain types of care. Forty-eight states provide Medicaid reimbursement for "synchronous" telemedicine, the exceptions being Massachusetts and Rhode Island. The factors for telemedicine reimburse-
ment that both private payers and Medicaid consider are the medical specialty type, the type of service provided, the “originating site,” and the “distant site.” The framework for telemedicine reimbursement undergoes consistent changes that adapt as the availability of care expands.
The General Assembly of Pennsylvania heard House Bill No. 15, which outlined the regulations for Pennsylvania telemedicine, in the 2019 session on March 5th. The bill includes guidelines for state licensure boards on how to regulate telemedicine. It discusses explicitly patient pri- vacy and data security standards, which must comply with the Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for Eco- nomic and Clinical Health Act. Under the same section, the bill also considers model policies for the appropriate
 use of telemedicine technologies. Pennsylvania mandates that telemedicine care complies with the current health care regulations such as the establishment of the patient- provider relationship, consent for treatment, appropriate examinations, and maintaining electronic medical records. “Out-of-State health care providers” are only permitted to offer telemedicine care through a federally operated facility or in certain emergency cases. Lastly, the bill dis- cusses the framework for reimbursement for both private payers and Medicaid. Currently, both Highmark and In- dependence Blue Cross offer coverage for telemedicine care in Pennsylvania; furthermore, Medicaid & Medicare reimbursement is supported outside of metropolitan statistical areas. All in all, general access to telemedicine care in Pennsylvania is expanding. As the need for medi- cal services in multi-state remote areas grows, so too will telemedicine. With the expansion of telemedicine nation- wide, we will continue to see an increased necessity for legal guidance to ensure the quality of patient care.

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