Maine recently passed legislation that will require health insurance companies to cover health care services provided by telepractice. The law goes into effect with new insurance contracts on Jan. 1, 2010.
The legislation, L.D. 1073, states that insurance companies in Maine "may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be provided through in-person consultation."
The support for this bill grew out of frustration experienced by staff at Waldo County General Hospital's Voice and Swallowing Center of Maine (Belfast), who were trying to provide voice treatment to patients traveling long distances.
In September 2008 the center was providing treatment to a teacher from northern Maine who drove eight hours—more than 500 miles round trip—to reach the center. The teacher had career-threatening vocal fold lesions and a serious voice disorder. Clinicians knew that the most efficacious way to provide treatment was by telepractice. However, even with repeated requests and documentation, the insurance company denied coverage for the treatment.
Despite the denial, voice specialists at the Voice and Swallowing Center developed a telepractice treatment program for this teacher. The center absorbed the cost to create a demonstration case in Maine to support legislative efforts to require health insurance coverage for telepractice.
The service was provided by direct high-speed video connection to the teacher's classroom computer. Three telepractice voice treatment sessions were provided, including coaching for the school's speech-language pathologist to help monitor the voice treatment (to see a video clip, go to the Voice and Swallowing Center of Maine's Web site). The teacher has returned to normal voicing and coached the varsity softball team. Laryngeal imaging demonstrates full resolution of the vocal fold lesions.
The experience prompted the Voice and Swallowing Center to contact Rep. John Piotti, the majority leader of the Maine House of Representatives, who agreed to sponsor L.D. 1073. The Voice and Swallowing Center contacted ASHA for information on telepractice bills in other states, and provided Rep. Piotti with comprehensive information about telemedicine, the efficacy of telemedicine, the status of telepractice laws in other states, and the rationale for this legislation in Maine.
After Rep. Piotti sponsored the bill, Rep. Ann Perry introduced similar legislation that restricted telepractice to "existing telemedicine networks," effectively limiting services to large organizations with existing high-cost telemedicine facilities. Proponents of the original bill were successful in demonstrating to Rep. Perry that allowing a greater variety of service delivery methods was a win-win for Maine residents. She was extremely responsive to amending the language in her bill to remove the restrictive language.
The Voice and Swallowing Center developed a comprehensive telepractice sourcebook and distributed it to legislators to demonstrate the many ways telepractice could be delivered, including secure video conferencing to home computers using widely available high-speed Internet connections. ASHA provided valuable information about the status of telepractice nationwide and research about its efficacy.
The manager of the Voice and Swallowing Center provided testimony at the public hearing on the bill, and written testimony was provided to members of the committee with jurisdiction over the bill. Testimony focused on the efficacy of telemedicine, especially the improved access to services and cost savings for individuals traveling long distances for treatment.
Coincidentally during this period, Waldo County General Hospital/The Voice and Swallowing Center of Maine became affiliated with MaineHealth, an integrated health care delivery network. As a result, a representative from the Voice and Swallowing Center now participates as a member of MaineHealth's telepractice planning workgroup, which is coordinating efforts to develop a comprehensive plan and working paper to organize telepractice in Maine.