Maryland and Vermont have become the 13th and 14th states to require private-sector insurance companies to pay for telemedicine services. Beginning Oct. 1, many private payers in the states will be required to cover medically necessary telemedicine services if the payer covers those same services when provided in person.
ASHA uses the term "telepractice" rather than "telemedicine" or "telehealth" to include services delivered remotely.
Twelve other states—California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas, and Virginia—are already part of a growing national trend to accept telehealth as an additional and potentially cost-effective way of delivering health services (See "Maine Advocacy Wins Telepractice Coverage," The ASHA Leader, Sept. 1, 2009).
Maryland defines telemedicine as "interactive audio, video or other telecommunications or electronic technology...to deliver a health care service." Under the law, health insurers and managed care organizations (MCOs) must cover health care services appropriately delivered using telemedicine technology, and coverage cannot be denied because services were provided through telemedicine rather than in person. Insurers are not required to cover telemedicine services if the health services would not be a covered benefit if provided in person or if the provider is out of network.
In addition, the law states that:
- Deductibles, copayments, or coinsurance for telemedicine services may apply as they would for in-person services.
- Telemedicine services may be subject to an annual maximum (as permitted by federal law) but not a lifetime maximum.
- Utilization review methods (such as preauthorization) may apply to telemedicine services if those same methods apply to in-person treatment.
- Insurers and MCOs may not distinguish between rural and urban patients in determining coverage for telemedicine services.
Finally, the law mandates two additional studies: one by the Department of Public Safety and Correctional services to examine telemedicine services in correctional facilities to serve inmates, and one by the Department of Health and Mental Hygiene (Medicaid) to review the literature and other Medicaid agencies' telemedicine policies and procedures to determine the potential effect of Medicaid coverage of telemedicine on utilization, prices, substitution, and other services.
ASHA played a role in the success of this legislation by responding to letters of concern that essentially sought to exclude telepractice, particularly in audiology and hearing aid dispensing, from the bills. Letters signed by President Shelly Chabon confirmed support for telepractice, described current effectiveness research, and drew a distinction between telepractice and the direct-to-consumer model of hearing health care services. She also indicated that the Maryland Board of Examiners had already recognized the use of telemedicine by licensed speech-language pathologists and audiologists in its state-approved regulations and successfully urged the legislature to approve the bills.
Vermont also moved forward with coverage for telemedicine services. It is similar to Maryland's law, but requires those receiving telemedicine services to do so in a health care facility. Despite this limitation, the law may be seen as clearing the way for more widespread applications in the future.
Vermont's mandate requires "all health insurance plans [to] deliver services [via telepractice] to a patient in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation."
It defines "health care facility" as "all public, private, proprietary, or nonprofit institutions that offer diagnosis, treatment, inpatient or ambulatory care…and the buildings in which those services are offered." It does not include health maintenance organizations.
- Insurance plans may require originating-site health care providers to document the reason the services are being provided by telemedicine rather than in person.
- Ophthalmology and dermatology telemedicine services may be provided by store-and-forward means, and may require the distant site provider to document why the services are being provided this way. The patient's informed consent is also required for store-and-forward delivery.
- Insurance plans are not required to reimburse the distant site provider if the provider has insufficient information to render an opinion.
- Vermont's mandate includes Medicaid coverage and reimbursement.
This law also requires a study be performed by the Commissioner of Financial Regulation, in conjunction with health care providers, insurers, and interested stakeholders, to consider whether Vermont should include coverage of telemedicine services delivered outside of a "health care facility." This report is due by January 2013.
There are many nuances in state and federal laws, regulations, and payer requirements for telepractice services; ASHA recommends that SLPs and audiologists verify coverage before providing or billing for telepractice.