Telemedicine laws and developments: A state-by-state analysis

Telemedicine has the potential to improve access to care and ease the physician shortage. However, physician licensing and other regulations, a lack of reimbursement parity laws and other obstacles have hindered telemedicine's expansion.

Following is a list of some of the laws, regulations and proposed legislation in each state affecting the use of telemedicine.

Alabama

  • Alabama Medicaid reimburses for medically necessary telemedicine services. The state no longer reimburses for store-and-forward teledermatology.
  • Medicaid reimburses for in-home monitoring only for patients in the Medicaid "Patient 1st" program.
  • HB 334, signed into law in April, gives the state the authority to regulate teleoptometry.
  • Alabama is one of nine states that requires special telemedicine licensure for physicians.
  • Alabama is one of 26 states that has an informed consent policy for telemedicine.

Alaska           

  • Alaska's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • In April, Alaska legislature passedbill that would allow physicians to diagnose or provide a prescription for patients either online or over the phone. The bill was designed to improve care access for the state's large number of rural residents, according to its sponsor, Rep. Lynn Gattis (R-Wasilla). "With 20 percent of our population living in rural areas, it is imperative that access to routine medical care be as quick and economical as possible," she said.
  • According to the Center for Connected Health Policy, Alaska's Medicaid has the least restrictive remote patient monitoring reimbursement policy.

Arizona         

  • Private payers will be required to reimburse for telemedicine starting Jan. 1, 2015.
  • In April, Gov. Jan Brewer (R) signed HB 2172, which recognizes the use of telemedicine in psychology.
  • Arizona's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • Arizona is one of 26 states that has an informed consent policy for telemedicine.

Arkansas       

  • Medicaid reimburses for telemedicine encounters that happen in real time (as opposed to store-and-forward technology).
  • A pending regulation would require prior authorization for telemedicine services.

California

  • The Telemedicine Development Act of 1996 prohibits health plans from requiring a face-to-face visit if the service can be provided via telemedicine. The Telehealth Advancement Act, which became state law Jan. 1, 2012, expanded on the 1996 law to include a larger number of telemedicine services and ensure reimbursement parity.
  • AB 1310 would prohibit the state's department of healthcare services from requiring a physician to physically be in California when treating a patient, though the physician must still be licensed in California and the patient must be in California. The bill has been referred to the appropriations committee.
  • California's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • A bill currently in the California legislature would allow store-and-forward technology for teledentistry.
  • AB 1771 would require health insurers to cover physician visits conducted over the phone. The bill is currently in the state Senate.
  • California is one of 26 states that has an informed consent policy for telemedicine.

Colorado       

  • Colorado Medicaid reimburses for telemedicine services at the same rate as in-person services.
  • Medicaid also reimburses for store-and-forward technology for patients who meet certain conditions, including multiple hospitalizations in a 12-month period and required monitoring of the patient at least five times per week.
  • Private payers cannot require a face-to-face visit as a prerequisite for payment if the service can be provided via telemedicine, though the patient must reside in a county with less than 150,000 residents.
  • Physicians need full state licenses to practice in Colorado, though exceptions are made for those working with Shriner's Hospital, a national network of pediatric facilitates.
  • Colorado is one of 26 states with an informed consent policy for telemedicine.

Connecticut   

  • A bill currently in the state's Senate, SB 202, would require insurers to cover services delivered via telemedicine if the same service would be covered in-person.
  • Phone calls and audio-only consults are specifically excluded from Connecticut's definition of telemedicine.

Delaware       

  • The state's Medicaid program began reimbursing for telemedicine services in 2012.
  • Delaware prohibits physicians from prescribing medications to patients with whom they do not have an existing relationship.

Florida

  • In May, the Florida legislature ended its session without passing a much-contested telemedicine bill because lawmakers could not agree on whether out-of-state physicians should be allowed to treat Florida patients via telemedicine.
  • Florida is one of 26 states that has an informed consent policy for telemedicine.    

Georgia         

Hawaii           

  • In July, Gov. Neil Abercrombie (D) signed Senate bill 2469, which requires a service provided via telemedicine to be reimbursed at the same rate as the same service provided in person.
  • Radiologists licensed in other states may use telemedicine to provide radiology services in Hawaii.

Idaho 

  • HCR 46 would direct the state's department of health and welfare to create a council to develop telemedicine standards, rules and procedures for the state. The bill has passed both houses of the state's legislature.
  • Idaho's Medicaid currently only reimburses for telepsychiatry.
  • Idaho is one of 26 states that has an informed consent policy for telemedicine.

Illinois

  • Illinois's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • Bills currently in the Illinois House and Senate would require health plans to cover telemedicine services.
  • SB 647, awaiting the Governor's signature, would bar insurance plans from requiring an in-person visit prior to a telemedicine encounter.

Indiana

  • Under a law passed in 2013, Medicaid reimburses home health agencies, federally qualified health centers, rural health clinics, community mental health centers and critical access hospitals for telemedicine services.
  • Senate bill 0346 would provide Medicaid reimbursements to pharmacists who provide medication therapy management services to patients via telemedicine. This bill has been referred to a subcommittee.  
  • Indiana is one of 26 states that has an informed consent policy for telemedicine.

Iowa   

  • A bill, HF 2160, would require Medicaid to reimburse telemedicine services at the same rate as in-person services, and not require a face-to-face consultation prior to telemedicine services. The bill also specifically excludes phone calls, email and facsimile transmission from the definition of telemedicine.
  • Iowa allows in-state physicians to request consults from out-of-state physicians, and the consulting physician can then practice in the state for a limited time (no more than 10 consecutive days or 20 days in one year).

Kansas           

  • A bill that would require coverage for mental health services delivered via telemedicine recently died in committee.
  • Kansas is one of 26 states that has an informed consent policy for telemedicine.

Kentucky      

  • In 2013, Kentucky expanded Medicaid coverage for telemedicine services. Covered services now include physical health evaluations, mental health evaluations and diabetes self-management training.
  • State law prohibits private insurers from denying coverage because a service is provided via telemedicine rather than in-person.
  • Kentucky is one of 26 states that has an informed consent policy for telemedicine.

Louisiana      

  • The Louisiana Telehealth Access Act, signed into law in June, establishes the state's telemedicine standards. Among other things, it requires payers reimburse for telehealth, prohibits payers from requiring an in-person visit as a condition for payment and establishes the La. Commission on Telehealth Access to further study telemedicine and make recommendations as appropriate.
  • Louisiana is one of nine states that requires special telemedicine licensure for physicians.
  • It is also one of 26 states that has an informed consent policy for telemedicine.

Maine

  • In 2009, a law was enacted that requires all health plans in the state to cover telemedicine. Insurers may include a deductible, copayment or coinsurance for telemedicine as long as the amount is not more than would be charged during an in-person visit.
  • In April 2014, legislation was passed to allow behavioral health specialists and registered nurses to be reimbursed by the state's Medicaid program for services rendered via telemedicine.
  • Maine is one of 26 states that has an informed consent policy for telemedicine.

Maryland

  • In 2012, a parity law went into effect in Maryland, requiring insurers to cover telemedicine services at the same rates as in-person services.
  • Beginning Oct. 1, 2014, Maryland's Medicaid program will expand its reimbursement for telemedicine services beyond use in instances involving cardiovascular disease, stroke, in the emergency department or to provide access to a specialist. The legislation, signed into law April 14, would also provide coverage for services rendered through store-and-forward telemedicine as well as remote patient monitoring.   
  • Maryland is one of 26 states that has an informed consent policy for telemedicine.

Massachusetts

  • A pending bill, H 2114, would require telemedicine services be covered the same as in-person services. A similar bill, S 2075, is currently being considered in the Senate.
  • H 948 would require coverage of mental health services delivered via telemedicine.

Michigan

  • A parity law passed in 2012 prohibits payers from requiring face-to-face visits as a condition for reimbursement and mandates telemedicine services be covered the same as in-person visits.

Minnesota

  • Minnesota's Medicaid program reimburses for telemedicine video consults, as well as recognizes and reimburses for store-and-forward telemedicine.
  • Medicaid also reimburses for remote patient monitoring, but only for skilled nursing visits and in the Elderly Waiver and Alternative Care programs.

Mississippi     

  • A law passed in 2013 requires health plans in Mississippi to reimburse for telemedicine services at the same rate as in-person services.
  • Mississippi Medicaid reimburses for video-based telemedicine.
  • Mississippi is one of 26 states that has an informed consent policy for telemedicine.

Missouri        

  • As of Jan. 1, 2014, health plans are required to cover telemedicine services if that same service would be covered in person. Additionally, patients cannot be charged higher co-pays or fees for telemedicine services as compared with in-person services. However, health plans do not have to reimburse for site origination fees, just for diagnosis, consultation or treatment.
  • Out-of-state physicians may provide consults in Missouri as long as the Missouri physician remains the "ultimate authority" in the case.
  • Missouri is one of 26 states that has an informed consent policy for telemedicine.

Montana        

  • A parity law went into effect in January, meaning providers will be reimbursed at the same rate for telemedicine services as for in-person services.
  • Montana is one of nine states that requires special telemedicine licensure for physicians.

Nebraska       

  • LB 1078 would require insurers to cover telemedicine services. The bill was approved by the Governor in April.
  • With some exceptions, telemedicine is only covered if the patient does not have comparable services available within a 30-mile radius.
  • Nebraska is one of 26 states that has an informed consent policy for telemedicine.

Nevada          

New Hampshire

  • Under New Hampshire law, private payers cannot deny coverage for telemedicine services.
  • House bill 1158 would require payers issuing health plans under the state's managed care law to offer financial incentives to patients for choosing low-cost options, like telemedicine. The bill is currently being studied by lawmakers.

New Jersey    

  • S 2338 would require private payers, the State Health Benefits Commission and the School Employees' Health Benefits Commission to cover telemedicine services. The bill was introduced Aug. 11, 2014.
  • Assembly bill 2161 would allow federally qualified health centers more flexibility in contracting with mental health providers for telemedicine services. The bill has been referred to a subcommittee.
  • New Jersey is one of 26 states that has an informed consent policy for telemedicine.

New Mexico  

  • Private payers in New Mexico are required to reimburse telemedicine services in a manner consistent with in-person services.
  • New Mexico is one of nine states that requires special telemedicine licensure for physicians.
  • New Mexico's Medicaid program recognizes and reimburses for store-and-forward telemedicine as well as live video telemedicine.

New York     

  • S04337 would require Medicaid and private insurers to cover telemedicine services. The bill has passed the Senate and is being considered by the New York Assembly.

North Carolina         

  • Similar bills in the House and Senate would direct the state's department of health and human services to study the potential benefits of telemedicine and prohibit the department from adopting payment or other policies that might discourage the use of telemedicine.

North Dakota           

  • North Dakota Medicaid reimburses for telemedicine services, though holds "actual visual contact (face-to-face) must be maintained between practitioner and patient." Telemedicine reimbursement is also limited to patients who live "a sufficient distance" from comparable services.
  • According to the American Telemedicine Association, no legislation that would create reimbursement parity for telemedicine services is currently being considered in the state.

Ohio   

  • Beginning Jan. 1, 2015, Ohio Medicaid will reimburse for telemedicine services.
  • Under Ohio law, physicians may not prescribe medication for patients they have not personally physically examined. Exceptions include on-call, emergent and similar situations, as well as telepsychiatry.
  • Ohio is one of nine states that requires special telemedicine licensure for physicians.
  • Ohio is one of 26 states that has an informed consent policy for telemedicine.

Oklahoma

  • The Oklahoma Telemedicine Act, which went into effect in 1997, requires private payers to reimburse for telemedicine services.
  • Oklahoma's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • Oklahoma is one of 26 states that has an informed consent policy for telemedicine, though a bill introduced in the House in 2013 would repeal this requirement.

Oregon

  • Since 2009, all insurers in Oregon have been required to cover telemedicine services.

Pennsylvania 

  • HB 491 would require insurance coverage for telemedicine services. The bill is currently in committee.
  • In 2012, state Medicaid coverage for telemedicine was expanded to include specialist consults and other services. The expansion also removed the requirement that the referring physician participate in the consult.

Rhode Island

  • HB 7717 would require insurers to cover telemedicine services. The bill is currently in committee.

South Carolina

  • H 3779 would require individual and group HMOs to cover telemedicine services. The bill is currently in committee.
  • SB 290 would provide coverage for telemedicine services for state employees.

South Dakota

  • Medicaid reimburses for consultations, follow-up visits and pharmacological management services delivered via telemedicine.
  • South Dakota's Medicaid program recognizes and reimburses for store-and-forward telemedicine.
  • According to the American Telemedicine Association, no legislation that would create reimbursement parity for telemedicine services is currently being considered in the state.

Tennessee      

  • Medicaid does not reimburse for telemedicine (though the state's Department of Mental Health and Substance Abuse Services allows for reimbursement for delivering crisis services via telemedicine).
  • parity law was recently passed that would require health insurers to cover services delivered remotely via telemedicine at the same rate as the same service delivered in person. The law applies to services provided by both in- and out-of-network providers.
  • A proposed rule change in Tennessee would mandate in-person physician visits both precede and supplement telemedicine consults.
  • Tennessee is one of nine states that requires special telemedicine licensure for physicians.
  • Tennessee is one of 26 states that has an informed consent policy for telemedicine.

Texas 

  • Under Texas law, insurers may not exclude a telemedicine service from coverage if that same service would be covered in person.
  • The state requires telemedicine providers make a "good faith effort to identify and coordinate with existing providers to preserve and protect existing healthcare systems and medical relationships in an area."
  • Texas is one of nine states that requires special telemedicine licensure for physicians.
  • Texas is one of 26 states that has an informed consent policy for telemedicine.

Utah   

  • Medicaid reimburses for some diagnostic and therapeutic services rendered via telemedicine, including diabetes management and services to children with special needs.
  • Utah is one of 26 states that has an informed consent policy for telemedicine.
  • Physicians licensed in other states may practice in Utah for a limited time during a specific event.

Vermont        

  • All insurers in Vermont must cover telemedicine services at the same rate as in-person services. Telemedicine copays and other fees may not exceed those for in-person services.
  • Some store-and-forward services, including teleophthalmology and teledermatology, may be covered by insurers.
  • Vermont is one of 26 states that has an informed consent policy for telemedicine.

Virginia         

  • Virginia requires all insurers to cover live-video telemedicine.
  • Virginia's Medicaid program recognizes and reimburses for store-and-forward telemedicine.

Washington   

  • HB 1448 would require health plans to reimburse telemedicine services at the same rate as in-person services. The insurer would also be required to reimburse the originating site for facility use at the same rate as for in-person visits. The bill has been referred to the Rules committee.

Washington, D.C.

West Virginia

  • HB 4531, introduced into the House in February, would require all health plans and HMOs to reimburse for telemedicine services "in a manner consistent with coverage for healthcare services provided through in-person consultations."

Wisconsin

  • AB 458, enacted into law this year, stipulates mental health services provided via telemedicine will be reimbursed by the state's Medicaid program even if the provider is located outside Wisconsin.
  • Wisconsin law specifically excludes telephone calls and Internet messaging from its definition of telemedicine.
  • Wisconsin is one of 26 states that has an informed consent policy for telemedicine.

Wyoming       

  • Wyoming is one of nine states that requires special telemedicine licensure for physicians.
  • The Wyoming Board of Medical Examiners may revoke, suspend or restrict the license of any physician who prescribes medication over the Internet.
  • Wyoming is one of 26 states that has an informed consent policy for telemedicine. Providers must obtain written consent from patients before delivering services via telemedicine.

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