According to one recent survey, telemedicine services (i.e., remote delivery of healthcare services using telecommunications technology) among large employers (500 or more employees) grew from 18% in 2014 to 59% in 2016. Common selling points touted by telemedicine vendors include reduced health care costs and employee convenience. However, state licensure laws imposing restrictions on telemedicine practitioners can often limit the value (or even availability) of telemedicine services to employees.
But that seems to be changing.
Texas Law Change
This summer Texas passed legislation (SB 1107) prohibiting regulatory agencies with authority over a health professional from adopting rules pertaining to telemedicine that would impose a higher standard of care than the in-person standard of care. With the enactment of SB1107, the Texas Medical Board must revise portions of its existing telemedicine regulations, which had largely been viewed as some of the most restrictive in the country. Key revisions proposed by the Board at its July meeting included the elimination of the following requirements:
- Patient must be physically in the presence of an agent of the treating telemedicine practitioner
- Physical examination of the patient by the telemedicine practitioner in a traditional office setting within the past twelve months
- Interaction between the patient and telemedicine practitioner must be via live video feed
However, it appears that the Board will continue its prohibition against the use of telemedicine for prescribing controlled substances for the treatment of chronic pain.
Prescribing Controlled Substances
Meanwhile other states have relaxed their rules relating to telemedicine practitioners seeking to prescribe controlled substances. For example, the Florida Board of Medicine replaced its ban on any prescription of controlled substances using telemedicine with a new rule that allows telemedicine practitioners to issue prescriptions except in the case of controlled substances for the treatment of psychiatric disorders. Delaware, Indiana, Michigan, Ohio and West Virginia have also expanded the circumstances under which telemedicine practitioners can prescribe controlled substances.
For more information on the Texas legislation, read this overview from Bryan Cave’s healthcare attorneys.
Expanded State Licensing of Practitioners
State licensing laws generally preclude or restrict a provider licensed in one state from delivering medical services to individuals in another state. Consequently, an out-of-state physician (absent certain exceptions) must obtain a full and unrestricted license to practice medicine on patients in a particular state. In an effort to facilitate license portability and the practice of interstate telemedicine, the Federation of State Medical Boards developed an Interstate Medical Licensure Compact. So far, 25 states participate in the Compact or have taken action to become Compact states. Under the Compact, licensed physicians can qualify to practice medicine across state lines within the Compact if they meet the agreed upon eligibility requirements.
Employer Compliance Considerations
These and other actions by states to facilitate the growth of telemedicine may encourage more employers to jump on the telemedicine bandwagon. However, employers should be aware that as with any group health plan, the provision of a telemedicine program to employees can raise a number of compliance issues under the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), Employee Retirement Income Security Act (ERISA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA) as well as disqualify individuals participating in a high deductible health from making or receiving contributions to their health savings account.