Telemedicine: Practicing Medicine across State Lines

Licensure: The definition of telemedicine varies by state and, therefore, so do the licensure requirements. Prior to the provision of telemedicine services, it’s critical that providers check applicable state laws to confirm that they are properly licensed to practice medicine where the patients are located. A few states require a separate telemedicine license, whereas others require the provider to be licensed where the patient is located. There are limited exceptions for consultations, but such exceptions typically apply only where the consultations provided are not routine or do not exceed a certain threshold number of consultations (often no more than 10 consultations annually).

Consent, patient encounter, scope of services: Several states require that providers obtain the patient’s written consent prior to delivering telemedicine services, and a few others require verbal consent. Patient consent should be documented in the patient’s medical record. In addition, many states require that the provider satisfy certain elements in order to create a valid patient encounter. This can include an initial face-to-face visit. Finally, several states limit the type of services that may be provided via electronic means, as well as the permissible technology for providing telemedicine services. For these reasons, it’s imperative that applicable state law be reviewed to ensure compliance.

The Federation of State Medical Boards (FSMB) drafted the Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. This model policy is intended to provide guidance to state medical boards when regulating the use of acceptable telemedicine technology. In addition, the model policy addresses licensure, establishment of the physician–patient relationship, informed consent, and privacy and security of patient medical records, among other topics. The intent of this policy is to ease the ability to practice telemedicine across state lines.

Reimbursement: Reimbursement continues to act as a barrier to telemedicine. Medicare offers limited reimbursement for such services and typically requires an initial face-to-face encounter between a patient and a provider, with certain exceptions for patients located within a healthcare professional shortage area. In addition, Medicare will generally reimburse only for face-to-face, interactive video consultation services that mimic in-person face-to-face interactions between patients and providers.

Because Medicaid is state specific, reimbursement for telemedicine services varies from state to state. There is also no applicable reimbursement standard for private payers. Less than half of states have enacted statutes that recognize or require reimbursement for telemedicine services by private payers. Some payers understand the value of telemedicine services and will reimburse for a wide range of telemedicine services, whereas others have yet to develop reimbursement policies and, therefore, payment for telemedicine services may require prior approval.