by MELISSA McGINLEY
Telemedicine advocates scored a big victory in early August with the passage of the Balanced Budget Act of 1997. The final version of the Congressional budget agreement includes provisions for the reimbursement of select telemedicine consultations by Medicare, starting January 1, 1999. About $100 to $200 million should be available for telemedicine reimbursement at that time, experts estimate.
The Act's telehealth provisions grew out of a bill introduced by Senator Kent Conrad (D-ND), the Comprehensive Telehealth Act (S. 385). Upon review, House and Senate conferees agreed to a scaled down version of the original bill, which would have required Medicare to reimburse any eligible provider for telehealth services by July 1, 1998.
The new law allows for reimbursement only to providers working in rural areas designated as Health Personnel Shortage Areas (HPSAs). The payments will be shared between the referring and consulting health professionals and will not be greater than the current fee schedule for the health services provided. Further, no facility or transmission costs will be eligible for reimbursement. The Health Care Financing Administration is currently identifying areas eligible for the HPSA designation.
Jay Sanders, M.D., president of the American Telemedicine Association, calls the act "a major step in making telemedicine an integral part in the delivery of health care." "This legislation, " he says, "represents [a] major public policy [decision] that helps assure access to health care for all Americans, regardless of their geographic location or socio-economic status."
On the state level, eight more states have passed telemedicine bills since the last CLEAR News report, bringing the total to 15 for the 1997 legislative season. A summary of these actions follow.
California. Amended its definition of "telemedicine" to exclude telephone conversations and electronic mail messages between a practitioner and patient (S. 922).
Hawaii. Limited, 3-month licenses must be granted to licensed, nonresident physicians substituting for Hawaiian doctors due to illness, vacation or training. Military medics and nonresident, consulting practitioners are excluded (S. 512)
Illinois. Nonresident doctors delivering care via electronic means to Illinois residents must be fully licensed, unless they are providing consultations, second opinions or follow up care (S. 314). The Department of Public Health will conduct a telemedicine feasibility study (H. 1342).
Iowa. The Department of Health and Human Services will conduct a telemedicine pilot program and appropriate funding for reimbursement to eligible providers participating in the program (S 542).
Louisiana. HMOs must reimburse providers for eligible telemedicine services (H 785). Medical services furnished in another state will be reimbursed under certain conditions and a committee will study the effects of relaxing current licensing standards (S 500). Six appointees will be added to the Coordinating Council on Telemedicine and Distance Education (S 503).
Minnesota. Hospitals can use grants to establish a telemedicine system (S 1208).
North Carolina. Nonresident physicians who treat patients in the state via electronic means must be fully licensed and are subject to reasonable regulations by the North Carolina Medical Board. Exceptions are granted for infrequent consultations, educational training or regular interstate practice performed by physicians in bordering states. Also allows residents to bring malpractice claims against nonresidents into state courts (H. 814).
Texas. Medicaid must reimburse telemedicine services and consultations (H 2386, 2017). Re-defines "telemedicine" to exclude telephone or fax communications (H 2033).
This article is part three in a four-part series on telepractice legislation.
[source: Health Policy Tracking Service, National Conference of State Legislatures]