Telemedicine by state: Examining the winners and losers

By Dan Bowman 05/04/2015

Connecticut and Rhode Island were the only two states to receive composite failing grades for telemedicine coverage and reimbursement efforts, according to an updated analysis published Monday by the American Telemedicine Association.
The analysis, unveiled as ATA kicks off its 20th annual conference in Los Angeles this week, compares telemedicine adoption in all 50 states and the District of Columbia based on 13 indicators, including parity laws (or lack, thereof) in place. Connecticut, for all but three measures, earned "Fs," with ATA noting in its report that the state's Medicaid agency won't cover information or services provided to a client by a provider either electronically or via telephone. Rhode Island's report card mirrored Connecticut's, with ATA pointing out that despite a multiyear effort to introduce legislation regarding coverage under private insurance and Medicaid, no telemedicine parity law exists.
Conversely, the District of Columbia and five states--Maine, New Hampshire, New Mexico, Tennessee and Virginia--were recognized as the most supportive areas for telemedicine policies. Of note, 25 states were highlighted for recognizing the home as an originating site for care, while 16 states were highlighted for recognizing schools and school-based health centers as originating sites.
"Regarding Medicaid regulations, states are slowly moving away from the traditional hub-and-spoke model and allowing a variety of technology applications," the report's authors said.
A second report released simultaneously examines state laws and medical board standards for telemedicine in each state. Texas and Alabama each received the lowest composite scores overall, with both states remaining "stringent" when it comes to clinical practice rules. Additionally, ATA determined that no states received a top score for their licensure policies.
"This means that every state imposes a policy that makes practicing medicine across state lines difficult, regardless of whether or not telemedicine is used," the report's authors said.
The Texas Medical Board ruled last month that doctors must examine patients in person before they may order prescriptions for them, striking a blow to telemedicine provider Teladoc. The board and Teladoc have wrangled in court since 2011, largely over the three-word phrase: "face-to-face."
A survey published in Telemedicine and e-Health in February found obtaining state medical licenses to be a time-consuming process and a big barrier to the use of telemedicine across state lines.