Legal Lines

Telehealth Offers Advances and Challenges

By Sandra G. Nye, J.D., MSW

What is telehealth, and why is it important for EA professionals to be aware of this health care trend? Telehealth may be defined as the use of electronic information and technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include email, videoconferencing, the Internet, store-and-forward imaging, streaming media, and land and wireless communications.

Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine pertains specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

Originally used to describe administrative or educational functions related to telemedicine, telehealth has increased its scope and contribution to healthcare, stressing the use of myriad technology solutions. Telehealth can be something as simple as two health professionals discussing a case over the telephone or as sophisticated as performing robotic surgery between facilities at different ends of the globe through Skype and other modern methods. Telehealth can prevent unnecessary visits and give patients easier and quicker access to care.

Twenty-two states and the District of Columbia have enacted legislation that requires insurers to pay the same amount for telehealth as for in-person care. (Restrictions apply in six of those states.) Although limitations often exist, 47 states offer some type of telehealth coverage in Medicaid. Congress is working on legislation to improve access to covered telehealth services in Medicare.

Telehealth is not adequately reimbursed, but there are currently more than 100 telemedicine bills before state legislatures, many of which deal with reimbursement. Others address licensure to practice telemedicine. Thirty-six states have required full medical licensure to practice telemedicine.

Twenty-eight states have exceptions for “infrequent” or “occasional consults.” Some states define “occasional,” e.g., Delaware: (fewer than six per year); New Mexico (no more than 10 per year); and Wyoming (no more than seven days in any 52-week period).

Licensure and Licensure Stipulations
Nine states require a special telemedicine license: Alabama, Louisiana, Montana, New Mexico, Nevada, Ohio, Tennessee, Texas and Wyoming. Some states add additional requirements such as: 1) The telemedicine practitioner must be fully licensed in another state; 2) The practitioner may not have a physical office in the state in which he or she practices telemedicine; and 3) He or she has not been found guilty of any ethics violations.

Iowa permits “incidental” advisory consultations of out-of-state doctors; the consultant doctor cannot practice in Iowa more than 10 consecutive days or 20 days in one year. Forty-one states require a physical exam or pre-existing physician-patient relationship before diagnosing, treating and prescribing.

Fourteen states permit physical exams to take place electronically: California, Hawaii, Indiana, Kansas, Louisiana, Maryland, Nevada, New Mexico, North Carolina, Ohio, South Dakota, Texas, Vermont, and Virginia.

Twenty-nine states require that practitioners complete a medical history about the patient. The definition of “history” varies from state to state, but 30 states specifically prohibit medical questionnaires or patient-provided histories as the sole basis for writing a prescription.

The licensure landscape is changing rapidly. This means that practitioners that engage in services across state lines must be thoroughly familiar and comply with current licensing and insurance requirements of not only their own state, but also other states in which they accept assignments. It is strongly recommended that legal consultation be retained.

Sandra Nye is the author of the popular “Employee Assistance Law Book.” She may be reached at