In today’s age of advanced connectivity, technology is shaping the delivery of healthcare services. By engaging in telehealth, providers can utilize technologies such as mobile devices, video conferencing, and real-time data sharing to provide healthcare services remotely.
Despite the vast opportunities for healthcare delivery available through technology, legal policy poses a great barrier to telehealth. In the United States, 49 states have some form of legislation relating to telehealth, the Medicaid programs in 48 states and the District of Columbia provide coverage for some form of telehealth, and the Medicare program has its own set of telehealth coverage rules. These state and Medicare telehealth policies vary widely, although there have been attempts to establish more uniform rules.
While many different aspects of telehealth are regulated, telehealth policies tend to revolve around where the services take place, who provides the services, and the technology utilized. Typically, a telehealth encounter is considered to occur at the “originating site,” which is where the patient is physically located when receiving telehealth treatment. Medicare typically limits telehealth services to rural or underserved areas, and requires a patient to be at certain specified origination sites, such as a practitioner’s office, a hospital, a rural health clinic or a skilled nursing facility. Like Medicare, a few states also restrict telehealth services to rural and underserved areas. While certain states, such as New York, also restrict telehealth services to certain originating sites, more than half of the states, including New Jersey and California, allow patients to receive telehealth services at any location.
Who provides the services is another issue that must be carefully considered. Medicare and most states, including New Jersey, New York, and California, require a provider to be licensed in the state where the telehealth patient is located, thus requiring the practitioner to follow that state’s professional practice rules and recordkeeping requirements. Over 20 states have adopted the Interstate Licensure Compact that makes it easier for member-state physicians to obtain a license in another member state, and almost 30 states have adopted the Nurses Licensing Compact that allows member-state licensed nurses licensed to practice in another member state. Several states, including Ohio and Texas, even offer special telehealth certifications to out-of-state practitioners.