Policy Issues in Telehealth
The purpose of telemedicine is to remove distance as a barrier to health care. While telehealth is an accepted resource to bridge the gap between local and global health care, integrating telehealth into existing health infrastructures presents a challenge for both governments and policy makers (HRSA, 2011). Today there are policy barriers that prevent the expansion of telehealth, including reimbursement issues raised by Medicare and private payers, state licensure, and liability and privacy concerns.
Reimbursement policies prevent the total integration of telemedicine into health care practice (Prinz, 2008). Today, there is no overall telemedicine reimbursement policy in the federal health care system (HRSA, 2011 & OAT, 2003). As a result, reimbursement for telecare has been limited and somewhat haphazard. It’s up to each state to specify what telemedicine services, if any, are eligible for Medicaid reimbursement (HRSA, 2011 & OAT, 2003).
There are two policies which support telemedicine services. In 1997, the Balanced Budget Act (BBA) required that Health Care Financing Administration (HCFA) pay for some telemedicine consultation services to Medicare recipients. However, several administrative limitations restricted the effectiveness of this legislation. For example, patients had to be located in Rural Health Professional Shortage Areas (HPSAs). This meant that many patients had access to general practitioners but not to specialists, and store-and-forward consultations were excluded. In 2000, the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (S.B. 2505) sought to redress some of these limitations. For example, it reimburses a person for telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a county that is outside of any Metropolitan Statistical Area (MSA), as defined by HRSA and the Census Bureau. The originating site must be a medical facility and not the patient's home, and Medicare does cover store-and-forward applications, such as teleradiology and remote EKG applications. While the Center for Medicare Services (CMS) has not formally defined telemedicine for the Medicare program because the federal government does not mandate reimbursement for telehealth under Medicaid, states have the option to reimburse for Medicaid services through telehealth. For example, in states such as Alaska and Hawaii Medicare does cover store-and-forward applications, such as teledermatology, whereas 35 states allow for at least some reimbursement for telehealth services. Medicaid reimbursement for telehealth services by psychologists is available in 13 states. Coverage and billing requirements vary by state.
Currently, there is no single widely accepted reimbursement standard for private payers. Some insurance companies value the benefits of telehealth and will pay for a wide variety of...