Alaska Removes in-State Restriction for Telehealth; Other States Consider Similar

The Alaska Legislature this weekend passed a Medicaid bill, SB-74, that includes telehealth provisions allowing out-of-state physicians to provide telehealth services in the same way as in-state physicians. Telehealth physicians must be licensed by the Alaska Medical Board. Also, the bill allows certain Alaska-licensed behavioral health professionals to provide services remotely, authorizes regulations to establish a standard of care for physicians prescribing medications without a physical examination, and sets up a telemedicine business registry. “Though this bill is complex, it will bring about the kind of simple reforms that will cause Alaskans to say, ‘Why weren’t we doing that already?’” said Alaska Sen. Pete Kelly, the bill’s Republican sponsor. Gov. Bill Walker (I) hadn’t signed the bill but applauded its passage in a statement Monday. The Legislature also passed HB-234, which requires healthcare insurers in the state to provide coverage for mental health benefits provided through telehealth by a provider licensed in Alaska.

The FTC supported telehealth aspects of Kelly’s bill, saying in a staff comment last month (see 1603280025) the legislation would make "a procompetitive improvement in Alaska’s telehealth law.” The FTC staff said the bill “would likely increase the supply of telehealth providers, enhance competition, and reduce healthcare costs, thereby benefiting Alaskans, especially underserved populations with limited access to healthcare.” The FTC didn’t comment on the final bill.

“It’s a major step forward,” said Mario Gutierrez, executive director of the Center for Connected Health Policy. Telehealth is vital in states like Alaska that have a shortage of service providers, he said. “We’re going to see more of this around the country,” Gutierrez predicted. “The ice is breaking among state legislators around their fear that telehealth will only add more cost to their Medicaid program.” Telehealth can provide more efficient care at a lower cost, he said.

“It’s a great piece of legislation,” said Claudia Tucker, vice president-government affairs for telehealth service provider Teladoc. “It will go a long way to providing increased access to care in Alaska and decreasing healthcare costs.” Teladoc pushed for the bill in Alaska, and supports similar legislation in Louisiana, the only other state with an in-state physician restriction, she said.

Several other states also have recently passed or are considering telemedicine legislation. The Louisiana Senate had a vote scheduled for late afternoon Monday on a bill, SB-328, that -- like the Alaska bill -- would remove a requirement that the telehealth provider must have a practice within the state. March 24, West Virginia Gov. Earl Ray Tomblin (D) signed into law HB-4463, to permit the practice of telemedicine, establishing some requirements and authorizing a rulemaking. Earlier the same month, the Virginia Legislature passed a bill, SB-369, setting up a pilot program to use telemedicine to expand healthcare services in rural areas. Other states considering telehealth legislation include Missouri and Tennessee.

Broadband-based healthcare “can dramatically improve patient outcomes, create efficiencies and improve our bottom lines by reducing healthcare costs,” Clyburn said in prepared remarks for the California Telehealth Network Annual Summit Monday. “By one account, the U.S. could lower its healthcare costs by $197 billion over the next 25 years through the use of remote monitoring to track the vital signs of patients with chronic diseases. [But] a persistent digital divide too often means that millions lack access to these advanced offerings which in turn means that all of us will be denied those benefits.”

Clyburn said she wants to hear ideas on how the FCC could revise the Healthcare Connect Fund to make it “better suited to meet today’s and tomorrow’s needs.” She also urged stakeholders to weigh in on an FCC proposal from its January 2014 tech transitions order (docket 13-5) to allocate $50 million for experiments to improve access to advanced telecommunications and information services for healthcare for vulnerable populations in rural, high-cost and insular areas. “The FCC did not receive sufficient proposals to move forward, but that proceeding remains open and I call on you to participate if you have yet to do so,” said Clyburn.

A public notice circulated among commissioners in March seeks comment on regulatory, policy and infrastructure issues for broadband-enabled healthcare services, Clyburn said. The notice doesn’t propose any rule or policy changes, but will help the FCC and the Connect2Health Task Force to get a better understanding of the state of broadband health connectivity, learn about future uses of broadband-enabled health technologies and wireless medical devices, and flag any possible regulatory issues or challenges, she said.

In about a month, the Task Force will release a national map that overlays broadband and health data at the county level, Clyburn said. The map “will help us to better understand where infrastructure gaps, poor health outcomes, and limited healthcare access coincide,” she said. “We all have to prioritize and it is critical to identify the areas where public-private partnerships can get the biggest bang for the buck.”