A new Telemedicine Act is wending its way through the legislative process in Pennsylvania. Senate Bill 780 of 2017 (attached hereto as a PDF) has been unanimously passed by the Senate and referred to the House Professional Licensure Committee on June 19, 2018. Pennsylvania is one of the few states that does not have a dedicated Telemedicine Act and Pennsylvania is attempting to address the two major issues in telemedicine in one Act, i.e. payment parity and professional regulation.
Although the payment issues are only addressed briefly in the Act, the provisions are significant. Section 6 entitled “Insurance Coverage of Telemedicine”, provides as follows:
- Health insurance policies issued, delivered, executed or renewed in the Commonwealth after the effective date of this Section (which has not yet been determined) shall provide coverage for telemedicine delivered by a participating network provider who provides a covered service via telemedicine consistent with the third party insurers’ medical policies.
- A health insurance policy may not exclude a healthcare service for coverage solely because the service is provided through telemedicine.
- A health insurer shall reimburse a healthcare provider for telemedicine if the health insurer also reimburses the same participating provider for the same service through an in-person encounter.
This concept is known in the industry as payment parity because it provides for equal coverage and payment.
The telemedicine regulation section is essentially a licensing provision which also defines the key concepts regarding the performance of telemedicine. The regulatory provisions of this Act provide as follows:
- Healthcare providers validly licensed in the Commonwealth are authorized to practice telemedicine in accordance with the Act, which essentially means they may deliver telemedicine services to residents of the Commonwealth of Pennsylvania. Delivery of telemedicine services in other states is regulated by the other states and usually requires licensing in the state of the patient’s location. Conversely, an out-of-state provider providing telemedicine services to residents of the Commonwealth must comply with this Act, and be licensed by Pennsylvania.
- Healthcare providers providing telemedicine services to individuals located in the Commonwealth who do not have an established provider-patient relationship must do the following:
a. Verify the location and identify of the individual receiving care, and
b. Disclose the healthcare provider’s identity, geographic location and medical specialty or credentials.
- Healthcare providers must:
a. Obtain informed consent regarding the use of telemedicine technologies.
b. Provide an appropriate examination or assessment using telemedicine technologies.
c. Establish a diagnosis and treatment plan.
d. Create and maintain electronic medical records within 24 hours.
e. Provide a visit summary to the individual if requested and have an emergency action plan in place for medical and behavioral health emergencies and referrals.
The appropriate telemedicine technologies are defined as electronic information and telecommunication technologies including but not limited to interactive audio and video, remote patient monitoring or store and forward systems that meet the requirements of HIPAA. Healthcare providers may utilize interactive audio without interactive video if used in conjunction with store and forward technology and the provider makes a determination that the same standard of care can be provided, but the provider must inform the patient that the patient has an option to request interactive audio and video.
Allowable technologies do not include audio only medium, voicemail, fax, email, instant messaging or text messaging or online questionnaires–or any combination thereof. That raises the issue of how the Board of Medicine would react to a physician performing those acts, since it is defined as “not being telemedicine”. I presume that would be seen as practicing medicine in an unauthorized manner.
Note that the Act excludes provider-to-provider a consultations from the definition of telemedicine, but that has always been the case and it is fairly obvious since the other physician is presumably not a patient and the consulting physician is not providing a service it could be billed to a patient; there is no face-to-face encounter and no telemedicine encounter.