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First, there are many long rows to hoe before telemedicine services are accepted for Medicaid reimbursement at the state level.
Second, in states where a legislator does the math and latches on to telemedicine reimbursement as a pet cause, it’s quite possible to convince peers on both sides of the aisle of its worth.
Variegated state laws make patient privacy compliance tough for providers who want to exchange patient data over state lines and licensure requirements complicate things for physicians who desire to practice in multiple states. Along those same lines, there is no rhyme, reason or consistency to Medicaid telemedicine reimbursement rules between states.
Furthermore, the present toxic American political climate has poisoned whole state legislatures toward President Obama’s Affordable Care Act (ACA) and its expanded Medicaid funding, which some states either have refused or are in the process of refusing. Some politicians errantly lump the ideas of “telemedicine reimbursement” and “expansion of entitlements” together. In reality, according to the ATA, Medicaid telemedicine reimbursement can cut a state’s costs through home monitoring of some patient populations, telemental health screening and counseling via remote video feeds, providing less expensive coverage for at-risk pregnancies and premature births, as well as helping keep patients out of emergency rooms (and ambulances) for off-hours, primary care.
There are 122 telemedicine bills presently proposed by state and federal governments. Two state governments, Mississippi and Maryland, have successfully passed telemedicine reimbursement laws, creating a model for other states to follow. The blueprint begins in one session with a bill that simply allows for telemedicine reimbursement. In subsequent sessions, the sponsor fills in more of the blanks (such as defining telemedicine for the purpose of Medicaid reimbursement or defining what services would be covered for which patient populations).
That’s exactly what Democrat Maryland state Senator Catherine Pugh did, starting last year with advocating Senate Bill 781, which authorized telemedicine coverage upon its passing. Session by session, her team has added to the bill, extending the coverage to Medicaid cardiovascular and emergency department services as well as certain specialist care. The bills also have established a task force that will set goals for telemedicine coverage and will research which services and populations help the most patients and get the biggest bang for the state’s buck. To explain the value of telemedicine, she’s enlisted University of Maryland School of Medicine practitioners to perform demos for legislators, and has mobilized a group to strategize her next moves.
“We’re very excited in the state of Maryland because we see telemedicine moving forward,” Pugh said.
Pugh is the deputy majority leader in the Maryland Senate, which of course helped build partisan momentum behind telemedicine reimbursement. The two-house Republican majority in Mississippi, however, has had a hard time agreeing on whether or not to reauthorize Medicaid funding despite having the country’s highest federal matching rate (74 cents of every Medicaid dollar Mississippi spends comes from Washington), let alone get into the nuts and bolts of divvying up the reimbursement pie.
The disagreements stop, however, when it comes to telemedicine. Republican state senator and vice-chair of its appropriations committee, Terry Burton, reported at the conference that the Mississippi Senate passed his Senate Bill 2209 unanimously, in large part because it was championed by the University of Mississippi Medical Center. The bill authorizes coverage of live video physician consultations, and excludes care via other forms of communication such as phone texts, email and fax. It went on to pass 120 to 2 in the House, it was signed into law by the governor earlier this year and goes into effect July 1.
“It’s a no-brainer in Mississippi, it really is,” said Burton, who added that telemedicine’s biggest benefit in the eyes of both legislators and payers in the state was increasing access to care. “As sparse as our population is, we have very few urban centers, everything’s rural…and I think that’s why the bipartisan support was there to unanimously pass the bill.”