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WASHINGTON, D.C. -- The time has come for old federal laws that regulate telehealth to be modernized, said politicos from both sides of the aisle during National Health IT Week.
That's the consensus among most constituencies in the telehealth sphere , including some of the regulatory agencies themselves, such as the Federal Trade Commission (FTC) and Federal Communications Commission (FCC), as well as more obvious health IT players such as HIMSS and the American Telemedicine Association.
Even the American Medical Association says it now supports updating telemedicine rules -- with the caveats that doctors must be paid appropriately and that doctor and patient meet face-to-face before any remote relationship is established -- that have not been changed in as long as 15 years.
Telehealth reform laws before Congress
But while there are about six major national bills in play that would regulate telehealth, none are expected to be approved before the current lame-duck Congress expires, likely in January after the November 2014 elections, according to Tom Leary, HIMSS vice president, government relations.
Nevertheless, telemedicine reform has the most traction it's seen in years and at least one meaningful bill is likely to resurface and make it out of Congress and onto the president's desk in 2015, Leary told SearchHealthIT.
"Overall, there's general consensus that telehealth brings more access to care for more individuals," Leary said. "There's large bipartisan support for it."
That broad sense of agreement was on display at National Health IT Week in Washington D.C., at a packed hearing held by the U.S. Senate Special Commission on Aging, with nearly all who presented testimony in favor of change.
Old Medicaid rules
Perhaps the only participant at the session who expressed reluctance was Marc Hartstein, director of CMS' hospital and ambulatory group, which writes and enforces the rules for Medicaid reimbursement.
Hartstein and his agency came under some criticism for what are seen as restrictive Medicaid rules on telemedicine payment eligibility that are holding back spread of the technology, along with a byzantine patchwork of state laws on physician certification that telemedicine supporters say stymie doctors who want to see patients telemetrically in other states.
"This is definitely an area we can continue to invest in and improve healthcare in the U.S.," Matt Quinn, director of healthcare Initiatives for the FCC, said at the hearing. The FCC is trying to install more broadband wireless infrastructure in rural areas to help support telemedicine, Quinn said.
"Telehealth lies at the intersection of technology and medicine, and regional barriers might be slowing development," said Andrew Gavil, director of the FTC's Office of Policy Planning.
For his part, Hartstein explained that under current laws Medicaid pays for only 75 categories of telemedicine use cases and mainly to patients in federally designated rural Health Professional Shortage Areas and a few rural-like urban areas. And he cautioned that as a civil servant he could not express an opinion as to whether he agreed with the laws or not.
Lack of change unacceptable to retired senator-telehealth advocate
Medicaid's constrained approach was unacceptable to the hearing's moderator, retired U.S. Senator John Breaux, a conservative Democrat from Louisiana who co-founded in February 2014 the bipartisan Alliance for Connected Care with former Senate majority leaders Trent Lott, a Republican, and Democrat Tom Daschle.
Telemedicine backers in the political realm come from both liberal and conservative quarters but tend to cluster in rural states such as those of the former senators from Louisiana, Mississippi and South Dakota, states that also have medically underserved populations in poor cities.
"It's time for Congress to come together," Breaux said. "It's obvious that what was good 15 years ago in restricting it to rural areas makes very little sense today in 2014."
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