Delaware becomes 29th state to regulate telemedicine
Delaware has become the 29th state to enact a telemedicine commercial reimbursement statute after the state's governor approved an updated law regulating the virtual services. However, some have concerns that the regulation is confusing over its differentiation between telemedicine and telehealth.
Delaware has become the 29th state to require health insurers to pay for telemedicine after the state's governor approved an updated law regulating the virtual services. But some say the legislation lacks a distinction that could diminish the cost-saving benefits of telehealth.

Democratic Gov. Jack Markell signed House Bill 69 into law Tuesday, defining state regulations surrounding telemedicine and prohibiting insurers from engaging in discriminatory practices against providers who use telemedicine to deliver care.

“We are making an effort in Delaware to transform the way healthcare is delivered and paid for and this piece of legislation supports that,” Markell said. “Telemedicine will improve access to information and medical care for Delawareans, leading to better health outcomes for patients and reduced costs for hospitalizations and transportation.”

The American Telemedicine Association applauded the move; the organization has pushed states to put telemedicine visits on an equal playing field with in-person exams.

“We see no reason that they should be payed less than what that service would if that service were provided through telemedicine,” said Latoya Thomas, director of the ATA's State Policy Research Center. “Telemedicine is not a service and it's not a benefit, it's a way of delivering care. We see that these telemedicine parity laws guarantee providers and beneficiaries access to care in the same way they would if they were in person.”

Thomas said the laws have proven necessary because some healthcare providers using telemedicine have at times had claims denied solely because the services were performed remotely. Nonetheless, she said states have been relatively quick to pass laws surrounding the technology, with the number of states with laws on the books having doubled in two years.

Fifteen states have introduced legislation this year, and Rhode Island, New Jersey, North Carolina and Pennsylvania are actively considering bills, Thomas said. “They're realizing it's not just ensuring access to care but that it can also reduce costs,” she said.

But Mario Gutierrez, executive director of the Sacramento-based National Telehealth Policy Resource Center, had some concerns about the law's differentiation between telemedicine and telehealth, the latter being the use of technology for social services, remote patient monitoring or other non-clinical procedures.

The regulation is somewhat confusing because it defines telehealth as opposed to telemedicine, but doesn't appear to offer protections for telehealth tasks, Gutierrez said. He said most states have enacted laws that cover both telemedicine and telehealth.

“A lot of this will likely be left to the regulatory process to the state, so I'd be anxious to see how this is defined,” Gutierrez said.

Gutierrez also said the law appears to require that “store and forward” services, which transmit patient medical information such as diagnostic imaging or dermatology images to an outside provider, be reimbursed at the same level as they would be in-person. He said this defeats the capabilities of these services to save hospitals and physicians money from having to hire in-house providers.

“Very few states actually have clean, clear laws and regulations governing telehealth,” Gutierrez said. “So this is a good example...where there is a good faith effort to create legislation but they've made it much more confusing than it needs to be.”

Federally, there's been little to no progress, though Rep. Mike Thompson (D-Calif.) is expected to introduce today new Medicare legislation including telehealth parity.

In May, Alabama and Minnesota joined an interstate compact that makes it easier for physicians to have licenses in multiple states, a move that could help telemedicine physicians treat individuals in other states. The Federation of State Medical Boards has a policy stating that the practice of telemedicine occurs in the state where the patient—not the doctor—is located.