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The use of telemedicine continues to grow as the medical community, the public and insurers see the potential benefits of virtual medical visits to speed treatment, control costs and simplify follow-up care, but legislation and regulation facilitating its use to treat injured workers has been slow to emerge.
The trend toward telemedicine has led state and federal lawmakers to introduce more laws to encourage and regulate telemedicine used in Medicare, Medicaid and through private payers, but only a handful of proposals would amend workers compensation regulations to expand telemedicine.
While states may define covered telemedicine differently, the technology includes live video-audio medical visits, asynchronous “store-and-forward” images and data, and patient monitoring devices.
Workers compensation programs typically limit services to an initial live audio-video consultation with a doctor to decide what care might be needed.
None of the 62 telehealth bills passed by state legislatures in 2017 were related to workers compensation, according to a roundup by the nonprofit Center for Connected Health Policy based in Sacramento, California.
“There have been a lot of federal and state telehealth bills introduced in the last couple of years and I think that’s been gaining momentum,” said Mei Kwong, executive director of the Center for Connected Health Policy. “Most of them have not been about workers compensation, however.”
But in recent months, Colorado, Tennessee, Texas, New York and Washington have proposed either new administrative rules or laws, mostly to expand telemedicine for injured workers beyond rural areas or to provide payment parity with other insurance.
A state-by-state breakdown shows where some of the latest regulatory proposals stand:
Colorado: The state amended its Workers Compensation Rules of Procedure with Treatment Guidelines to specifically include telemedicine in its fee schedule. The rule was approved in 2017 and updated this year.
The change was made administratively, said Christy Culkin, medical services manager, Colorado Division of Workers Compensation based in Denver.
“Colorado passed H.B. 1029 in 2015 that mandated telemedicine across all health care agencies, but it excluded government agencies, which meant it excluded Medicaid and workers compensation,” she said. “We felt like it was a good idea to adopt it for workers compensation even though it wasn’t mandated, so we wrote it into our fee schedule.”
The schedule reimburses telemedicine at the same rate as an in-office visit, plus $5.
Tennessee: The Tennessee Division of Workers Compensation amended its Rules for Medical Payments to add specific language on telehealth, effective Feb. 25. The amendment states that payments for telehealth will be based on Medicare guidelines.
“The rule addressing telehealth was part of an overall update of our medical payments rule that included several changes other than telehealth to bring the rule up to date,” said Abbie Hudgens, administrator for the Tennessee Bureau of Workers Compensation in Nashville, Tennessee.
Texas: The Texas Division of Workers Compensation has proposed changing its regulations to expand telemedicine services beyond rural areas. Health care providers follow Medicare policies and billing provisions for workers compensation services. Under the proposal, however, Medicare limitations on geographic area would not apply.
New York: A.B. 1419 and a related S.B. 3951 would amend the workers compensation law to require telehealth services as covered expenses. First introduced in January 2017, both bills are now in committee.
S.B. 833 would establish a task force to study the use of telehealth within the workers compensation system. That bill passed the state Senate in June 2017, but the Assembly sent it back and it now sits in a Senate committee.
Assemblywoman Addie Jenne sponsored A.B. 1419 and said she wants the bill to be voted on before the session ends in June.
“I’ve become involved in this arena because I live in a rural area with a physician shortage” where residents have to travel an hour or more to see a specialist, she said. Her district lies along the St. Lawrence River.
“People who are hurt at work also experience that same kind of access problem,” she said.
Lawmakers passed a bill a few years ago to achieve some parity between telemedicine and other medical services, Ms. Jenne said.
“We’ve been going back and addressing the small pockets that were missing, and workers compensation was one of those,” she said.
Ms. Jenne called S.B. 833 a “fallback” if her bill does not pass. “I think it will end up being a question of cost,” she said.
Washington: Workers compensation is handled either by the Washington Department of Labor and Industries or by self-insured employers, with medical second opinions done by an independent medical examiner.
S.B. 6226 introduced this year would require self-insured employers to provide independent medical examiners with electronic health records before the patient’s appointment. It would also require the director of the Department of Labor and Industries to provide access to telemedicine for independent medical exams and require a state-sponsored collaborative to develop policies for telemedicine exams and a training program for physicians.
The Washington State Telehealth Collaborative, hosted by the University of Washington, was created in 2016 and includes legislators, health care providers and insurers who research telemedicine initiatives.
S.B. 6226 passed the Senate in February, but stalled in the House until the legislature adjourned in March.
Telemedicine is especially valuable in rural eastern Washington, said State Sen. Steve Conway, whose provision to require the director or a designee to join the collaborative passed via amendment to another bill.
“If you’re an injured worker in Yakima and you have to go to Spokane three hours away for an independent medical exam, that can be time-consuming and costly,” he said. “If that can be handled through telemedicine, it could provide a tremendous savings.”
The collaborative will need to address questions of reimbursement and appropriate uses of telemedicine, Mr. Conway said. “These are the kinds of questions that need to be resolved,” he said.
Whether separate legislation is needed for telemedicine in workers compensation seems to be open to debate.