Telemedicine Law Now Officially in Place

Virtual doctor measures blood pressure

The new telemedicine law went into effect July 1. The legislation (House Enrolled Act 1263), authored by Rep. Cindy Kirchhofer (R-Indianapolis), was enthusiastically supported by the Indiana Chamber because it increases access to care and potentially could reduce costs. Prior to the bill’s passage, Indiana was one of only four states that had not adopted telemedicine legislation.

Telemedicine is defined as the delivery of health care services using electronic communication and information technology, including: secure videoconferencing; interactive audio – using store and forward technology; or remote patient monitoring technology between a provider in one location and a patient in another location. Physicians, physician assistants who have authority to prescribe, licensed advanced practice nurses who have authority to prescribe and optometrists are all authorized to utilize telemedicine.

To provide the telemedicine service, a provider must have established a patient-provider relationship. In that patient-provider relationship, the provider, at a minimum, must obtain the patient’s name and contact info and location; disclose the provider’s name and title; obtain informed consent; obtain the patient’s medical history and other information to establish a diagnosis; discuss that diagnosis with the patient along with the evidence for and risks and benefits of various treatment options including when it is advisable to seek in-person care. The provider must also create and maintain a medical record for the patient and notify the patient’s primary care physician; issue proper instructions for appropriate and follow-up care and provide a telemedicine visit summary to the patient, including any prescriptions.

The law allows for a provider to issue a prescription through telemedicine even if the patient has not seen the provider in person previously as long as: the provider has satisfied the applicable standard of care in treating the patient; the issuance of a prescription is within the provider’s scope of practice; and the prescription is neither a controlled substance nor an abortion-inducing drug. At this time, the law prohibits ophthalmic devices such as glasses, contact lenses or low-vision devices.

An out-of-state provider may conduct telemedicine business in Indiana but must certify to the Indiana Professional Licensing Agency that it agrees to be subjected to the jurisdiction of the courts of law of Indiana and all substantive and procedural laws concerning a claim against the provider.

There was concern during session about liability in providing telemedicine services. Therefore, the General Assembly included a provision that if a provider provides telemedicine services then that provider would be held to the same standards of care as if the health service was provided in an in-person setting.

Regarding the aforementioned prohibition against providing eye glasses and contact lenses, the Indiana Chamber has recently been in discussion with a company that would like to have that provision changed during the next legislative session. This company says it has the capability, via the Internet, of providing a refractive eye exam as accurate as one completed in the doctor’s office. The way the law stands currently, this telemedicine company (based upon its business model) would be prohibited from conducting any business in Indiana.

Telemedicine Movement Moving Forward in Indiana

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Our friends at Gibson Insurance posted a blog today about the advancement of telemedicine in Indiana. They also included comments from Indiana Chamber VP Mike Ripley:

Prior to March 21, 2016, Indiana was one of just a handful of states that had not legislatively addressed the subject of telemedicine. Meanwhile Illinois and Ohio currently have proposed telemedicine parity bills but nothing set in stone – and Wisconsin has no parity legislative activity at this time. Michigan’s laws went into effect in 2012 and Kentucky was well ahead of the game with legislation in 2000, but the first state to address telemedicine by law was actually Louisiana in 1995. 21 years ago?! Why was Indiana so late to answer the call?…

WHAT SHOULD INDIANA EMPLOYERS KNOW?
According to Mike Ripley, the Vice President of Health Care and Employment Law Policy at the Indiana Chamber of Commerce, it was surprising the law was not passed sooner, as it had many supporters. Ripley explained that insurance carriers, employers, and health care providers were ready to embrace telemedicine technology, yet the stakeholders could not agree on exactly how it should work in the Hoosier state.
The competing interests that delayed the law were ultimately united when the stakeholders agreed that the standard of care for a virtual visit would have to be the same as the standard of care for an in-person visit. Once all parties were able to rally around this central concept, the bill passed swiftly through the legislature. The standards of care at the heart of the bill are yet to be clearly defined in terms of telemedicine, but you may read the specific language of Indiana’s House Bill 1263 to gain a better understanding of the law.
Although the issues around the standards of care continue to develop, the law clearly states a phone call is insufficient to satisfy the standard of care. We anticipate technology such as video chatting and Skype will be used to effectuate the provision of care by telemedicine. The law also addresses the types of maladies that may (and may not) be treated through telemedicine. In Mr. Ripley’s words, one easy way to remember what is fair game under the bill is “anything ending with ‘-itis’ – is permissible to treat via telemedicine.” The law prohibits narcotic prescribing and psychiatric services through telemedicine.

Furthermore, see our recent blog about the importance of telemedicine, and its potential impact on many quality of life factors.

Telemedicine a Potentially Healthy Benefit of Broadband Access

Virtual doctor measures blood pressure

For the upcoming July/August edition of BizVoice, I spoke with Smithville Fiber Executive Vice President Cullen McCarty about developments in broadband — both in Indiana and around the globe.

One aspect he mentioned was the significant impact on health broadband access could play for Americans living in rural areas as telemedicine capabilities increase.

“The importance is having the ability to stay at home and talk with your doctor from there, whether it’s through FaceTime or some type of interactive technology,” McCarty says. “You can have a doctor’s visit without a stethoscope. You can take blood pressure over a device and have that information shot back to the doctor.”

Fitbits and Apple Watches may also be able to transfer diagnostics to doctors as well, he adds, noting aging Hoosiers will need to take advantage of all avenues to increase medical efficiency.

“In Southern Indiana, a lot of hospitals and clinics are a far drive for some in rural areas, like Orange and Greene Counties,” McCarty offers. “It takes a lot of gas and money, so I think that’s where telemedicine will take off. Plus, you have specialists who read X-rays. An example we were given several years ago is that there are people in other parts of the country and the world who read X-rays, and they send it back to the doctor.”

He relays an example of someone getting an X-ray in Bloomington and having it sent to a radiologist who lives on a golf course in Texas.

“There are many different applications for telemedicine,” McCarty points out. “I think it’s a big driver in getting broadband into people’s homes who don’t see the value yet.”

Telemedicine a Major Health Issue in 2016 Session

16358656House Bill 1263 (Telemedicine), authored by Rep. Cindy Kirchhofer (R-Indianapolis), was enthusiastically supported by the Indiana Chamber during the 2016 Indiana legislative session. Numerous organizations supported the concept and not one opposed; the Indiana State Medical Association remained neutral. The bill allows physicians, physician assistants, advanced practice nurses that have authority to prescribe drugs and optometrists to prescribe medicine to a patient via telemedicine services.

While everyone supported the concept, getting everyone to agree on the final version was a rocky process. Concerns ranged from existing patient/provider relationships, out of state providers, hospital relationships to standards of care and jurisdiction for medical malpractice. But by the end, the conference committee report had only one vote against in both houses.

Senate Bill 165 (Healthy Indiana Plan or HIP), authored by Sen. Patricia Miller (R-Indianapolis), is the Governor’s measure to repeal the former HIP plan and codify into statute the current HIP 2.0. The Pence administration believes that codifying the current plan strengthens its position with the Centers for Medicare and Medicaid Services for when the new 1115 Medicaid waiver is negotiated.

Opponents believe that codifying the existing plan leaves no room for flexibility. Chiropractic services under the HIP 2.0 plan were added in the House on second reading but removed in conference committee. The bill passed both houses, mostly along party lines with a few exceptions. The Chamber has been supportive of the core principles of HIP and HIP 2.0, offering an alternative to the Medicaid system by providing a power account (similar to an HSA) which encourages individual responsibility in a participant’s medical decisions.