This document summarizes key topics discussed at the 2015 Georgia Partnership for Telehealth conference, including interstate licensure, reimbursement, scope of practice, and fraud and abuse considerations for telemedicine. Some states have passed laws allowing out-of-state telemedicine licenses or use the Interstate Medical Licensure Compact to facilitate cross-state practice. Medicare reimburses for telehealth services at parity with in-person visits if audio/video technology is used and the patient is in a rural area. States vary in their Medicaid and private insurance parity laws for telemedicine coverage and payments.

1. TELEMEDICINE AND LAW
GEORGIA PARTNERSHIP FOR TELEHEALTH
2015 CONFERENCE

2. INTERSTATE LICENSURE
Out-of-state telemedicine licenses Interstate Medical Licensure Compact Other licensure exceptions

3. OUT-OF-STATE TELEMEDICINE LICENSES
Example 1: “The board shall issue a telemedicine license to allow the
practice of medicine across state lines to an applicant who holds a full
and unrestricted license to practice medicine in another state or
territory of the United States.” LA. REV. STAT. ANN. § 1276.1(A)
Example 2 (requiring reciprocity): “[T]he commission shall only issue
a special purpose license to practice medicine or osteopathy across
state lines to an applicant whose principal practice location and license
to practice is located in a state or territory of the United States whose
laws permit or allow for the issuance of a special purpose license to
practice medicine or osteopathy across state lines or similar license to a
physician whose principal practice location and license is located in this
state.” ALA CODE § 34-24-507

4. INTERSTATE MEDICAL LICENSURE COMPACT
• Proposed in late 2014 by the Federation of State Medical
Boards
• Creates new, expedited pathway to licensure outside of a
physician’s primary state
• To be administered by interstate commission
• Introduced as legislation in 15 states, already signed by
Wyoming and South Dakota
• Would greatly facilitate licensure process for telemedicine
providers seeking to extend into multiple states

5. Medicare:
• Part B reimburses at rates generally equal to in-person care
• “Interactive telecommunications system” with “real-time audio and video”
• Patient must be in Health Professional Shortage Area
REIMBURSEMENT
MEDICARE REIMBURSABLE SERVICES
Services:
Emergency department; inpatient/
outpatient; subsequent hospital services
(max 1 tele-consultation every 3 days);
psychotherapy; pharmacologic mgmt;
transitional care mgmt; more
Patient location (in HPSA):
Hospitals, physicians’ offices, FQHCs,
Rural Health Clinics, hospital-based
dialysis centers, skilled nursing facilities,
community mental health centers

6. MEDICAID/PRIVATE INSURANCE PARITY
Medicaid AND Private Insurance
Medicaid OR Private Insurance
Proposed legislation

7. MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov

8. MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov

9. MEDICAID/PRIVATE INSURANCE PARITY
Source: mmis.georgia.gov

10. • States’ laws will vary as to authority of physician extenders (NPs, PAs,
etc.) – be mindful!
SCOPE OF PRACTICE
• Georgia’s medical board rule offers good example of inclusive approach
to telemedicine scope of practice:
Electronic consultations authorized so long as a physician,
physician assistant or nurse practitioner has:
1. Has personally examined the patient; or
2. Is performing the service at the request of a physician, physician
assistant or nurse practitioner who has physically seen the patient; or
3. The technology is equal or superior to an personal examination,
regardless of whether the patient has been seen
Ga. Comp. R. & Regs. 360-3-.07

11. • How can a telemedicine arrangement be structured without implicating
illegal referrals?
• U.S. Office of Inspector General Advisory Opinion No. 11-12
• Issued August 29, 2011
• Neuroscience group sought to become exclusive tele-stroke practice
for hospital system, consulting with hospital patients via telemedicine
and, if necessary, taking neuro emergency transfers
• OIG approved arrangement! Why?
• While hospital could not use other tele-stroke providers, there
was no requirement of referrals to group – could still transfer
stroke patients anywhere
• Primary goal was to save money, reduce transfers, help patients
FRAUD AND ABUSE

12. FRAUD AND ABUSE
Safe harbor protection: Personal Services Arrangements
• Note: not always necessary to meet safe harbor (e.g. Advisory
Opinion 11-12; no safe harbor protection but still compliant)
• Personal Services Arrangements are always compliant if:
• The agreement is in writing and signed by both parties,
for a term of > 1 year
• The agreement sets forth an exact schedule of services
• The aggregate compensation is set in advance
• Compensation does not reflect value or volume of
referrals

13. • Other potentially relevant safe harbors:
• Investment interests
• Referrals for specialty services
• Federally Qualified Health Centers
FRAUD AND ABUSE