TeleMedicine and Tricare: What Does the New Law Mean?

December 21, 2017 Hunter Zahedi

An important step forward for the use of telemedicine services was made when the Defense Authorization Bill was passed in Dec 2016 with approval for expanded telemedicine coverage for Tricare beneficiaries and some active duty military and veterans. This was the first time that federal payment authorization was made for telemedicine services, an important first step for the acceptance, and the widespread insurance coverage, of these services.

Tricare is the medical insurance program for retired military members, and this program, as well as VA and military medical services, falls under the jurisdiction of the federal government. But states control licensing and scope of practice for physicians and nurse practitioners. The original federal bill had the licensing requirements of telemedicine providers located in the state of origin for the physician, rather than the patient. This would have opened access to services considerably, but would also have cut state medical boards out of the loop on issues of scope of practice, discipline, and other state-mandated supervisions.

Further, both state boards of medicine and nursing have been working on a number of inter-state compacts for licensing. These ongoing efforts to allow practice across state lines while ensuring high quality standards would be rendered ineffective with a federal telemedicine law that allowed physicians to practice in any state, via the telemedicine interface technologies.

Both the AMA and the AAFP contested the original language in the law, and it was changed to set the state of practice for physicians and nurse practitioners as the state of origin for the patient, rather than the provider. While this had limited the development and spread of telemedicine services, the demand for, and acceptance of the practice is expanding rapidly among consumers.

How is TeleMedicine Being Used?
There are two systems in place for the rapidly evolving telemedicine field. The VA is using the system to provide services for primary care, urgent care and other routine health care visits. Their method uses the existing structure of patient enrollment and eligibility, and allows patients who are already part of their system another access to services. They have their own unique technology, which is tied into the electronic medical records, and VA staff can use the system, as well as determine a need to see patients in person.

Another practice model is developing in which a for-profit company purchases the telemedicine technology interfaces and software, and develops a group practice made up of providers who are licensed in a number of states. A consumer can go to the website and search for a provider licensed in his or her state, and contact that provider via the system to set up an appointment. Providers can conduct an interview over the video system or audio, using a telephone call. Many of these practices are developing the ability to accept and bill a wide variety of insurances, but many more remain cash businesses. For consumers who have insurance that accepts telemedicine coverage, such as Tricare, the system with these practices is to pay up front and submit receipts for reimbursement.

The convenience of the telemedicine system is a very strong draw. Since the prescription drug system in this country is becoming more automated, providers can prescribe and deliver medications to consumers through a wide range of systems that do not require a paper prescription and an in-person visit to a pharmacy. The challenge will remain managing controlled substances prescriptions, which should not, for safety, be prescribed to a new patient over a telemedicine visit. These prescriptions require specific identification protocols when picking up medicines from the pharmacy, and new guidelines and restrictions are expected regarding opioid prescribing which will further restrict  this prescribing practice.

New technologies regarding in-home monitoring equipment, such as heart monitors, blood pressure monitors, scales, and blood sugar monitors are being developed which will provide a provider's office with the monitoring to ensure good quality chronic medical care follow up. For the frail elder with transportation challenges or fragile immune systems, telemedicine can provide convenient, accessible health care.
For more information about telemedicine practices and services, please contact us.

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