This memorandum discusses telemedicine (or telehealth, used interchangeably) laws in Arkansas, Colorado, Illinois, Iowa, Kansas, Missouri, Nebraska, Oklahoma, and Texas, as well as recent telemedicine-related Kansas legislation and 2023 legislation in Arkansas, Illinois, Oklahoma, and Texas.
Telemedicine Laws in Nearby States
Information on telemedicine and telehealth definitions, establishing a physician-patient relationship through telemedicine, and insurance coverage provided through telemedicine is detailed below. [Note: Provisions are excerpted to reflect relevant law.]
Definition of Telemedicine or Telehealth in State Law
| Arkansas | “Telemedicine” means the use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient. “Telemedicine” includes store and forward technology and remote patient monitoring and does not include the use of audio-only electronic technology by a physician to renew a written certification that was previously issued to the same patient (Ark. Code Ann. § 17-80-402). |
| Colorado | “Telemedicine” means the delivery of medical services through technologies that are used in a manner that is compliant with the federal “Health Insurance Portability and Accountability Act of 1996 [HIPAA]”, Pub.L. 104-191, as amended, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, or treatment of a patient while the patient is located at an originating site and the person who provides the services is located at a distant site (Colo. Rev. Stat. Ann. § 12-240-104, relocated 2019). “Telehealth” means a mode of delivery of health care services through HIPAA-compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site. (Colo. Rev. Stat. Ann. § 10-16-123). |
| Illinois | “Telehealth services” means the evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional that generates interaction or treatment recommendations. “Telehealth services” includes telemedicine and the delivery of health care services, including mental health treatment and substance use disorder treatment and services to a patient, regardless of patient location, provided by way of an interactive telecommunications system, asynchronous store and forward system, remote patient monitoring technologies, e-visits, or virtual check-ins (225 ILCS 150/5). “E-visit” means a patient-initiated non-face-to-face communication through an online patient portal between an established patient and a health care professional. “Interactive telecommunications system” means an audio and video system, an audio-only telephone system (landline or cellular), or any other telecommunications system permitting 2-way, synchronous interactive communication between a patient at an originating site and a health care professional or facility at a distant site. “Interactive telecommunications system” does not include a facsimile machine, electronic mail messaging, or text messaging. “Virtual check-in” means a brief patient-initiated communication using a technology-based service, excluding facsimile, between an established patient and a health care professional. “Virtual check-in” does not include communications from a related office visit provided within the previous 7 days, nor communications that lead to an office visit or procedure within the next 24 hours or soonest available appointment (215 ILCS 150/5). |
| Iowa | Telemedicine means the delivery of health care services through the use of real-time interactive audio and video, or other real-time interactive electronic media, regardless of where the health care professional and the covered person are located. “Telehealth” does not include the delivery of health care services delivered solely through audio-only telephone, electronic mail message, or facsimile transmission (ICA § 514C.34). |
| Kansas | “Telemedicine,” including “telehealth,” means the delivery of healthcare services or consultations while the patient is at an originating site and the healthcare provider is at a distant site. Telemedicine shall be provided by means of real-time two-way interactive audio, visual, or audio-visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, that facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s healthcare. “Telemedicine” does not include communication between: (A) Healthcare providers that consist solely of a telephone voice-only conversation, email, or facsimile transmission; or (B) a physician and a patient that consists solely of an email or facsimile transmission (KSA 40-2,211). |
| Missouri | “Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. “Telehealth” or “telemedicine” shall also include the use of asynchronous store-and-forward technology (Mo. Ann. Stat. § 191.1145). |
| Nebraska | “Telehealth” means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient. Telehealth includes services originating from a patient’s home or any other location where such patient is located, asynchronous services involving the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care practitioner at another site for medical evaluation, and telemonitoring. Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law (Neb. Rev. Stat. Ann. § 71-8503). “Telehealth consultation” means any contact between a patient and a health care practitioner relating to the health care diagnosis or treatment of such patient through telehealth (Neb. Rev. Stat. Ann. § 71-8503). “Telemonitoring” means the remote monitoring of a patient’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage (Neb. Rev. Stat. Ann. § 71-8503). |
| Oklahoma | “Telemedicine” and “telehealth” means technology-enabled health and care management and delivery systems that extend capacity and access, which includes: synchronous mechanisms, which may include live audiovisual interaction between a patient and a health care professional or real-time provider-to-provider consultation through live interactive audiovisual means; asynchronous mechanisms, which include store and forward transfers, online exchange of health information between a patient and a health care professional and online exchange of health information between health care professionals, but shall not include the use of automated text messages or automated mobile applications that serve as the sole interaction between a patient and a health care professional; remote patient monitoring; and other electronic means that support clinical health care, professional consultation, patient and professional health-related education, public health, and health administration (36 OS § 6802). Note: The same definition is also found at 59 OS § 478. |
| Texas | “Telehealth service” means a health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology (Tex. Occ. Code Ann. § 111.001). “Telemedicine medical service” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology (Tex. Occ. Code Ann. § 111.001). |
Establishing the Professional Relationship Through Telemedicine
| Arkansas | (2) “Healthcare professional” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of the practice of his or her profession (Ark. Code Ann. § 17-80-402). (4) “Professional relationship” means at minimum a relationship established between a healthcare professional and a patient when: (A) The healthcare professional has previously conducted an in-person examination and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals; (B) The healthcare professional personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals; (C) The treatment is provided by a healthcare professional in consultation with, or upon referral by, another healthcare professional who has an ongoing relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care; (D) An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient; (E)(i) A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients; (E)(ii) A relationship established under rules of the Arkansas State Medical Board may be utilized for telehealth certification; (F) A relationship exists in other circumstances as defined by rule of a licensing or certification board for other healthcare professionals under the jurisdiction of the appropriate board and their patients if the rules are no less restrictive than the rules of the Arkansas State Medical Board; (G)(i) The healthcare professional who is licensed in Arkansas has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a patient located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the patient; (G)(ii) For purposes of this subchapter, a health record may be created with the use of telemedicine and consists of relevant critical information required to treat a patient, and is reviewed by the healthcare professional who meets the same standard of care for a telemedicine visit as an in-person visit (Ark. Code Ann. § 17-80-402). (a)(1) A healthcare professional at a distant site shall not utilize telemedicine with respect to a patient located in Arkansas unless a professional relationship exists between the healthcare professional and the patient or the healthcare professional otherwise meets the requirements of a professional relationship as defined in § 17-80-402. (2) The existence of a professional relationship is not required in the following circumstances: (A) Emergency situations where the life or health of the patient is in danger or imminent danger; or (B) Simply providing information of a generic nature, not meant to be specific to an individual patient. (b) If the establishment of the professional relationship is permitted via telemedicine under § 17-80-402(4)(E) or § 17-80-402(4)(F), telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter. (c) “Professional relationship” does not include a relationship between a healthcare professional and a patient established only by the following: (1) An internet questionnaire; (2) An email message; (3) Patient-generated medical history; (4) Text messaging; (6) A facsimile machine; or (7) Any combination of means listed in subdivisions (c)(1)-(5) of this section (Ark. Code Ann. § 17-80-403). |
| Colorado | (J)(5) The physician-patient/psychologist-patient relationship needs to be established. (a) This relationship is established through assessment, diagnosis and treatment of the patient. Two-way live audio/video services is acceptable to ‘establish’ a patient relationship. (b) Physicians / psychologists need to meet standard of care. (c) The patient is required to provide the appropriate consent for treatment. Source: 7 CCR 1101-3 (Rule 18) – specific to the Department of Labor and Employment, workers’ compensation. (e) A [insurance] carrier shall not: (III) Require a covered person to have a previously established patient-provider relationship with a specific provider in order for the covered person to receive medically necessary telehealth services from the provider (Colo. Rev. Stat. Ann. § 10-16-123). |
| Illinois | “Established patient” means a patient with a relationship with a health care professional in which there has been an exchange of an individual’s protected health information for the purpose of providing patient care, treatment, or services (225 ILCS 150/5). “Health care professional” includes, but is not limited to, physicians, physician assistants, optometrists, advanced practice registered nurses, clinical psychologists licensed in Illinois, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, licensed certified substance abuse disorder treatment providers and clinicians, and mental health professionals and clinicians authorized under Illinois law to provide mental health services, and qualified providers listed under paragraph (8) of subsection (e) of Section 3 of the Early Intervention Services System Act, dietician nutritionists licensed in Illinois, and health care professionals associated with a facility (225 ILCS 150/5). |
| Iowa | As a condition of reimbursement pursuant to paragraph “a”, a health carrier shall not require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person (ICA § 514C.34). A valid provider-patient relationship may be established through any of the following means: a. Through an in-person encounter which includes an in-person medical interview and physical examination conducted under the standard of care required for an in-person encounter. b. Through consultation with a primary care provider who has an established relationship with the patient and who agrees to participate in or supervise the patient’s care. c. Through telehealth, if the standard of care does not require an in-person encounter, in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telehealth, and the student’s parent or guardian is present (ICA § 208A.3). [Note: ICA § 208A.3 is specifically regarding establishment of provider-patient relationship for services provided via telehealth in a school setting.] |
| Kansas | (b) Telemedicine may be used to establish a valid provider-patient relationship (KSA 40-2,212). |
| Missouri | Physicians licensed under chapter 334 who use telemedicine shall ensure that a properly established physician-patient relationship exists with the person who receives the telemedicine services. The physician-patient relationship may be established by: (1) An in-person encounter through a medical interview and physical examination; (2) Consultation with another physician, or that physician’s delegate, who has an established relationship with the patient and an agreement with the physician to participate in the patient’s care; or (3) A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine (Mo. Ann. Stat. § 191.1146). In order to establish a physician-patient relationship through telemedicine: (1) The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in person; and (2) Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth (Mo. Ann. Stat. § 191.1146). |
| Nebraska | The Nebraska Telehealth Act does not: (1) Alter the scope of practice of any health care practitioner; (2) authorize the delivery of health care services in a setting or manner not otherwise authorized by law; or (3) limit a patient’s right to choose in-person contact with a health care practitioner for the delivery of health care services for which telehealth is available (Neb. Rev. Stat. Ann. § 71-8504). [Note: The Nebraska Telehealth Act requires certain disclosures but does not address how to establish the physician-patient relationship.] |
| Oklahoma | A. Unless otherwise prohibited by law, a valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in this state through telemedicine, provided that the physician: 1. Holds a license to practice medicine in this state; 2. Confirms with the patient the patient’s identity and physical location; and 3. Provides the patient with the treating physician’s identity and professional credentials. D. A physician-patient relationship shall not be created solely based on the receipt of patient health information by a physician. The duties and obligations created by a physician-patient relationship shall not apply until the physician affirmatively: 1. Undertakes to diagnose and treat the patient; or 2. Participates in the diagnosis and treatment of the patient (59 OS § 478.1). |
| Texas | (a) For purposes of Section 562.056, a valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service or a teledentistry dental service and a patient receiving the service as long as the practitioner complies with the standard of care described in Section 111.007 and the practitioner: (1) has a preexisting practitioner-patient relationship with the patient established in accordance with rules adopted under Section 111.006; (2) communicates, regardless of the method of communication, with the patient pursuant to a call coverage agreement established in accordance with (A) Texas Medical Board rules with a physician requesting coverage of medical care for the patient; or (B) State Board of Dental Examiners rules with a dentist requesting coverage of dental care for the patient; or (3) provides the telemedicine medical services or teledentistry dental services through the use of one of the following methods, as long as the practitioner complies with the follow-up requirements in Subsection (b), and the method allows the practitioner to have access to, and the practitioner uses, the relevant clinical information that would be required in accordance with the standard of care described in Section 111.007: (A) synchronous audiovisual interaction between the practitioner and the patient in another location; (B) asynchronous store and forward technology, including asynchronous store and forward technology in conjunction with synchronous audio interaction between the practitioner and the patient in another location, as long as the practitioner uses clinical information from: (i) clinically relevant photographic or video images, including diagnostic images; or (ii) the patient’s relevant clinical records, such as the relevant medical or dental history, laboratory and pathology results, and prescriptive histories; or C) another form of audiovisual telecommunication technology that allows the practitioner to comply with the standard of care described in Section 111.007. (b) A practitioner who provides telemedicine medical services to a patient as described in Subsection (a)(3) shall: (1) provide the patient with guidance on appropriate follow-up care; and (2) if the patient consents and the patient has a primary care physician, provide to the patient’s primary care physician within 72 hours after the practitioner provides the services to the patient a medical record or other report containing an explanation of the treatment provided by the practitioner to the patient and the practitioner’s evaluation, analysis, or diagnosis, as appropriate, of the patient’s condition. (c) Notwithstanding any other provision of this section, a practitioner-patient relationship is not present if a practitioner prescribes an abortifacient or any other drug or device that terminates a pregnancy (Tex. Occ. Code Ann. § 111.005). |
Coverage for Services Provided Through Telemedicine
| Arkansas | (c)(1) A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise. (2) A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person. (3) A health benefit plan may voluntarily reimburse for healthcare services provided through means described in § 23-79-1601(7)(C). (e) A health benefit plan shall not impose on coverage for healthcare services provided through telemedicine: (1) An annual or lifetime dollar maximum on coverage for services provided through telemedicine other than an annual or lifetime dollar maximum that applies to the aggregate of all items and services covered; (2) A deductible, copayment, coinsurance, benefit limitation, or maximum benefit that is not equally imposed upon all healthcare services covered under the health benefit plan; (3) A prior authorization requirement for services provided through telemedicine that exceeds the prior authorization requirement for in-person healthcare services under the health benefit plan; (4) A requirement for a covered person to choose any commercial telemedicine service provider or a restricted network of telemedicine-only providers rather than a covered person’s regular doctor or provider of choice; or (5) A copayment, coinsurance, or deductible that is not equally imposed upon commercial telemedicine providers as those imposed on network providers (Ark. Code Ann. § 23-79-1602), |
| Colorado | (1) It is the intent of the general assembly to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a provider without in-person contact with the provider. (2)(a) A health benefit plan that is issued, amended, or renewed in this state shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to all terms and conditions of the health benefit plan or dental plan. Nothing in this section requires the use of telehealth when a provider determines that delivery of care through telehealth is not appropriate or when a covered person chooses not to receive care through telehealth. A provider is not obligated to document or demonstrate that a barrier to in-person care exists to trigger coverage under a health benefit plan for services provided through telehealth. (b)(I) Subject to all terms and conditions of the health benefit plan or dental plan, a carrier shall reimburse the treating participating provider or the consulting participating provider for the diagnosis, consultation, or treatment of the covered person delivered through telehealth on the same basis that the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider (Colo. Rev. Stat. Ann. § 10-16-123). |
| Illinois | (b) An individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. An individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered. (c) To ensure telehealth service, e-visit, and virtual check-in access is equitable for all patients in receipt of health care services under this Section and health care professionals and facilities are able to deliver medically necessary services that can be appropriately delivered via telehealth within the scope of their licensure or certification, coverage required under this Section shall comply with all of the following: (1) An individual or group policy of accident or health insurance shall not: (A) require that in-person contact occur between a health care professional and a patient before the provision of a telehealth service; (B) require patients, health care professionals, or facilities to prove or document a hardship or access barrier to an in-person consultation for coverage and reimbursement of telehealth services, e-visits, or virtual check-ins; (C) require the use of telehealth services, e-visits, or virtual check-ins when the health care provider has determined that it is not appropriate; (D) require the use of telehealth services, e-visits, or virtual check-ins when a patient chooses an in-person consultation; (E) require a health care professional to be physically present in the same room as the patient at the originating site, unless deemed medically necessary by the health care professional providing the telehealth service; (F) create geographic or facility restrictions or requirements for telehealth services, e-visits, or virtual check-ins; (G) require health care professionals or facilities to offer or provide telehealth services, e-visits, or virtual check-ins; (H) require patients to use telehealth services, e-visits, or virtual check-ins, or require patients to use a separate panel of health care professionals or facilities to receive telehealth service, e-visit, or virtual check-in coverage or reimbursement; or (I) impose upon telehealth services, e-visits, or virtual check-ins utilization review requirements that are unnecessary, duplicative, or unwarranted or impose any treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than the requirements applicable to the same health care service when rendered in-person, except procedure code modifiers may be required to document telehealth. (2) Deductibles, copayments, coinsurance, or any other cost-sharing applicable to services provided through telehealth shall not exceed the deductibles, copayments, coinsurance, or any other cost-sharing required by the individual or group policy of accident or health insurance for the same services provided through in-person consultation. (3) An individual or group policy of accident or health insurance shall notify health care professionals and facilities of any instructions necessary to facilitate billing for telehealth services, e-visits, and virtual check-ins. (j) Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other telehealth services, including, but not limited to, services not required for coverage provided through an asynchronous store and forward system, remote patient monitoring services, other monitoring services, or oral communications otherwise covered under the policy. (k) There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site under this Section other than requiring the telehealth services to be medically necessary and clinically appropriate (215 ILCS 5/356z.22). |
| Iowa | 2. Not withstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth. 3 b. A health carrier shall not exclude a health care professional who provides services for mental health conditions, illnesses, injuries, or diseases and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state if all of the following requirements are met: (1) The health care professional is licensed in this state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses, injuries, or diseases via telehealth in compliance with paragraph “a”. (2) The health care professional is able to satisfy the same criteria that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state. 4. a. A health carrier shall reimburse a health care professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility. b. As a condition of reimbursement pursuant to paragraph “a,” a health carrier shall not require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person. 5. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2019: a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis. b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A. c. An individual or group health maintenance organization contract regulated under chapter 514B. d. A plan established pursuant to chapter 509A for public employees. 6. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance (ICA § 514C.34). |
| Kansas | (b) No individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, or the Kansas medical assistance program [KMAP] shall exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine, rather than in-person contact, or based upon the lack of a commercial office for the practice of medicine, when such service is delivered by a healthcare provider. (c) The insured’s medical record shall serve to satisfy all documentation for the reimbursement of all telemedicine healthcare services, and no additional documentation outside of the medical record shall be required. (d) Payment or reimbursement of covered healthcare services delivered through telemedicine may be established by an insurance company, nonprofit health service corporation, nonprofit medical and hospital service corporation, or health maintenance organization in the same manner as payment or reimbursement for covered services that are delivered via in-person contact is established (KSA 40-2,213). |
| Missouri | Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment (Mo. Ann. Stat. § 376.1900). |
| Nebraska | (2) Any insurer offering (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state, (b) any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, or (c) any self-funded employee benefit plan to the extent not preempted by federal law, shall provide upon request to a policyholder, certificate holder, or health care provider a description of the telehealth and telemonitoring services covered under the relevant policy, certificate, contract, or plan. (3) The description shall include: (a) A description of services included in telehealth and telemonitoring coverage, including, but not limited to, any coverage for transmission costs; (b) Exclusions or limitations for telehealth and telemonitoring coverage, including, but not limited to, any limitation on coverage for transmission costs; and (c) Requirements for the licensing status of health care providers providing telehealth and telemonitoring services. Except as otherwise provided in section 44-793, the reimbursement rate for any telehealth service shall, at a minimum, be the same as a comparable in-person health care service if the licensed provider providing the telehealth service also provides in-person health care services at a physical location in Nebraska or is employed by or holds medical staff privileges at a licensed facility in Nebraska and such facility provides in-person health care services in Nebraska (Neb. Rev. Stat. Ann. § 44-312). |
| Oklahoma | A. For services that a health care practitioner determines to be appropriately provided by means of telemedicine, health care service plans, disability insurer programs, workers’ compensation programs, or state Medicaid managed care program contracts issued, amended, or renewed on or after January 1, 1998, shall not require person-to-person contact between a health care practitioner and a patient. B. Subsection A of this section shall apply to health care service plan contracts with the state Medicaid managed care program only to the extent that both of the following apply: 1. Telemedicine services are covered by, and reimbursed under, the fee-for-service provisions of the state Medicaid managed care program; and 2. State Medicaid managed care program contracts with health care service plans are amended to add coverage of telemedicine services and make any appropriate capitation rate adjustments. C. Any health benefit plan that is offered, issued, or renewed in this state by an insurer on or after the effective date of this act shall provide coverage of health care services provided through telemedicine, as provided in this section. D. An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine and is not provided through in-person consultation or contact between a health care professional and a patient when such services are appropriately provided through telemedicine. An insurer may limit coverage of services provided by telehealth consistent with coding and clinical standards recognized by the American Medical Association or the Centers for Medicare and Medicaid Services as covered if delivered by telehealth or telemedicine, except as agreed to by the insurer and provider. E. An insurer shall reimburse the treating health care professional or the consulting health care professional for the diagnosis, consultation, or treatment of the patient delivered through telemedicine services on the same basis and at least at the rate of reimbursement that the insurer is responsible for coverage for the provision of the same, or substantially similar, services through in-person consultation or contact. F. An insurer shall not apply any deductible to telemedicine services that accumulates separately from the deductible that applies in the aggregate to all items and services covered under the health benefit plan. G. Any copayment or coinsurance applied to telemedicine benefits by an insurer shall not exceed the copayment or coinsurance applied to such benefits when provided through in-person consultation or contact. H. An insurer shall not impose any annual or lifetime durational limits or annual or lifetime dollar maximums for benefits or services provided through telemedicine that are not equally imposed upon all terms and services covered under the health benefit plan. I. An insurer shall not impose any type of utilization review on benefits provided through telemedicine unless such type of utilization review is imposed when such benefits are provided through in-person consultation or contact. Any type of utilization review that is imposed on benefits provided through telemedicine shall not occur with greater frequency or more stringent application than such form of utilization review is imposed on such benefits provided through in-person consultation or contact. J. An insurer shall not restrict coverage of telemedicine benefits or services to benefits or services provided by a particular vendor, or other third party, or benefits or services provided through a particular electronic communications technology platform; provided, that nothing shall require an insurer to cover any electronic communications technology platform that does not comply with applicable state and federal privacy laws. K. An insurer shall not place any restrictions on prescribing medications through telemedicine that are more restrictive than what is required under applicable state and federal law (36 OS § 6803). |
| Texas | (a) A health benefit plan: (1) must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, teledentistry dental service, or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting; and (2) may not: (A) exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation; and (B) subject to Subsection (c), limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service based on the health professional’s choice of platform for delivering the service or procedure. (b) A health benefit plan may require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation. (b-1) Subsection (b) does not authorize a health benefit plan to charge a separate deductible that applies only to a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service. (c) Notwithstanding Subsection (a), a health benefit plan is not required to provide coverage for a telemedicine medical service, a teledentistry dental service, or a telehealth service provided by only synchronous or asynchronous audio interaction, including: (1) an audio-only telephone consultation; (2) a text-only e-mail message; or (3) a facsimile transmission. (d) A health benefit plan may not impose an annual or lifetime maximum on coverage for covered health care services or procedures delivered as telemedicine medical services, teledentistry dental services, or telehealth services other than the annual or lifetime maximum, if any, that applies in the aggregate to all items and services and procedures covered under the plan (Tex. Ins. Code Ann. § 1455.004). |
Recent Telehealth-related Legislation in Kansas
Audiology and Speech-Language Pathology Interstate Compact
SB 77 (2021) enacted the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC). The stated purpose of the ASLP-IC is to facilitate the interstate practice of audiology and speech-language pathology with the goal of improving public access to audiology and speech-language pathology services.
The ASLP-IC provides licensure requirements for participating states. Licenses issued by a home state to audiologists or speech-language pathologists are recognized by each member state as authorizing the practice of audiology or speech-language pathology in each member state. The privilege to practice audiology or speech-language pathology is derived from the home state license. The ASLP-IC also requires member states to recognize the right of an audiologist or speech-language pathologist licensed in a member state to practice in another member state via telehealth.
The ASLP-IC is currently active in 29 states. States with pending legislation to adopt the ASLP-IC include Alaska, Illinois, New Jersey, Pennsylvania, and Wisconsin.
Psychology Interjurisdictional Compact
SB 170 (2021) enacted the Psychology Interjurisdictional Compact (PSYPACT), which provides for the interjurisdictional authorization of psychologists across state boundaries to practice telepsychology using telecommunication technologies and provide temporary in-person, face-to-face psychology services.
The PSYPACT, among other things, regulates the day-to-day practice of telepsychology and the temporary (30 days within a calendar year) in-person, face-to-face practice of telepsychology by psychologists across state boundaries in performing their psychological practice as assigned by appropriate authority. The PSYPACT requires compact states to recognize the right of a psychologist licensed in a PSYPACT state to practice telepsychology in other compact states in which the psychologist is not licensed. The PSYPACT establishes specific requirements for a psychologist licensed to practice in a compact state to exercise the authority to practice interjurisdictional telepsychology under the terms and provisions of the PSYPACT. The home state maintains authority over the license of any psychologist practicing into a receiving state under the authority to practice interjurisdictional telepsychology.
The PSYPACT has been in effect in Kansas since January 1, 2022. The PSYPACT formed in April 2019 when the seventh state enacted it into law, and it is currently effective in 39 states. The fortieth state, Vermont, enacted PSYPACT in 2023 with a tentative effective date of July 1, 2024.
Pharmacy Act—Amendments
Sub. for SB 238 (2021), among other things, amended and updated the Pharmacy Act of the State of Kansas (Pharmacy Act) with regard to the powers, duties, and functions of the State Board of Pharmacy. The bill defines the practice of telepharmacy and requires the State Board to adopt rules and regulations for the oversight and administration of telepharmacy.
The bill defines the practice of telepharmacy as the practice of pharmacy by a pharmacist located in Kansas using telecommunication or other automations and technologies to deliver personalized, electronically documented, real-time pharmaceutical care to patients, or their agents, who are located at sites other than where the pharmacist is located, including prescription dispensing and counseling and to oversee and supervise telepharmacy outlet operations. Telepharmacy outlets must be registered as a pharmacy under the Pharmacy Act, be owned by the managing pharmacy, and have a pharmacy technician on-site who performs activities under the electronic supervision of a pharmacist located in Kansas, who must be available to consult with and assist the pharmacy technician in performing activities.
Telemedicine Waivers; Licensure, Temporary Permits, and Regulatory Requirements
Senate Sub. for HB 2208 (2021), among other things, authorized licensed out-of-state physicians with telemedicine waivers to practice telemedicine in Kansas, among other things. The bill, more specifically authorizes a licensed out-of-state physician with a telemedicine waiver issued by the Board of Healing Arts (BOHA) to practice telemedicine in Kansas. The bill also amended the disciplinary authority of the Behavioral Sciences Regulatory Board (BSRB) and modifies licensure and temporary permit requirements of professional counselors, social workers, marriage and family therapists, addiction counselors, psychologists, and master’s level psychologists.
Out of State Telemedicine Practice
The bill authorizes a physician holding a license issued by the applicable licensing agency of another state or who otherwise meets the requirements of the bill to practice telemedicine to treat patients located in Kansas if the physician receives a telemedicine waiver issued by the Board of Healing Arts.
The bill requires the Board of Healing Arts to issue the waiver within 15 days from receipt of a complete application, if the physician:
- Submits a complete application, which may include an affidavit from an authorized third party that the applicant meets the requirements, in a manner determined by the Board of Healing Arts, and pays a fee not to exceed $100; and
- Holds an unrestricted license to practice medicine and surgery in another state or meets the qualification required under Kansas law for a license to practice medicine and surgery and is not the subject of any investigation or disciplinary action by the applicable licensing agency.
The bill requires a physician to practice telemedicine in accordance with the bill to conduct an appropriate assessment and evaluation of a patient’s current condition and document an appropriate medical indication for any prescription issued.
Rules and Regulations for Telemedicine Waivers
The bill requires any person who receives a telemedicine waiver to be subject to all rules and regulations pertaining to the practice of the licensed profession in Kansas and be considered a licensee for the purposes of the professional practice acts administered by the Board of Healing Arts. The bill also requires any waiver issued to expire on the date established, unless renewed by the Board of Healing Arts upon receipt of payment of an annual renewal fee not to exceed $100 and evidence the applicant continues to meet qualifications of the bill.
The bill does not prohibit a licensing agency from denying a waiver application if the licensing body determines granting the application may endanger the health and safety of the public.
Out-of-state Authorizations
The bill authorizes:
- A physician holding a license issued by the applicable licensing agency of another state to provide, without limitation, consultation through remote technology to a physician licensed in Kansas; and
- An applicable health care licensing agency of Kansas to adopt procedures consistent with this section to allow other health care professionals licensed and regulated by the licensing agency to practice telemedicine within the profession’s scope of practice by Kansas law, as deemed by the licensing agency to be consistent with ensuring patient safety.
Counseling Compact
HB 2288 (2023) enacted the Counseling Compact (Compact) to facilitate interstate practice of licensed professional counselors. Among the objectives of the Compact is allowing for the use of telehealth technology to facilitate increased access to professional counseling services.
The Compact requires member states to recognize the right of a licensed professional counselor, licensed by a home state in accordance with the Compact, to practice professional counseling in any member state via telehealth under a privilege to practice as provided in the Compact and rules promulgated by the Counseling Compact Commission. Under the Compact, a licensee providing professional counseling services in a remote state under the privilege to practice is required to adhere to the laws and regulations of the remote state.
The Compact is currently active in 29 states. New Jersey, South Carolina, Rhode Island, Wisconsin, and the District of Columbia currently have pending legislation to enact the Compact.
2023 Telehealth-related Legislation in Nearby States
In 2023, 45 states introduced legislation with provisions related to telemedicine. Of the states covered above, Arkansas, Illinois, Oklahoma, and Texas updated or created telemedicine law during their 2023 respective legislative sessions.
Arkansas
In 2023, Arkansas passed HB 1129, which provides for reimbursement from the State Medicaid Program for screening for behavioral health conditions and behavioral health services provided via telemedicine (2023 Ark. Act 494 (ACA § 20-77-148)).
HB 1261 (2023) allows an ambulance service’s operators to triage and transport a patient to an alternative destination in the state or treat in place if the ambulance service is coordinating care of the patient through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. The bill also provides for the reimbursement rate for an ambulance service coordinating the care of the enrollee through telemedicine (2023 Ark. Act 480 (ACA § 20-13-107)).
SB 465 (2023) creates the Continuum of Care Program in the Department of Human Services for certain pregnant women and parents, with the purpose of facilitating the operation of a statewide telemedicine support network that provides community outreach, consultations, and care coordination for women who are challenged with unexpected pregnancies (2023 Ark. Act 703 (ACA § 20-8-1003)).
Illinois
In 2023, Illinois enacted HB 2395, which adds telemedicine to the definition of “practice of veterinary medicine” and provides parameters for telemedicine use in veterinary care (2023 Ill. Legis. Serv. P.A. 103-309).
SB 250 (2023) makes appropriations to the Department of Commerce and Economic Development for grants, loans, and contracts intended to support expanding and strengthening existing broadband infrastructure, health information technology, and telemedicine, among other things (2023 Ill. Legis. Serv. P.A. 103-6).
Oklahoma
In 2023, Oklahoma passed HB 2686, which amends statute relating to the establishment of the physician-patient relationship to add an exception. Telemedicine encounters in Oklahoma may not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, unless the encounter is used to prescribe opioid antagonists or partial agonists; the bill adds another exception to allow Schedule III, IV, or V controlled substances approved by the U.S. Food and Drug Administration for medication assisted treatment or detoxification treatment for substance use disorder (2023 Okla. Sess. Law Serv. Ch. 250).
SB 12X (2023) amends law relating to the use of telemedicine when a person is believed by law enforcement to require mental health treatment. The bill states sheriffs and peace officers may request an assessment at the point of initial contact with a person who is believed to require treatment, conducted by the Department of Mental Health and Substance Abuse Services. The Department may utilize telemedicine when such capability is available through a mobile computing device in the possession of the local law enforcement agency (2023 Okla. Sess. Law Serv. 1st Ex. Sess. Ch. 28).
Texas
Texas enacted HB 617 (2023), creating the Next Generation 9-1-1 Telemedicine Medical Services and Telehealth Services Pilot Project, which will establish a pilot project to provide emergency medical services instruction and emergency prehospital care instruction through a telemedicine medical service or telehealth service provided by regional trauma resource centers to health care providers in rural area trauma facilities and emergency medical services providers in rural areas. The bill includes definitions for “telehealth service,” “telemedicine medical service” (2023 Tex. Sess. Law Serv. Ch. 667).
SB 1146 (2023) establishes procedures to be used during the regularly scheduled transportation of female inmates for nonemergency medical care. The bill provides for the Department of Criminal Justice, in conjunction with The University of Texas Medical Branch at Galveston and the Texas Tech University Health Sciences Center, to establish procedures to increase opportunities and expand access to telemedicine medical services and telehealth services (2023 Tex. Sess. Law Serv. Ch. 1162).
by Leighann Thone, PhD
Research Analyst
785-296-4181