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INTRODUCTION

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In Federalist Papers No. 45, President James Madison stated that “[t]he powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite.” 1 Neither he, nor other visionaries of our founding government, could have foreseen the impact this position would have on the health and well-being of a technologically advanced society 200 years later.

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Innovations in health care, such as telehealth, have elevated the influence of state-level policies in the larger health ecosystem. States are playing a significant role to ensure that nontraditional health care delivery models such as telehealth are accessible, secure, equitable, and worth merit. For example, agencies with regulatory oversight of health professionals, health facilities, utilities, public health and welfare services, insurance, commerce, and business can all shape regulatory policies that affect telehealth adoption and utilization.

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Lawmakers also look beyond their own state borders to align policies that facilitate interstate collaboration. Health care workforce shortages coupled with more mobile societal lifestyles find patients, providers, and caregivers seeking advice, treatment, and consultations in another state. The concepts of where health care is rendered and received when telehealth intervenes challenge the ethical and regulatory boundaries of states’ rights and state borders.

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Although policies related to telehealth are varied and nuanced, they provide a necessary framework to enable existing and new manners for which telehealth is permitted, delivered, and financed. However, the nature of these policies is sometimes caught between competing interests and technological evolution. How does a state entity allow room for innovation and mobility while defining standards for telehealth development, adoption, and utilization that protect business and public interest?

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INSURANCE COVERAGE AND REIMBURSEMENT OF TELEHEALTH

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Telehealth providers who rely on the health insurance market for a revenue stream and sustainability must navigate a system that is not always clear on eligibility, coverage, and payment. Traditionally, lack of coverage and payment for telehealth has been a barrier to adoption by providers and patients across the health care spectrum. The enforcement of billing practices by some insurers would indiscriminately permit coverage and payment for telehealth-provided services such as radiology but deny payment for other covered health care services provided remotely.

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Over the past few decades states have tried to correct this loophole by developing and promoting statutory and regulatory insurance frameworks that encourage telehealth adoption and utilization statewide. The progress in states’ acceptance of telehealth has been incremental yet significant. In 2005, 24 state Medicaid programs covered telehealth-provided services and only two reimbursed for telehealth in the home. 2 Twelve years later, 50 state Medicaid programs and the District of Columbia cover telehealth-provided services and 39 reimburse for telehealth in the home. 3

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Whereas the states are incubators of innovations with decades of experience embracing telehealth, conversely, federal programs like Medicare have found very ...

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