On March 20, 2015, Colorado Governor John Hickenlooper signed into law HB 15-1029, which requires that insurers operating in Colorado reimburse health care providers for telehealth services in all of Colorado’s counties, urban or rural, regardless of size. Previously, Colorado law required insurers pay for telehealth services only for counties with 150,000 residents or fewer. In addition, this legislation carries three important requirements for commercial insurers:
Insurers must reimburse providers who deliver care through telemedicine on the same basis that the carrier is responsible for coverage of services delivered in person;
Insurers cannot charge deductible, copayment or coinsurance amounts that are not equally imposed on all terms and services covered under the health benefit plan; and
Insurers cannot impose an annual or lifetime dollar maximum that applies separately to telemedicine services.
Health plans have until January 1, 2017, to make all necessary changes prescribed by the law.
Despite these important changes to Colorado law, there remain some gaps with respect to “true parity” between in-person and technology-enabled patient-provider visits. For example, Colorado Medical Board Policy 40-09 continues to state that it is unprofessional conduct for Colorado physicians to provide treatment, including issuing a prescription, without first obtaining a “physical evaluation.” Likewise, the Colorado Pharmacy Board Rule 3.00.21 prohibits a pharmacist from dispensing prescriptions to patients that the pharmacist knew or should have known did not have a valid (i.e., in-person) preexisting patient-practitioner relationship. In September 2014, the Colorado Telehealth Working Group wrote a letter urging the Colorado Medical Board to clarify its policy to permit the establishment of the physician-patient relationship through telemedicine and enable prescribing through telemedicine.
The key issue will then be whether these boards will act on their own to allow physicians and pharmacists to provide prescriptions to patients without a physical face-to-face meeting or whether additional legislation is required. There are obviously valid policy reasons behind these board rules, including concerns about drug abuse and physicians writing prescriptions based on inadequate patient information. Nonetheless, it seems the era of the “patient-centered” health care system has arrived and with it greater demands for accessibility, patient monitoring and convenience. The new generation of millennial health care consumers will likely expect greater access. A recent Salesforce.com report found that 60 percent of millennials would be interested in having a video chat with their physician so they don’t have to come into the office for an appointment. It seems there is an opportunity to adopt new telemedicine policies that allow for the appropriate use of telehealth technologies to establish physician-patient relationships while maintaining appropriate safeguards and protections.