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Telemedicine

Medical Solution For The Technological Evolution

Telehealth, is the universal term for a broad array of current telemedicine applications, including non-clinical services, such as instruction and training, administration, and continuing medical education; while telemedicine, is defined as, “the use of telecommunication and information technologies to provide clinical health care, at a distance”, by means of a growing variety of applications and services, using two-way video, emails, smart-phone technology, wireless tools, and other forms, of telecommunication technology — telemedicine refers specifically to remote clinical services.

Originating as a solution for hospitals to extend medical care, to patients geographically situated in remote regions of the country, more than 40 years ago, telemedicine is now a significant and rapidly growing component of health care, in the United States, and is fully-integrated into the ongoing operations of hospitals, home health agencies, speciality departments, private physician offices, and the consumer/patient’s home and workplace.

Medicine vs. Telemedicine

Telemedicine products and services, do not fall into a separate medical speciality, instead it is most often part of the larger investment by healthcare institutions, either in the delivery of clinical care, or information technology. Generally speaking, there is no distinction made between telemedicine and those services provided on site — even in the reimbursement fee structure, there is no separate coding required for billing of remote services.

Telemedicine incorporates a wide array of remote healthcare services, including: video conferencing patient consultations, transmission of medical records and still imagery, remote monitoring of vital signs, continuing medical education for physicians, nursing call centers and consumer-focused wireless applications, and e-health including the use of patient-portals.

Benefits of Telemedicine

In its brief 40 year history, telemedicine has seen a significant amount of growth, based on the four fundamental benefits it provides. Firstly, telemedicine improves patient access, bringing healthcare services to patients in distant locations, both rural and urban. Secondly, telemedicine is cost effective, reducing the running costs of healthcare — not only has telemedicine been shown to reduce the cost of healthcare, it also increases efficiency permitting the improved management of chronic diseases. Thirdly, telemedicine is improving the quality of healthcare. Aas the world becomes more and more technologically advanced, telemedicine is the answer to our demand for consumer convenience — telemedicine is a technological solution, reducing the travel time and related stresses, for patients and their family. 

Safety of Telemedicine

Telemedicine strictly adheres to the technical standards and clinical practice guidelines, and is backed by decades worth of research and demonstrations. Telemedicine is a cost-effective and, most importantly, safe way, to deliver health care 

Identified according to certain indicators — chosen according to the most current and accessible information available, as assembled and published by state public entities. The indicators, are compiled according to the standard-protocol for physician-patient encounters, and licensing requirements.

* Please note: Physician licensure and medical practice policies, vary state-to-state. Each state medical board has it’s own unique set of requirements and procedures for authorizing and regulating medical practice standard, despite the uniform application of physician state licensure and guideline recommendations, by groups such as the FSMB. 

Coverage of Telemedicine

Telehealth, and subsequently telemedicine services, are supported by the federal government, by means of Medicare and Medicaid. The coverage of telemedicine state-by-state, is composed of the following factors: Physician-Patient Encounters; Telepresenter; Informed Consent; and Licensure.

  • Physician-Patient Encounters — Each state institutes its own set of standards to be followed by physicians when using telemedicine, some states are more stringent than others and may require an in-person consultation and clinical examination before a physician may provide a patient with telemedicine care. There are currently 22 states with progressive practice protocol’s, however in stark contrast, Alabama, Arkansas and Texas, have some of the most stringent clinical practice rules, in the country. Arkansas, is the only state to require an in-person visit before most telemedicine encounters. While the Alabama and Texas Medical boards, permit the use of telemedicine only when the patient is at an established medical site. 
  • Telepresenter — Each state's Medical board policies and private insurance parity laws vary, with some states applying more stringent requirements for telemedicine, as opposed to in-person services. Alabama and Texas are currently the only two states, to require that a health care provider simply be available on the premises and not physically with the patient, during a telemedicine consultation. Alaska, Hawaii and Louisiana, currently have some of the country’s most stringent laws, in this effect. While California, permits that a patient may provide verbal consent without, a telepresenter present on-site.
  • Informed Consent — Each state Medical board and private insurance parity policy, varies state-to-state, with some states again enforcing, more stringent regulations than others. While some states do not require that a patient provide informed consent, prior to a telemedicine encounter, sixteen states and District of Columbia, require informed consent be given by the patient. Alabama, Indiana, Oklahoma, Texas and Washington, require the patient provide written consent. While Rhode Island, requires informed consent be given, before use of text-messaging and electronic-mail systems.
  • Licensure — May states have responded to the use of telecommunication as a complementary addition to healthcare-service delivery, with policies that accommodate patient choice, peer consultations, and health provider shortages. Irrespective of telemedicine, every state nationwide, currently imposes policies that make medical practice across state lines, difficult. At this time, the only states that do not allow any form of licensure exemption for physician-to-out-of-state-patient consultations, are Michigan, North Dakota, Pennsylvania, and South Dakota. While the Massachusetts Board of Registration in Medicine, permits the use of peer-to-peer out-of-state consultations. The district of Columbia, Maryland, New York, and Virginia, permit the licensure reciprocity of bordering states. 

* Please note: At this time, the only states to offer a conditional telemedicine license to out-of-state physicians, are Alabama, Louisiana, Minnesota, Nevada, New Mexico, Ohio, Oregon, Tennessee, and Texas. Montana repealed it’s telemedicine licensure, favoring instead, a full unrestricted license requirement for out-of-state physicians.

Medicaid Coverage of Telemedicine

Currently there are 9 states, and the District of Columbia, with laws mandating the cover and reimbursement, of telemedicine-provided services, under the state’s particular Medicaid programs: California, Colorado, Kentucky, Maryland, Minnesota, Mississippi, Nebraska, Texas, Vermont, and District of Columbia.

Private Insurance Payers Coverage of Telemedicine

There are currently 29 states, and the District of Columbia, that have Parity laws for private insurance coverage. The general terms of the state’s laws, state that a health benefit plan may not deny coverage on the basis that the coverage is provided through telemedicine, if the health care service would be covered, were it provided in-person. Covering more than 130 million Americans, the following state's have adopted mandates enacting the coverage of telemedicine: Arizona (*at this time, coverage is limited to rural areas, and only applies to certain health care providers), Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Hawaii, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Mexico, New York, Oklahoma, Oregon, Tennessee, Texas, Vermont, Virginia, and Washington.

Nationwide Landscape of Telemedicine

According to the American Telemedicine Association (ATA), the states fall into one of three categories, when factoring in the differing state law's and contrasting medical board standards (* Please note: The ATA only applies to health care services in general, and does not apply specifically to medical marijuana evaluations): 

  • "Category 01"

There are currently, only twenty-two states with a supportive policy landscape, that not only accommodates telemedicine adoption, but also usage: 

Colorado; Connecticut; Delaware; Illinois; Indiana; Kansas; Maine; Maryland; Massachusetts; Minnesota; Montana; New Hampshire; New Jersey; New Mexico; New York; Ohio; Oregon; South Carolina; Tennessee; Utah; Virginia; and Wisconsin.

  • "Category 02"

Falling in the middle of the spectrum — with programs that are adequate, but also have room for improvements — are twenty-six states, and the District of Columbia: 

Alaska; Arizona; Arkansas; California; Florida; Georgia; Hawaii; Idaho; Iowa; Kentucky; Louisiana; Michigan; Mississippi; Missouri; Nebraska; Nevada; North Carolina; North Dakota; Oklahoma; Pennsylvania; Rhode Island; South Dakota; Vermont; Washington; West Virginia; and Wyoming.

  • "Category 03"

While the remaining two states, continue to obstruct the advancement, and development of telemedicine:

Alabama; and Texas.

Landscape of Medical Marijuana Telemedicine Services Online

At this time qualified patients seeking a medical marijuana evaluation, may use medical marijuana telemedicine services to see a medical marijuana doctor online, only if they reside in: 

At this time, patients living in any of the following states, may use medical marijuana telemedicine services online for all follow-up appointments, after first establishing a bonafide doctor/patient relationship, in-person: 


Telemedicine Policy State-by-State

  • ALABAMA

Alabama, currently falls into the least supportive category, "Category 03”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • ALASKA

Alaska, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • ARIZONA

Arizona, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • ARKANSAS

Arkansas, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • CALIFORNIA

California, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • COLORADO

Colorado, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • CONNECTICUT

Connecticut, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • DELAWARE

Delaware, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • DISTRICT OF COLUMBIA

District of Columbia, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • FLORIDA

Florida, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • GEORGIA

Georgia, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • HAWAII

Hawaii, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • IDAHO

Idaho, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • ILLINOIS

Illinois, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • INDIANA

Indiana, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • IOWA

Iowa, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; however, there is legislated Medicaid coverage.

  • KANSAS

Kansas, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • KENTUCKY

Kentucky, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • LOUISIANA

Louisiana, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • MAINE

Maine, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • MARYLAND

Maryland, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • MASSACHUSETTS

Massachusetts, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; OR legislated Medicaid coverage.

  • MICHIGAN

Michigan, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • MINNESOTA

Minnesota, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • MISSISSIPPI

Mississippi, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • MISSOURI

Missouri, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • MONTANA

Montana, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • NEBRASKA

Nebraska, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; however there is legislated Medicaid coverage.

  • NEVADA

Nevada, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • NEW HAMPSHIRE

New Hampshire, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • NEW JERSEY

New Jersey, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • NEW MEXICO

New Mexico, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • NEW YORK

New York, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • NORTH CAROLINA

North Carolina, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • NORTH DAKOTA

California, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated North Dakota coverage.

  • OHIO

Ohio, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • OKLAHOMA

Oklahoma, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • OREGON

Oregon, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • PENNSYLVANIA

Pennsylvania, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • RHODE ISLAND

Rhode Island, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • SOUTH CAROLINA

South Carolina, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • SOUTH DAKOTA

South Dakota, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • TENNESSEE

Tennessee, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • TEXAS

Texas, currently falls into the least supportive category, "Category 03”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • UTAH

Utah, currently falls into the most supportive category, "Category 01”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • VERMONT

Vermont, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; AND legislated Medicaid coverage.

  • VIRGINIA

Virginia, currently falls into the most supportive category, "Category 01”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • WASHINGTON

Washington, currently falls into the middle category, "Category 02”. At this time, the state does have legislated Parity laws for private insurance coverage; however there is NO legislated Medicaid coverage.

  • WEST VIRGINIA

West Virginia, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • WISCONSIN

Wisconsin, currently falls into the most supportive category, "Category 01””. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.

  • WYOMING

Wyoming, currently falls into the middle category, "Category 02”. At this time, the state does NOT have legislated Parity laws for private insurance coverage; or legislated Medicaid coverage.