Legislative Committee passes telemedicine rule, but no decision yet on ‘store and forward’ provision

A rule allowing doctors and patients to establish a relationship using audiovisual technology was approved by a legislative subcommittee Tuesday (Aug. 16). But the rule still would not let some telemedicine companies operate in Arkansas, so those companies will attempt to change the law in next year’s legislative session.

The Arkansas Rules and Regulations Subcommittee of the Arkansas Legislative Council Tuesday approved the Arkansas State Medical Board’s amendment of Regulation 2.8. It now allows the use of real-time audiovisual technology for the first-time establishment of the doctor-patient relationship, rather than requiring the doctor and patient to first meet in person.

Under the rule, the technology must provide information that would be at least equal to what would be obtained in person. That relationship must first be established while the patient is at a licensed medical facility that would connect him or her to the distant provider. The distance provider must be licensed in Arkansas.

On Tuesday, the subcommittee’s chairman, Sen. David Sanders, R-Little Rock, declared the regulation passed when he saw no objection. The regulation will go in effect in about 10 days.

Still to be decided is Regulation 38, which would define requirements for doctors to practice telemedicine. The main remaining disagreement is over “store and forward technology” – defining how information is digitally passed from one entity to another. The Arkansas State Medical Board will discuss the issue in October; afterward, it would go to the Legislature.

“A version will be passed by the Medical Board,” Kevin O’Dwyer, an attorney for the Medical Board, told reporters after the meeting. “I don’t know what version. Whether it will have ‘store and forward’ or not … that I don’t know.”

Several vendors, the largest being Teladoc, offer services where patients can be treated remotely for minor ailments. Under Teladoc’s model, patients contact doctors they have never met in person by using audiovisual devices or a telephone. In 2014, the Medical Board made it more difficult for those types of telemedicine companies to operate. The company says Arkansas is the only state where it’s unable to do business. A number of Arkansas entities, including America’s Car Mart and the Arkansas Trucking Association, want to offer those kinds of services to employees and members.

In 2015, the Legislature passed a law giving the State Medical Board the authority to expand the definition of “doctor-patient relationship,” thereby expanding telemedicine. The Medical Board in June gave the go-ahead to establish a relationship using two-way, real-time audiovisual communication.

Claudia Tucker, Teladoc’s vice president of government affairs, said in an interview that even with the change to Regulation 2.8, companies like hers still will not be able to provide their services without changes to the law. She said Teladoc and other telemedicine companies will attempt to do so when the Legislature meets next year.