Senate panel advances telemedicine bill

A bill allowing patients to establish telemedicine relationships with medical providers from wherever the patient is located passed the Senate Public Health, Welfare, and Labor Committee Tuesday, two years after the passage of a previous, more restrictive telemedicine law.

Senate Bill 146 by Sen. Cecille Bledsoe, R-Rogers, builds upon previous actions by the State Medical Board by allowing that relationship to be created wherever the patient is located. Under a 2015 law, the patient was required to establish that relationship from the site of another medical provider.

Previously, the State Medical Board had decided a relationship can be established between a patient and a medical provider using two-way audiovisual technology. After the first encounter, interactions do not require two-way audiovisual communications. Under the bill, telemedicine can be used in place of in-person visits so long as the quality of the care is equal to in-person care.

The bill also provides that reimbursements to insurance companies be done on the same basis for both in-person and telemedicine services.

The bill states that school-based services shall be provided by the child’s regular pediatrician or other primary care provider, or by a professional with an arrangement with that provider. Sen. Stephanie Flowers, D-Pine Bluff, took issue with that provision, saying that parents, not a medical provider, should approve the arrangement.

Bledsoe said parental consent requirements are contained elsewhere in state law, but she would amend the bill on the Senate floor to make that more explicit.

Legislators discussed concerns about how telemedicine could bypass local medical providers in rural areas, endangering their presence in underserved areas.

Speaking on behalf of the bill was Dr. Dan Rahn, UAMS chancellor, and David Wroten, executive vice president of the Arkansas Medical Society, among others. Bledsoe told legislators that Walmart, J.B. Hunt, AARP Arkansas, the Association of Arkansas Counties and others support the bill.

The bill passed, 6-2, with only Flowers and Sen. John Cooper, R-Jonesboro, voting no. It is scheduled to be considered by the full Senate Thursday.

When the first bill was passed in 2015, Bledsoe and Wroten, who represents the state’s physicians, had been wary of telemedicine. Among the big issues was having the patient located at an “originating site” in a doctor’s office. Teladoc, a telemedicine membership service, said Arkansas has had the nation’s most restrictive telemedicine laws – so restrictive, in fact, that the state was the only one where Teladoc’s business model didn’t work.

Wroten and Bledsoe said the state’s telemedicine law has evolved as they and the medical community become more accustomed to the practice.

“The bill in 2015 was a starting point,” Wroten said. “As everybody gets more comfortable and learns more about telemedicine, and we start looking at what other states are doing, we’ll be amending the bill as we go along to address those issues.”

Bledsoe said, “This has been a process for me. I grew up with it just being a certain way, and I just through the years have seen what telemedicine can do, and every step was a process. … At the end of the day, I really believe that this is going to provide health care to the rural areas, and we’re going to hold up the standard of excellence.”