Urgency to Define Rules for Telemedicine in New Jersey

Lawmakers try to ensure Garden State is not left out of the growing use of electronic communications between healthcare providers and patients

Despite several years of discussion, New Jersey remains among the last states in the nation without regulations that specifically address telemedicine. But that could finally change in the months to come.

The Senate health committee will consider a bipartisan proposal today that would define telemedicine in state law, establish who is eligible to participate, stipulate what technology can be used, and determine how the cost of these services would be covered.

According to the Office of Legislative Services, New Jersey is one of two states that lack an official definition of the practice, which generally involves the use videoconferencing or other electronic communication to connect healthcare providers and patients. Healthcare advocates have largely embraced telemedicine as a way to make care more easily available to those in need, especially patients with chronic diseases, but physicians have raised concerns about the quality of care and the impact on their payment stream.

The practice is growing quickly nationwide, in large part because of technological improvements. Telemedicine is now used in more than 60 percent of all healthcare institutions, according to a federal report released in August. “In general, telehealth holds promise as a means of increasing access to care and improving health outcomes. Some analysts also see the potential for telehealth to reduce costs,” the U.S. Department of Health and Human Services report said.

With rapid growth in the adoption of the practice, governments are still catching up. The Center for Medicare and Medicaid Services is now testing several Medicare pilot projects for telemedicine, DHHS said, and 48 states use Medicaid to cover at least some e-health treatments. Some 32 states require insurance companies to pay for telemedicine at the same rates they use for traditional, in-person visits.

New Jersey has supported a handful of projects that use electronic technology to connect physicians or other providers, including an effort that links pediatricians with child psychiatrists, of whom there is a chronic shortage. Rutgers University launched a pilot program this summer to connect 10 patients in Newark with a community health center operated by the nursing school.

[related]But the lack of an overarching state policy is a problem for patients and the healthcare industry, supporters of telemedicine have said. Without regulatory guidelines, telemedicine providers and investors are likely to avoid the Garden State and establish programs elsewhere. In addition, they note, patients lose out on the opportunity for convenient care that could improve their health – and save the system money over time.

The proposal (S-291/A-1464) scheduled for a vote today would authorize healthcare providers — including doctors, physician assistants, nurse practitioners, clinical social workers, psychiatrists and psychoanalysts, mental health screeners, and others — to diagnose and treat patients using certain electronic technology. The bill allows for two-way video conferencing or similar services, but would not permit the use of audio-only telephone, email, text, or instant messaging for this purpose.

The measure, sponsored by health committee chairman Sen. Joseph Vitale (D-Middlesex), Sen. Jim Whelan (D-Atlantic) and Sen. Diane Allen (R-Burlington), notes that the same safety and quality standards used for traditional healthcare delivery would apply to telemedicine. (An Assembly version — sponsored by Assemblyman Herb Conaway (D-Gloucester), a physician who leads that health panel, Assemblywoman Pamela Lampitt (D-Camden), Assemblyman Craig Coughlin (D-Middlesex), Assemblywoman Valerie Vainieri Huttle (D-Bergen), and Assemblyman Joseph Lagana (D-Bergen)— awaits a committee hearing.)

In-state providers would be subject to traditional licensing requirements, under the proposal. A patient could receive remote care from an out-of-state doctor who holds a reciprocal medical license, a mechanism New Jersey established in 2014 that allows the state to give an out-of-state provider permission to treat Garden State patients if the licensing requirements in that physician’s home state sufficiently align with regulations here. . (According to the DHHS report, four out of five states require telemedicine providers to be licensed in-state.)

In addition, the legislation underscores that New Jersey’s Medicaid and NJ Family Care programs, as well as private plans that cover public employees, must pay for telemedicine treatments at the same rate as traditional care. It also stresses that these plans are not allowed to require an in-person visit before a patient is eligible for telemedicine coverage. Plus, it requires managed care plans to cover telemedicine treatments at the same reimbursement level they pay for in-person care.

The 53-page bill has been altered extensively since it was re-introduced in January, thanks in part to changes requested by the Medical Society of New Jersey, which represents physicians. Doctors have worried that, despite the potential benefits, telemedicine could reduce the quality of care for patients that depend on personal interaction with a provider and that it could also increase competition from out-of-state providers who have lower business costs.

An OLS analysis of a previous, but quite similar, version of the bill suggested the state might experience a growing demand for reciprocal licenses from out-of-state providers. Overall, the measure is expected to involve minimal cost to the state up front, but greater access to care and better outcomes for patients with chronic diseases and other issues, the office wrote, noting that these trends “may result in decreased expenditures in the long term.”