2007: Practicing Across State Lines
Hageseth v. Superior Court, May/07:
Practicing across state lines is probably the hottest issue in telehealth and in medicine in general. The issue is whether psychotherapists or medical doctors can treat clients in other states via the phone, email, or Internet. One of the first cases to reach the courts took place in May/07 in CA.
Following is a case synopsis.
The case, Hageseth v. Superior Court, involved a Colorado doctor who participated in an online pharmacy. The doctor, Hageseth, issued an online prescription to a patient in California and was then charged criminally with practicing medicine without a license in California. (What partly fueled this case, but not directly relevant to the telehealth issue, are the facts that the patient committed suicide a few days after he fulfilled the prescription, and Dr. Hageseth was not allowed to prescribe at the time he wrote the prescription.) Hageseth claimed that he couldn't be charged with a California crime because he was beyond California's jurisdiction. The defense asserted that prosecuting Dr. Hageseth would create all sorts of trouble for California (or other states, which may follow suit) to try to regulate such conduct beyond its borders. The appeals court disagreed, finding that under traditional principles of "extraterritorial application of criminal law" the state of California could reach the doctor's conduct. The fact that the doctor's conduct took place "in cyberspace" -- that is, using email and Websites -- was irrelevant.
In Summary: This case is extremely important for the future of telehealth (e-therapy) across state lines and for the huge online prescription industry. This case has no bearing on practicing telehealth within one state when both clinician and patient reside in the state where the clinician is licensed.
2011: Medicare Relaxes Restrictions for Telehealth Credentialing
Starting July 5, 2011, Medicare will change its credentialing and privileging process for health care professionals providing services through telehealth systems. Hospitals will need to be credentialed and not each and every practitioner wanting to deliver telehealth. This represents a substantial relaxation of rules, and bodes well for reimbursement in the U.S. See full report: Medicare Relaxes Restrictions for Telehealth Credentialing
On October 7, 2011 California enacted a comprehensive law to advance telehealth.
The new law:
Replaces legal terminology of "telemedicine" with "telehealth".
Updates the definition of telehealth to allow a broader range of services.
Applies the definition to all licensed health professionals.
Replaces the need for an additional written patient consent specifically for telehealth services to a verbal consent.
Removes the Medi-Cal rule requiring documentation of a barrier to an in-person visit before a beneficiary can receive telehealth services.
Eliminates restrictions on reimbursement of services provided via email or telephone.
Eliminates restrictions on the physical location where telehealth services may be provided. It no longer it needs to be in doctors' offices or hospitals.
